Background: Cavum septum pellucidum (CSP) and cavum vergae (CV) are normal anatomical variations present in some children, adolescents, and adults. When the cavity is larger than normal, it is called a cyst. Symptomatic cases of CSP and CV cyst are rare, and the clinical presentation is varied. A case with multiple nerve involvement is described. Case Description: A healthy 17-year-old female presented a sudden headache, right cervicobrachialgia, right ptosis, visual changes, and left facial paralysis over 10 days. Head magnetic resonance imaging revealed CSP and CV cyst. Inflammation, infection, and vascular disorders were ruled out. We decided to perform a right transfrontal endoscopic intraventricular septostomy and a right Monro foraminoplasty, which were successful. One month after surgery, the patient had no more signs or symptoms. She has remained asymptomatic for the past year. Conclusion: Multiple nerve involvement was directly related to CSP and CV cyst. The cyst bilaterally occluded the foramen of Monro causing intracranial hypertension. It was possible to obtain complete resolution of the clinical features through neuroendoscopic fenestration and foraminoplasty.

Isolated hypertelorism is a rare congenital condition caused by craniofacial malformations.

Background: Porencephalic cysts are rare cerebrospinal fluid-filled cavities within the brain parenchyma, classified as either congenital or acquired (secondary to trauma, surgical interventions, ischemia, or infections). Clinical presentations vary depending on the cyst’s size, location, and associated mass effect, with diagnosis established through neuroimaging. This report describes a rare, life-threatening exacerbation of a chronic porencephalic cyst in an adult, progressing to hydrocephalus and acute intracranial hypertension (IH). Case Description: A 57-year-old female presented to an outpatient clinic with an 8-month history of gait disturbances, memory impairment, apathy–abulia, and wheelchair dependence. Eight years earlier, she had sustained a mild traumatic brain injury, during which a porencephalic cyst was incidentally detected on cranial computed tomography (CT) scan; however, she had not been followed up, and the finding was not disclosed during the current evaluation. A new cranial CT and magnetic resonance imaging revealed a large porencephalic cyst in the left frontal lobe with mass effect, bilateral foramen of Monro obstruction, and hydrocephalus. An elective endoscopic cyst-ventricle communication was planned. Two weeks later, the patient presented signs of acute IH, including severe headache, diplopia, and blurred vision. An emergent external ventricular drain (EVD) was placed into the cyst cavity, leading to rapid symptom relief. The EVD was subsequently replaced by a cyst-peritoneal shunt. One year later, the proximal catheter became exposed and required complete shunt removal. Since then, she has remained clinically stable and shunt free. Conclusion: This case represents a rare, adult-onset, life-threatening exacerbation of chronic porencephaly. It demonstrates the importance of long-term follow-up in patients with known porencephalic cysts, even if previously asymptomatic, and the efficacy of timely neurosurgical intervention and close radiological monitoring in preventing severe or potentially fatal complications.

Endolymphatic sac tumor (ELST) is a rare lesion. It may be sporadically or associated with Von Hippel-Lindau syndrome.

Oxcarbazepine (OXC) has demonstrated comparable efficacy to Carbamazepine (CBZ) in the treatment of Trigeminal neuralgia (TN), with the added benefit of fewer adverse events (AEs). Whether it can be used as a substitute for carbamazepine is yet to be verified. To address this, we conducted a comprehensive meta-analysis, exploring efficacy and adverse events in detail. We searched PubMed, Embase, Cochrane Library, and Google Scholar for studies comparing CBZ to OXC in patients with TN. The main outcomes were efficacy, AEs, frequency of neurological AEs, skin reactions, and alterations in laboratory parameters. Statistical analysis was performed using Review Manager 5.4.1. And the risk of bias was assessed using RoB-2 and ROBINS-I. We included 838 patients from three observational studies and two randomized clinical trials (RCTs). CBZ was used to treat TN in 445 (53.1%) patients. The CBZ group when compared with the OXC group had no significant difference in efficacy (OR:0.58; 95% Cl:0.14-2.40; p=0.45). Both groups had significant differences noted in AEs, with higher frequency observed in the CBZ group (OR:2.30; 95% Cl:1.49-3.54; p=0.0002). Similarly, there was a significant difference in neurological AEs (OR:2.76; 95% Cl:1.53-4.87; p=0.0007). OXC and CBZ demonstrated similar efficacy in treating trigeminal neuralgia. However, the consideration of adverse events may favor clinical decision-making to OXC due to its superiority. Nonetheless, more randomized controlled trials (RCTs) are necessary to confirm this conclusion in the future

Skull base meningoceles are extremely rare, most commonly resulting from congenital defects in sphenoid bone fusion. Inadequate embryonic fusion between the posterior sphenoid and the occipital bones may result in a transclival meningocele. Given the absence of a formal classification system for clival meningoceles and clear guidelines for the most appropriate endoscopic skull base surgical approach, we combined an anatomical study and a systematic review to characterize anatomical patterns, propose a preliminary classification, and discuss transoral and endonasal surgical corridors according to each clival subtype. In addition, we report the first known case of a primary clival meningocele successfully treated via a transoral endoscopic approach. The study was registered with PROSPERO (CRD42024575282) and received approval from the Ethics Committee (82878724.1.0000.5259). The systematic review followed PRISMA guidelines. PubMed/MEDLINE, Embase, and Cochrane were rigorously searched. Anatomical dissection of midsagittal skull base specimens was performed to assess surgical access to clival regions. Seventeen studies comprising 18 patients (mean age 30.7 years; 72.2% female) were included. Clival defects were classified as posterior transsphenoidal (n = 11), spheno-occipital (n = 1), and basioccipital (n = 6). The endoscopic endonasal approach appeared more appropriate for posterior transsphenoidal cases and the transoral route for basioccipital defects. Anatomical dissection studies confirmed that the endonasal corridor is more suitable for the upper third of the clivus and the transoral route for the lower third.