Background: The decade-long Syrian armed conflict killed or injured more than 11% of the Syrian population. Head and neck injuries are the most frequent cause of war-related trauma, about half of which are brain injuries. Reports about Syrian brain trauma victims were published from neighboring countries; However, none are available from Syrian hospitals. This study aims to report war-related traumatic brain injuries from the Syrian capital. Methods: We conducted a retrospective cohort study between 2014 and 2017 at Damascus Hospital, the largest public hospital in Damascus, Syria. Target patients were the victims of combat-related traumatic brain injuries who arrived alive and were admitted to the neurosurgery department or to another department but followed by the neurosurgery team. The collected data included the mechanism, type, and site of injury based on imaging findings; types of invasive interventions; intensive-care unit (ICU) admissions; as well as neurological status at admission and discharge including several severity scales. Results: Our sample consisted of 195 patients; Ninety-six of them were male young adults, in addition to 40 females and 61 children. Injuries were caused by shrapnel in 127 (65%) cases, and by gunshots in the rest, and most of them (91%) were penetrating. Sixty-eight patients (35%) were admitted to the ICU, and 56 (29%) underwent surgery. Neurological impairment was reported in 49 patients (25%) at discharge, and the mortality rate during hospitalization was 33%. Mortality and neurological impairment associated significantly with higher values on clinical and imaging severity scores. Conclusions: This study captured the full spectrum of war-related brain injuries of civilians and armed personnel in Syria without the delay required to transport patients to neighboring countries. Although the clinical presentation of injuries at admission was not as severe as that in previous reports, the inadequate resources (i.e., ventilators and operation rooms) and the lack of previous experience with similar injuries might have resulted in the higher mortality rate. Clinical and imaging severity scales can provide a handy tool in identifying cases with low probability of survival especially with the shortage of personal and physical resources.

Background: One of the longest-standing treatments to prevent delayed cerebral infarction (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH) remains raising the blood pressure to a certain level of mean arterial pressure. This may require high doses of norepinephrine, which has been associated with severe end organ damage. With this study, we aimed to investigate the effects of norepinephrine on the incidence of DCI in a clinical setting. Methods: We conducted a retrospective evaluation of patients with aSAH admitted to our institution between November 2018 and March 2021. Potential risk factors for DCI were analyzed and significant predictors were assessed by means of a logistic regression analysis to account for potential confounders. Results: In this study, 104 patients were included. Hereof, 39 (38%) showed radiologic signs of DCI between day three and 14 post-intervention. These patients had more frequent vasospasms (n = 37 vs. 30, p = 0.022), a higher Hunt & Hess score (3 ± 2 vs. 2 ± 1, p = 0.004), a lower initial Glasgow Coma Scale score (9 ± 5 vs. 12 ± 4, p = 0.003) and received a higher median norepinephrine dose (20,356μg vs. 6,508μg, p < 0.001). A logistic regression analysis revealed that only high-dose norepinephrine administration (OR 2.84, CI 1.56–7.8) and vasospasm (OR 3.07, CI 1.2–7.84) appeared to be significant independent risk factors for DCI. Conclusion: Our results indicate a significant association between higher dose norepinephrine administration and the occurrence of DCI. Future research including greater sample sizes and a prospective setting will be necessary to further investigate the relationship.

Purpose: Approaches for lumbar corpectomies can be roughly categorized into anterolateral (AL) and posterolateral (PL) approaches. It remains controversial to date whether one approach is superior to the other, and no comparative studies exist for the two approaches for lumbar corpectomies. Methods: A systematic review of the literature was performed through a MEDLINE/PubMed search. Studies and case reports describing technique plus outcomes and possible complications were included. Thereafter, estimated blood loss (EBL), length of operation (LOO), utilized implants, neurological outcomes, complication rates, and reoperation rates were analyzed. Results: A total of 64 articles reporting on 702 patients including 513 AL and 189 PL corpectomies were included in this paper. All patients in the PL group were instrumented via the same approach used for corpectomy, while in the AL group the majority (68.3%) of authors described the use of an additional approach for instrumentation. The EBL was higher in the AL group (1393 ± 1341 ml vs. 982 ± 567 ml). The LOO also was higher in the AL group (317 ± 178 min vs. 258 ± 93 min). The complication rate (20.5% vs. 29.1%, p = 0.048) and the revision rate (3.1% vs. 9.5%, p = 0.004) were higher in the PL group. Neurological improvement rates were 43.8% (AL) vs. 39.2% (PL), and deterioration was only noted in the AL group (6.0%), while 50.2% (AL) and 60.8% (PL) showed no change from initial presentation to the last follow-up. Conclusion: While neurological outcomes of both approaches are comparable, the results of the present review demonstrated lower complication and revision rates in anterolateral corpectomies. Nevertheless, individual patient characteristics must be considered in decision-making.

