The aim of this study was to determine whether apparent diffusion coefficient (ADC) bi-component curve-fitting histogram analysis and volume percentage change (VPC) prior to bevacizumab treatment can stratify progression-free survival (PFS) and overall survival (OS) in patients with glioblastoma multiforme (GBM) on first recurrence. We retrospectively evaluated 17 patients with recurrent GBM who received bevacizumab and fotemustine (n = 13) or only bevacizumab (n = 4) on first recurrence at our institution between December 2009 and July 2015. Both T2/FLAIR abnormalities and enhancing tumor on T1 images were mapped to the ADC images. ADC-L and ADC-M values were obtained trough bi-Gaussian curve fitting histogram analysis. Furthermore, the study population was dichotomized into two subgroups: patients displaying a reduction in enhancing tumor volume of either >55% or 41% or 0.05) in both univariate and multivariate analysis. CE-ADC and CE-VPC can stratify PFS for patients with recurrent glioblastoma prior to bevacizumab treatment.

Mycosis Fungoides (MF) is a rare malignant T-cell lymphoma, involving mainly the skin. In 50%–75% of cases, it can involve organs other than skin, with a 11%–14% Central Nervous System involvement (CNS). A 82-year-old woman presented to our Department with a 15-years history of MF with skin lesions. Neurological examination showed dysarthria and a left facio-brachial-crural hemiparesis. A CT scan showed a right fronto-rolandic lesion. A MRI, including DWI, confirmed the presence of the “neoplastic” lesion with slight hemorrhagic component and leptomeningeal contrast enhancement. Molecular TCR rearrangement test by PCR analysis was performed on skin biopsy, showed the presence of a single peak which fits with a monoclonal TCRG gene rearrangement (size 67). Molecular TCR test was also performed on the cerebrospinal fluid (CSF), which confirmed the presence of lymphocyte clone T g/ more expressed with the same size of that observed in the skin biopsy A total body CT scan did not show any lymphnodal or extranodal disease. The patient died after ten days. MF usually occurs in the context of advanced and often histologically transformed cutaneous disease. Isolated CNS involvement is remarkably rare. This case highlights the need for regular neurologic follow-up after the diagnosis of MF, in particular when features that suggest risk of disease progression are present. Furthermore, the analysis of the skin biopsy and above all of CSF by PCR technique, based on our experience, should always be executed in MF patients with signs or symptoms suggesting CNS involvement.

Background: Chronic subdural hematoma (cSDH) is a common condition, particularly in individuals over 65 years of age. Its pathophysiology involves traumatic and inflammatory processes, culminating in hematoma formation. Although surgical drainage is the primary treatment of choice, its significant recurrence rates have prompted exploration of non-surgical options. This study evaluates the effectiveness of middle meningeal artery (MMA) embolization as an alternative or adjunctive treatment in asymptomatic or paucisymptomatic cSDH patients. Methods: This two-center retrospective study analyzed 93 patients treated with MMA embolization at two hospitals between 2020 and 2024. Patients exhibited either asymptomatic or mild symptomatic cSDH (Markwalder score 0 or 1), with hematoma thickness >10 mm. Pre- and post-treatment CT scans were compared to assess hematoma thickness, with follow-ups conducted at three months. Statistical analysis included ANCOVA and Mann–Whitney U tests for outcome evaluation. Results: Of the 93 patients, 44 underwent bilateral embolization, and 49 underwent unilateral embolization. Treatment reduced hematoma thickness by an average of 59% at three months follow-up. The trabecular subtype showed the greatest thickness reduction compared to other subtypes (p < 0.05). No significant differences were found between embolization materials. Only 3.2% of patients experienced technical complications, and three patients experienced rebleeding during follow-up. Conclusions: MMA embolization appears to be a safe and effective treatment for cSDH, providing a minimally invasive alternative to surgery. The technique shows promise in reducing hematoma size, especially in the trabecular subtype. Further research is needed to confirm these findings and establish their role in routine clinical practice.

Brain health may be threatened by aneurysm ruptures, and early recognition of these vascular malformations allows for neuroradiological intervention. Neurointerventional procedures are usually performed with femoral artery access. In patients with severe anatomical complexity of the supra-aortic vessels, however, treatment by this approach could be hindered or impossible. Flow-diverter stent deployment is an effective and safe treatment for large, wide necked intracranial aneurysms, but it requires a complete and firm stability of the coaxial system to achieve a correct and precise deployment of the device. We present the first reported Italian case of a patient with an intracranial aneurysm which was treated with Flow-diverter stent (DERIVO^®; AcandisGmbH & Co. KG; Pforzheim; Germany) by direct common carotid artery puncture due to severe tortuosity of supra-aortic trunks.

Background: Middle meningeal artery embolization (MMAE) plus surgical evacuation is increasingly used for chronic subdural hematoma (cSDH), but predictors of length of stay (LOS) and outcomes associated with early discharge remain unclear. Methods: We performed a multicenter MESH Registry study (2019–2024) of patients undergoing MMAE and surgical evacuation for symptomatic cSDH. Short-stay discharge was defined as LOS ≤4 days. Predictors were identified using multivariable logistic regression. The 90-day composite adverse event was defined as cSDH recurrence requiring intervention, reintervention (repeat MMAE or surgical evacuation), or 30-day all-cause readmission. Safety was assessed using adjusted logistic regression, generalized estimating equations (GEE), inverse probability of treatment weighting (IPTW), and multiple imputation by chained equations (MICE). Results: Among 647 patients (mean age 72.6 years; 74.0% male), 156 (24.1%) had short-stay discharge. Median LOS was 8 days (IQR 5–15). Older age (aOR 0.76 per 10 years; 95% CI 0.62–0.93; P = 0.008), higher baseline modified Rankin Scale score (aOR 0.79 per point; 95% CI 0.67–0.94; P = 0.007), and greater midline shift (aOR 0.90 per mm; 95% CI 0.85–0.96; P = 0.001) were independently associated with lower odds of short-stay discharge. C‑statistic was 0.683. The 90-day composite event rate was 17.1% in short-stay versus 23.7% in long-stay patients. Short-stay discharge was not significantly associated with the composite outcome on adjusted analysis (aOR 0.56; 95% CI 0.30–1.07; P = 0.08), GEE (aOR 0.61; 95% CI 0.33–1.12; P = 0.11), or MICE (aOR 0.74; 95% CI 0.44–1.25; P = 0.26). IPTW showed a discordant association (OR 0.47; 95% CI 0.24–0.92; P = 0.03). Conclusions: Older age, worse baseline function, and midline shift were associated with longer hospitalization. Short-stay discharge was not associated with a statistically significant increase in adverse-event rates; however, the study was not powered to establish non-inferiority or safety equivalence, and clinically meaningful differences cannot be excluded.