Background: Temporal muscle thickness (TMT) on cranial CT scans has recently been identified as a prognostic imaging parameter for assessing a patient’s baseline frailty. Here, we analyzed whether TMT correlates with Traumatic brain injury (TBI) severity and whether it can be used to predict outcome(s) after TBI. Methods: We analyzed the radiological and clinical data sets of 193 patients with TBI who were admitted to our institution and correlated the radiological data with clinical outcomes after stratification for TMT. Results: Our analyses showed a significant association between high TMT and increased risk for intracranial hemorrhage (p = 0.0135) but improved mRS at 6 months (p = 0.001) as compared to patients with low TMT. Congruent with such findings, a lower TMT was associated with falls and reduced outcomes at 6 months (p < 0.0001 and p < 0.0001). Conclusion: High TMT was robustly associated with head trauma sequelae but was also associated with good clinical outcomes in TBI patients. These findings consolidate the significance of TMT as an objective marker of frailty in TBI patients; such measurements may ultimately be leveraged as prognostic indicators.

BACKGROUND AND OBJECTIVES: Intracranial infection in children is a rare but life-threatening condition that requires immediate neurosurgical care. The impact of the COVID-19 pandemic on incidence and outcome is unclear. METHODS: This study is a multicenter retrospective analysis of children who underwent neurosurgical treatment of intracranial infections (epidural abscess, subdural empyema, cerebral abscess, ventriculitis, and meningitis) between January 2014 and October 2024. Comparison of children with intracranial infections and neurosurgical intervention stratified by pre and postpandemic. RESULTS: The annual incidence of pediatric intracranial infections requiring neurosurgery increased significantly from 5.6 cases (95% CI: 4.0-7.5) prepandemic to 14.4 cases (95% CI: 11.2-18.0) postpandemic, with an incidence risk ratio (IRR) of 2.6 (95% CI: 1.8-3.8; P < .0001). Causative were the observed sinusitis-associated cases, with absolute numbers rising from 13 prepandemic to 31 postpandemic. The annual incidence increased from 1.81 cases (95% CI: 0.99-2.97) to 6.45 cases (95% CI: 4.44-9.00), yielding an IRR of 3.6 (95% CI: 1.9-7.1; P = .0001). For otitis-related cases, absolute counts surged from 6 to 19, accompanied by an incidence increase from 0.83 (95% CI: 0.33-1.69) to 3.95 (95% CI: 2.43-6.01), with an IRR of 4.7 (95% CI: 2.0-13.0; P = .0009). However, functional outcomes assessed by the pediatric modified Rankin Scale showed no statistically significant differences between pre- and postpandemic cohorts in the Wilcoxon-Mann-Whitney test, both at discharge ( P = .388) and at 3-month follow-up ( P = .927). CONCLUSION: Our study demonstrates a significant increase in the incidence of intracranial infections requiring neurosurgical treatment in children after the pandemic, with a 2.4-fold higher IRR compared with the prepandemic period. The postpandemic group had a significantly higher incidence of underlying complicated otitis and sinusitis.

Ранения головы часто сопряжены с внедрением в полость черепа инородных тел, это требует решения о необходимости хирургического лечения, его методе и объеме. Инородные тела желудочков встречаются редко, поэтому вопрос о хирургической тактике в их отношении остается открытым. Цель исследования — обобщение опыта лечения раненых с инородными телами желудочков головного мозга. МАТЕРИАЛ И МЕТОДЫ Представлены результаты лечения раненых с инородными телами в боковых желудочках. По ключевым словам «проникающие ранения», «инородные тела», «желудочки головного мозга», «gunshot injury», «ventricular foreign bodies» проведен поиск в базах данных e-Library, PubMed, GoogleScholar. Проанализированы сведения о лечении пострадавших с инородными телами в желудочках головного мозга. РЕЗУЛЬТАТЫ Трое раненых оперированы, удалены инородные тела из затылочного рога бокового желудочка, III желудочка и височного рога бокового желудочка. В 1 случае выбрана консервативная тактика. Катамнез составил от 1 мес до 7 лет. Исходы по шкале Глазго — 3—4 балла. Инвалидизация обусловлена тяжестью ранения и не связана с хирургическим лечением. Найдено 16 публикаций, соответствующих критериям поиска. Методы операций варьировали от стандартных хирургических доступов до стереотаксического. Показанием к удалению инородных тел была их миграция по желудочковой системе и развитие окклюзионной гидроцефалии. Нарастания неврологического дефицита не отмечено ни в одном из опубликованных наблюдений. ЗАКЛЮЧЕНИЕ Инородные тела желудочков мозга редки, их наличие создает трудности в выборе метода и сроков лечения. Показаниями к их удалению является миграция, развитие окклюзионной гидроцефалии и инфекционных осложнений. Способ удаления определяется индивидуально на основании локализации, магнитных свойств, характера ранения, предпочтений хирурга и других факторов.

