Background/Objectives: Cranial gunshot injuries represent severe traumatic brain injuries associated with high mortality rates. This study investigated whether integrating clinical findings at admission, including GCS score and pupillary response, with a CT-derived anatomical burden score and midline shift improves the prediction of in-hospital mortality. Methods: Adult patients aged 18 years and older with penetrating cranial gunshot injuries (n = 143) treated at a tertiary referral centre between 1 January 2005 and 31 December 2025 were retrospectively analysed using a single-centre cohort design. All included patients completed in-hospital follow-up, defined as hospital discharge or in-hospital death. Clinical variables, the anatomical burden score, and midline shift were evaluated using a multivariable logistic regression model where the primary outcome was in-hospital mortality. Model performance was assessed using ROC analysis, calibration measures, and bootstrap internal validation. Results: The in-hospital mortality rate was 56.6%, with early mortality occurring in 33.6% of patients. In the multivariable analysis, a low admission GCS score (≤8), bilateral non-reactive pupils, an increased anatomical burden score, and midline shift were independently associated with a higher risk of mortality. The model demonstrated good discrimination (AUC = 0.87; 95% CI 0.81–0.93), and similar performance was maintained following internal validation (optimism-corrected AUC = 0.86). The addition of radiological parameters to clinical variables improved model discrimination (ΔAUC = 0.07; 95% CI 0.02–0.11). Conclusions: The combined evaluation of admission clinical findings and CT-based anatomical parameters may support a more structured early estimation of in-hospital mortality risk in adult patients with penetrating cranial gunshot injuries.

Background/Objectives: Shunt-dependent hydrocephalus remains a major complication following aneurysmal subarachnoid hemorrhage (aSAH). Although several clinical–radiological prediction models have been proposed, the additional contribution of inflammatory biomarkers remains unclear. This study evaluated whether the platelet-to-neutrophil ratio provides additional predictive value beyond established clinical and radiological predictors of shunt-dependent hydrocephalus after aSAH. Materials and Methods: This retrospective single-center cohort study included 418 consecutive patients with aSAH treated using endovascular techniques between 2017 and 2025. Clinical severity parameters, ventricular burden-related radiological findings, and admission hematological variables were analyzed. Independent predictors of shunt-dependent hydrocephalus were identified using multivariable logistic regression analysis. Model performance was assessed using receiver operating characteristic analysis, calibration assessment, sensitivity analyses, and bootstrap internal validation. Results: Shunt-dependent hydrocephalus developed in 75 patients (18%). Lower Glasgow Coma Scale scores, intraventricular hemorrhage, increased Evans index, greater third ventricle width, lower platelet-to-neutrophil ratio, and external ventricular drain requirement were independently associated with shunt dependency. Incorporation of the platelet-to-neutrophil ratio increased the area under the curve from 0.84 (95% CI: 0.79–0.89) to 0.88 (95% CI: 0.84–0.92; p = 0.018). Internal validation demonstrated preserved model performance and calibration. Sensitivity analyses demonstrated similar findings after exclusion of external ventricular drain placement. Conclusions: Platelet-to-neutrophil ratio is independently associated with shunt-dependent hydrocephalus after aSAH and may be considered an additional component of integrated clinical–radiological risk assessment.

Background/Objectives: There is no consensus on whether it is possible to preserve implant retention during deep surgical site infections (SSIs), and there is no widely accepted treatment protocol to date for these patients. The aim of this study is to evaluate the efficacy of the debridement, antibiotics, and implant retention (DAIR) protocol in patients who were treated for degenerative thoracolumbar spinal disorder using spinal instrumentation. Methods: This retrospective study describes the 24-month outcomes of deep SSI that developed in 25 of 720 patients (3.5%) who underwent surgery for thoracolumbar degenerative spinal disorders (disc disease, spinal stenosis, and scoliosis) and were treated according to the DAIR protocol. Results: Of these 25 patients, 18 developed early infection (3 months). Staphylococcus aureus was isolated in 56% of the patients. The DAIR protocol was successful in 22 (88%) of the patients, while it failed in 3 (12%). Surgical implants were removed in 25% of patients with late-onset SSI, and only 11.1% with early onset and 0% with delayed SSI. All patients who failed DAIR were smokers. A significant association was found between the Charlson Comorbidity Index and the number of surgical interventions (p = 0.022). Conclusions: In this small retrospective cohort, the DAIR protocol appeared to be a feasible treatment option for deep SSI, particularly in early infections. Implant removal may be considered when infection persists after repeat DAIR or when implant loosening is observed.

Background and Objectives: Prognostic assessments in grade 4 diffuse astrocytic tumors primarily depend on clinical and molecular characteristics, with radiological attributes frequently assessed in isolation. In this study, we explored whether an integrated radiological approach combining tumor burden, anatomical spread, and mass effect could contribute to survival prediction. Materials and Methods: A total of 310 adult patients with histopathologically confirmed grade 4 diffuse astrocytic tumors, diagnosed between January 2022 and January 2025, were included in this retrospective single-center cohort. Preoperative MRI was used to assess contrast-enhancing tumor volume, edema volume, and brain volume, combined with anatomical spread and midline shift as a marker of mass effect. Tumor burden was defined as the ratio of enhancing tumor volume to brain volume (ETV/BV). Overall survival was analyzed using Kaplan–Meier and Cox regression methods. Model performance was evaluated with the C-index, bootstrap internal validation, and 12-month calibration. Results: Tumor burden was higher in IDH-wildtype tumors, which also showed higher midline shift and more frequent deep structure involvement and contralateral extension. In multivariable analysis, IDH status, age, tumor burden, midline shift, and deep structure involvement were independently associated with overall survival. A greater tumor burden was associated with reduced survival. The addition of molecular and imaging-derived variables improved discrimination, increasing the C-index from 0.69 to 0.76. Following bootstrap validation, the corrected value was 0.73. Calibration at 12 months demonstrated acceptable agreement between predicted and observed outcomes. Conclusions: An integrated radiological approach that combines tumor burden, anatomical spread, and mass effect may support prognostic assessment in addition to established clinical and molecular variables.