Background: The clinical utility of risk scores predicting shunt dependency after aneurysmal subarachnoid hemorrhage (aSAH) remains limited due to scarce validation data. This multicenter pooled analysis aimed to assess the predictive accuracy of existing post-aSAH shunt risk scores. Methods: Consecutive aSAH cases treated at two German university hospitals from January 2010 to July 2023 were pooled into a validation cohort. Total scores for the CHESS, CHESS-Huckman, and SDASH risk models were calculated, and their diagnostic performance was compared using receiver operating characteristic (ROC) curve analysis. Results: A total of 813 patients were included, of whom 215 (26.4%) required ventriculoperitoneal shunt placement within a median time of 29 days post-aSAH. All three risk scores were significantly associated with shunt dependency. ROC analysis showed that the CHESS-Huckman score had the highest predictive accuracy (AUC: 0.792, 95% CI: 0.761–0.824), followed by the SDASH (AUC: 0.782, 95% CI: 0.750–0.814) and CHESS (AUC: 0.780, 95% CI: 0.748–0.812) scores. Pairwise comparisons of AUCs were not statistically significant. All three scores showed good overall calibration, with CHESS–Huckman performing best, as confirmed by calibration intercepts and slopes, Brier scores, and decile-based analysis. Higher CHESS–Huckman scores correlated with earlier shunt placement, whereas delayed shunting (>30 days after aSAH) was most common in patients with moderate CHESS–Huckman scores (7–8 points), occurring in 47.4% of cases compared to 41.4% and 33.3% in patients scoring 0–6 and 9–10 points, respectively. Conclusions: This multicenter analysis validated existing risk scores for predicting shunt dependency after aSAH, with the CHESS–Huckman score demonstrating the nominally highest diagnostic accuracy. Integrating these risk scores into clinical practice could enhance early identification of patients requiring shunting, potentially reducing external ventricular drain weaning time, shortening hospital stays, and lowering the risk of cerebrospinal fluid infections.

Combined revascularization procedures have proven effective in reducing ischemic events in patients with moyamoya disease (MMD). However, patient-specific predictors for the degree of revascularization remain unclear. The objective of this study was to identify preoperative factors associated with postoperative revascularization patterns in adults with MMD. Clinical and radiographic data from adult MMD patients undergoing combined revascularization between 2020 and 2025 were analyzed. Baseline demographics, perioperative parameters, and imaging findings were collected. Postoperative revascularization patterns were categorized by Matsushima grade (MG), and clinical outcomes by the modified Rankin Scale (mRS). Predictors including anterograde flow through the internal carotid artery (ICA) terminus prior to revascularization, degree of preoperative collateral flow to the middle cerebral artery (MCA) territory, severe MMD (Berlin grade 3), age, sex, and cerebrovascular reserve (CVR) were assessed for association with MG. To mitigate small-sample bias, Firth's penalized logistic regression was used. Associations between MG and postoperative improvements in perfusion, CVR, and mRS were also evaluated. Thirty-three patients (22 females, median age: 47 years, IQR: 37-52) were included. Severe MMD (Berlin grade 3) was present in 13 patients, and anterograde ICA flow was absent prior to surgery in 10. Postoperative outcomes included stable mRS (n = 25), improvement (n = 7), and worsening (n = 1). Matsushima grades were A (n = 17), B (n = 7), and C (n = 9). Multivariable Firth logistic regression showed that absent anterograde ICA flow was an independent predictor of achieving MG A (OR 46, P = 0.001). Patients with MG A were more likely to demonstrate improved cerebral perfusion (P = 0.008), while no significant association with mRS improvement was observed (P = 0.739). The absence of anterograde ICA flow independently predicted robust postoperative revascularization in adult MMD after combined revascularization. Preoperative assessment of ICA patency may represent a practical imaging biomarker for identifying patients most likely to benefit from direct bypass surgery.