Introduction: Current guidelines suggest surgical decompression for ischemic cerebellar stroke in case of significant mass effect. Recent research has aimed to identify a possible threshold for mass effect. However, a computer-assisted volumetry in acute setting is time consuming and impracticable, wherefore the aim of this study was to assess the accuracy and clinical applicability of the ABC/2 method in case of ischemic cerebellar stroke. Materials and methods: Imaging data of 125 patients, including preoperative CT or MRI scans were used for volumetric analysis. The ABC/2 formula using scans in axial and coronal planes. BrainLab® Elements software was used for computer assisted volumetry by defining the region of interest allowing automated volumetric calculation. Measurements were conducted independently by blinded clinicians. Pearson correlation and Bland-Altmann test were used for statistical analysis. Results: Among the 125 cerebellar infarctions analyzed, there was no statistical difference of mean infarct volume measurement between the ABC/2 formula and computer-assisted volumetry (16.6mL vs. 15.91mL; range 0.8-67.7mL; p = 0.76). The Spearman correlation test indicated a strong correlation between the two methods (r = 0.985, 95% CI: 0.979–0.990, p < 0.0001). Discrepancies were most notable in smaller infarction volumes (<10 mL), prompting a subgroup analysis. For infarct volume less than 10mL, the ratio of volumetric differences ranged from 47% to 60%, with absolute volume differences from −3–3 mL whereas the ratio ranged from −20% to 29%, with absolute volume differences from −6–8 mL in cases with infarct volume greater equal 10mL. Conclusion: ABC/2 formula shows a good correlation with computer-assisted volumetry. Consequently, it could serve as a fast and practical tool for estimating cerebellar infarct volume and aiding decision-making in clinical practice. However, the limitations and variability of the ABC/2 method, particularly for smaller infarcts, must be considered.

Background: In recent years, there has been a noticeable increase in severe intracranial infections among pediatric patients, often requiring craniotomy or decompressive craniectomy. However, determining the optimal timing and material for cranioplasty in pediatric patients presents an ongoing challenge. Methods: We conducted a multicenter retrospective cohort study of pediatric patients treated between 2013 and 2024. A total of 76 children with intracranial infections were included; 37% of those underwent decompressive craniectomy. Of these, 21% subsequently received cranioplasty using various graft materials. Clinical, microbiological, radiological, and neurosurgical data were analyzed to assess risk factors, outcomes, and complications. Results: Craniectomy was significantly associated with the presence of sinusitis ( p = 0.025) and paresis ( p =  0.006). Streptococcus intermedius was the predominant pathogen identified in the craniectomy group ( p < 0.001). Cranioplasty was performed in 16 patients at a median of 6.9 months post-craniectomy, with a low complication rate (6.25%, one wound impairment). Functional outcome improved significantly in patients with hemicraniectomy after cranioplasty with favorable mRS scores at 3-month follow-up ( p = 0.037). Conclusion: Craniectomy is frequently required in pediatric patients with severe intracranial infections and is followed by delayed cranioplasty with low complication rates in our cohort. Careful timing and individualized material selection are essential for safe and successful cranial reconstruction in this vulnerable population.

Objectives: Stereotactic photodynamic therapy (sPDT) using 5-aminolaevulinic acid (5-ALA) as a cytotoxic photosensitizer may be a potentially prospective treatment option for malignant gliomas. Material and Methods: We analyzed data from 10 patients with recurrent malignant gliomas of the brain who were treated with sPDT at the Department of Neurosurgery of the Military-Medical Academy S. M. Kirov, from 2020 to November 2021. Three patients were treated with sPDT again after 3, 7, and 15 months due to relapse. Results: The median age of the patients was 55.5 years, range was 30–60 years, there were six men and four women. At the time of sPDT, 7 (70%) patients with recurrent tumors were diagnosed with glioblastomas (WHO grade IV), and 3 (30%) with anaplastic astrocytomas (WHO grade III). Tumors were without IDH mutation in 7 (70%) patients; MGMT gene expression status was evaluated in tumors in 9 (90%) patients. A 1p/19q co-deletion was not detected in any of the patients. The median tumor volume was 5.85 cm³ (min. 3.2 cm³, max. 22.5 cm³). We have found that the median recurrence-free period after sPDT in patients with anaplastic astrocytomas and glioblastomas was 435 and 195 days, respectively. Conclusion: This result allows to consider sPDT as one of the perspective methods of treatment of patients with recurrent gliomas of high malignancy in cases when repeated open surgical intervention has high risks of new neurological deficit.