Background/Objectives: Endovascular embolization is an effective treatment option for cerebral arteriovenous malformation (AVM) and dural arteriovenous fistulas (DAVFs). The objective of this study was to assess the safety and efficacy of Menox^TM in patients with cranial dural arteriovenous fistulas. Methods: From January 2021 to January 2023, 19 patients with intracranial DAVFs underwent embolization procedures. All patients were treated by embolization with Menox^TM or/and in combination with other embolization products such as Onyx (Covidien, Irvine, California), PHIL (MicroVention, Tustin, California), and Squid (Balt Extrusion, Montmorency, France). Treatment approaches were selected depending on the anatomical location of the fistula. Patients were monitored and followed-up for 12 months. Results: The patients’ mean age was 56.26 ± 16.49 years. Of these 19 patients, 58% (n = 11) were treated with the Menox^TM liquid embolizing agent (LEA) alone or in combination with different LEAs, while n = 7 were treated with other LEAs and 1 patient was treated solely with coils. Complete occlusion of DAVFs with Menox^TM and other agents was evident in 68.4% (n = 13/19) of patients. Complete occlusion (100%) was observed in the sinus rectus, transverse sinus, and diploic veins of the orbital roof, while complete occlusion was observed in 50% of falcotentorial patients and 60% of superior sagittal sinus patients. The lowest rate of complete fistula obliteration was observed in the dural carotid cavernous fistula (CCF) group (25%). An intra-procedural adverse event occurred in one patient. No other post-procedural adverse events were noted. Furthermore, in patients treated with Menox^TM, total occlusion was achieved in 72.7% (n = 8) of patients, whereas the non-Menox^TM group had 62.5% (n = 5) of patients with 100% occlusion and 37.5% (n = 3) of patients with subtotal occlusion. Conclusions: Outcomes using Menox^TM alone and in combination with other agents were effective, and it is safe for the treatment of dural arteriovenous fistulas.

Introduction: Very few studies address meningeal artery (MMA) histology, including some features of epidural hematomas (EDH). Materials and Methods: We microscopically analyzed 238 slices from ten MMA specimens. In addition, 61 patients with EDH were enrolled and examined. Both analyses were retrospective. Results: MMA analysis showed a larger subendothelial space and reduced media and adventitial coat, the latter continuous with the two dural parts (periosteal and meningeal layers). The 61 patients had an average age of 42.1 years. The EDH averaged 28.8 mm in diameter, but it did not affect outcomes (p=0.626). Vault bone fracture was seen in 95.1% of patients. An incidental fall was the most frequent cause (68.5%). Coma was present in 35.0%, whilst the Glasgow Coma Scale (GCS) on admission averaged 12. EDH was associated with other intracranial hemorrhages (19.7%), including subdural (9.8%), subarachnoid (4.9%), intracerebral (1.7%), or combinations thereof. Following EDH surgical evacuation, some patients had certain neurological or psychological disorders (19.7%). The mortality rate was 14%, especially in patients manifesting early neurologic symptoms (p=0.034). Conclusion: The MMA is well protected due to its structure and dural support. However, a strong head impact, especially associated with a bony fracture, leads to MMA rupture and a dural laceration resulting in EDH. The latter can be accompanied by neurological signs, as well as a mortality rate of 14%, which mainly depends on early neurological manifestation or coma occurrence.

Glial brain tumours, including astrocytoma IDH (Isocitrate Dehydrogenase) mutant and glioblastoma IDH wild-type, are highly malignant brain tumours with poor clinical outcomes. Genomic instability, encompassing microsatellite (MIN) and chromosomal instability (CIN), drives tumour heterogeneity and evolution. In this study, genomic instability was analysed in 85 patients using AP-PCR (Arbitrarily Primed Polymerase Chain Reaction) by comparing tumour and normal tissue (blood) DNA profiles of the same patient. Both types of alterations were present in all analysed samples, contributing almost equally to the total level of genomic instability. The dominant pattern of genomic instability in our cohort was low overall instability, predominantly manifesting as low-degree microsatellite instability. A general decrease in genomic instability was observed with increasing tumour grade. Glioblastoma IDH wild-type was more prevalent in older patients, whereas astrocytoma IDH mutant predominated in younger individuals. Notably, low genomic instability (both MIN and CIN) was associated with poorer survival in patients over 50 years of age. Females, compared to males, exhibited higher MIN in grade 2 tumours and elevated CIN in grade 4 tumours. Our results confirm that genomic instability contributes to tumour progression, MIN being the pivotal factor, and could serve as a prognostic biomarker in malignant gliomas.

