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.

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.

Background: Draining veins of the arteriovenous malformations (AVMs) can be the cause of hemorrhages, and the subject of a specific treatment. However, there are very scarce reports about their radiologic anatomy. Methods: Fifty-seven patients with cerebral AVMs were enrolled, almost with equal number of males and females. All of them underwent a neurologic examination, and then digital subtraction angiography, and computerized tomographic angiography. The obtained data were statistically analyzed. Results: The 57 patients had AVMs most often located in the frontal region (17.6%), and in the temporal and parietotemporal area (15.8% each). Supratentorial location existed in 88.4%, and infratentorial in 12.6%. Their draining veins ranged 1–17 in number (mean, 2.19). Singular veins were present in 22.8%, and double in 59.7%. Most of draining veins entered the superior sagittal sinus and other superficial vessels (63.2%), some terminated into deep veins or sinuses (12.3%), whilst both sites were present in 24.5%. Dilated draining veins existed in 88.9%, and venous aneurysms in 8.8%. An AVM hemorrhage was the initial sign in 49.2%. As for the AVMs treatment, endovascular embolization was performed (15.8%), surgical intervention (12.3%), and gamma knife irradiation (21.1%), whilst the remaining patients were treated conservatively, with a total mortality rate of 7.2%. Conclusion: Draining veins, which averaged 2.19 in number, terminated in various venous vessels. Most of them were dilated and tortuous, with rare aneurysms. A hemorrhage appeared in a half of the patients. Most of AVMs were treated by endovascular, neurosurgical, or radio-surgical interventions.

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.