Introduction: Scaphocephaly, the most common form of craniosynostosis, is caused by the premature fusion of the sagittal suture, resulting in an elongated skull shape and constrained cranial growth. Material and methods: This retrospective study included all consecutive patients with sagittal synostosis who were operated at the Clinic of Neurosurgery, UCCS, in the 20-year period. Detailed patient data were obtained from medical records and neuroradiological diagnostics. The follow-up period for these patients ranged from 6 to 20 years. The acquired data were thoroughly statistically analyzed. Results: There were 93 children with a clear male preponderance. In the majority of children, there were no perinatal complications, and the majority of mothers didn't have any chronic illnesses. Three types of surgical treatment were used, with an almost equal distribution. The mean blood loss during surgery varied across the three operative techniques, with the lowest blood loss observed using the TSEO technique. Successful treatment was observed in only 57.1% patients who underwent strip-suturectomy, 96.6% patients treated with the π procedure, and all patients treated with the TSEO technique. Statistical analysis revealed a significantly higher success rate of the TSEO and π procedure compared to strip-suturectomy. Cranial index remained dolichocephalic in 6/28 children treated with strip-suturectomy alone, while in all cases treated with TSEO and π procedure, cranial index normalized. The majority of operated children had no complications. Conclusion: Successful treatment of scaphocephaly requires a case-specific approach that extends beyond the surgical procedure itself. This series emphasizes the need for individualized treatment plans and a multidisciplinary approach throughout the surgical process.

Background: Multidetector computed tomography of the sphenoid sinus is the most accurate method for visualizing sinus pneumatization and all anatomical variations. Objective: To characterize the patterns of pneumatization of the sphenoid sinus and assess the association with variations in the bony structures of the sinus in relation to gender and age groups. Methods: Retrospective CT analysis of 127 patients (43 men and 84 women). Pneumatization patterns, skull base extensions, and Vidian canal types were classified. Results: Bilateral increased sphenoid sinus pneumatization shows a very strong age association (p = 0.001), with clustering in middle-aged (40-52) and elderly (≥ 66) groups. Right-sided preserved sphenoid sinus pneumatization shows a statistically significant association with gender (χ² = 3.90, p = 0.048), with a higher proportion of males than females. Bilateral pneumatization (BPP) showed a statistically significant association with age (p = 0.019); individuals with BPP were significantly younger. Sellar type predominated (67.7%), with frequent posterior and lateral extensions. The dorsal sphenoid sinus configuration is the only variant showing a statistically significant association with age (χ² = 8.17, p = 0.043). Complete sellar type shows a strong, consistent positive association with both anterior clinoid and pterygoid process pneumatization on all sides (p ≤ 0.015, often < 0.001). Type III Vidian canal occurred in ~ 40%. Vidian canal Type I is strongly associated with pterygoid process pneumatization, especially bilaterally (p < 0.001 in all cases). Conclusions: The cohort exhibits a highly pneumatized, surgically relevant sphenoid sinus phenotype, primarily developmental rather than symptom-driven.

Malignant gliomas are the most common primary tumors of the central nervous system (CNS), originating from glial cells. They account for 30% of all CNS tumors. Among them, glioblastoma (GBM) is the most common, accounting for 45% of all glial tumors, while low-grade gliomas (LGGs) account for 31.8% of all gliomas. The aim of this study was to analyze the protein-expression profile of HTR4 and PDE4D genes in patients with glioma by immunohistochemical (IHC) analysis, to determine whether some interrelationship between them exists, to correlate their expression with clinical and histopathological parameters and therapy, and to determine their impact on patients’ survival. In addition, we analyzed the level of genomic instability (GI) (microsatellite (MIN), chromosomal (CIN) and total GI) by AP-PCR, in order to understand whether it can represent a tool for biological stratification of glioma tumors and risk assessment. Our results revealed that synchronized expression of 5-HTR4 and PDE4D proteins represents a stable modulatory signaling axis of glial-tumor biology, and reflects the activity of cAMP signaling pathway, but cannot independently stratify patients. Moreover, our study confirms that the combination of MIN, CIN and total GI represents a powerful tool for biological tumor stratification, risk assessment and understanding the pathobiological spectrum of the disease.