BACKGROUND Teratomas are rare congenital tumors arising from pluripotent germ cells and contain tissues derived from all three germ layers: ectoderm, mesoderm, and endoderm. Intracranial teratomas are uncommon, accounting for less than 0.5% of all central nervous system tumors, and typically occur in midline structures such as the pineal or suprasellar regions. Primary involvement of cranial bones with transosseous extension is exceptionally rare. These lesions may lead to progressive cranial deformity and local bone destruction. While isolated cases involving the petrosal bone have been reported, localization at the cranial vault is exceedingly uncommon. To our knowledge, this report describes the first case of a transosseous teratoma involving the frontal and parietal bones. CASE PRESENTATION A 39 year old male presented with persistent headache and vertigo, associated with a subcutaneous swelling at the bregma that progressively enlarged following a hair transplant procedure. Imaging revealed an osteolytic transosseous lesion involving both the external and internal cortical tables, with intraspongious extension and multiple hair follicles embedded within the mass. The patient underwent complete surgical excision, including resection of the outer cortical bone to delineate tumor margins and achieve total removal clearly. Histopathological examination confirmed the diagnosis of a mature teratoma. The postoperative course was uneventful, and the patient was discharged on the third postoperative day without neurological deficits. DISCUSSION Transosseous teratomas of the cranial vault are extremely rare. Their pathogenesis is thought to involve aberrant migration of germ cells during embryogenesis, resulting in ectopic growth within bone. Differential diagnosis includes dermoid and epidermoid cysts, osteolytic skull tumors, and other germ cell neoplasms. Complete surgical excision remains the treatment of choice to prevent recurrence. Given the potential for malignant transformation, long term clinical and radiological follow up is recommended. CONCLUSION: This case underscores the importance of early diagnosis and complete surgical resection in the management of transosseous cranial teratomas. Further reports are needed to better define optimal management strategies for these rare lesions.

Background. Diffuse gliomas are the most frequent primary malignant tumors of the central nervous system in adults and are characterized by biological heterogeneity and high recurrence rates. The 2021 WHO Classification of CNS Tumors and the updated RANO 2.0 criteria have refined diagnostic and response assessment standards. The objective of this exploratory subanalysis was to characterize the clinical and imaging patterns of recurrence in patients with diffuse gliomas. Methods. This subanalysis was derived from an initial retrospective cohort of 290 patients diagnosed with glioma between 2021 and 2024 at a tertiary neuro-oncology center in Romania. Eligible cases had histopathologically confirmed diffuse glioma, documented recurrence during follow-up according to RANO 2.0 and EANO criteria, and complete MRI examinations available at recurrence. Patients without recurrence or without complete recurrence imaging data were excluded. Demographic characteristics, histological subtype, extent of resection, time to recurrence, and recurrence-related imaging features were analyzed using descriptive methods. Results. Thirty-one patients were included, predominantly glioblastomas (67.7%). A descriptive inverse correlation was observed between age at diagnosis and time to recurrence (r = -0.43). Because no inferential statistical validation (p-values or confidence intervals) was included, the inverse correlation should be treated with caution due to possible interpretation differences between the two groups. Most recurrences showed contrast enhancement (93.5%), commonly adjacent to the surgical cavity (58.1%). Advanced imaging frequently demonstrated diffusion restriction and increased perfusion parameters, suggestive of active tumor recurrence. Conclusions. In this exploratory subanalysis, recurrent diffuse gliomas exhibited distinct clinico-imaging phenotypes, with marked differences in recurrence timing across histological subtypes and heterogeneous MRI patterns at progression. Glioblastoma showed the earliest recurrence, while advanced imaging findings supported the concept that recurrence is not a radiologically uniform event. These preliminary, hypothesis-generating findings suggest that structured follow-up incorporating conventional and advanced MRI techniques may assist in the assessment of recurrent diffuse gliomas, although further research with larger cohorts is necessary to confirm these observations.

Introduction: Extracranial arteriovenous malformations (AVMs) are rare but challenging vascular anomalies characterized by direct arteriovenous connections that bypass the capillary network, leading to progressive lesion growth, hemorrhage, and functional impairment. The management of these lesions remains complex due to high recurrence rates and the need for multidisciplinary therapeutic approaches. Case Presentation: We report the case of a 51-year-old female presenting with a left retroauricular pulsatile mass, headaches, and audible bruits. Magnetic resonance imaging (MRI) revealed an extracranial AVM with a 17 × 30 mm nidus. Surgical resection was performed following preoperative evaluation, involving meticulous dissection, selective vascular control, and complete excision of the malformation. The patient had a favorable postoperative course, with no neurological deficits and early hospital discharge. Discussion: Extracranial AVMs pose significant diagnostic and therapeutic challenges. While embolization serves as an adjunctive measure to reduce intraoperative bleeding, complete surgical resection remains the definitive treatment. However, lesion recurrence is common due to residual microscopic arteriovenous shunts and neovascularization. Advances in molecular pathology have identified key angiogenic pathways involved in AVM progression, opening new avenues for targeted therapies. Conclusion: This case highlights the importance of early diagnosis, comprehensive imaging assessment, and individualized surgical planning for optimal patient outcomes. Multimodal strategies integrating endovascular techniques and surgical resection remain crucial in managing extracranial AVMs. Long-term follow-up is essential to detect potential recurrence and guide future therapeutic decisions.

Background: Adult-onset isolated focal dystonia (AOIFD) is the most common form of dystonia, being the third most common movement disorder. AOIFD has a heterogenous phenotype, etiopathogenesis being incompletely understood, both genetic and environmental factors playing a role. Objective: The objective of this study was to characterize a cohort of Romanian patients with AOIFD and to explore the potential associations between environmental factors and disease progression. Methods: We conducted an observational cross-sectional study on patients with AOIFD evaluated in a tertiary neurology referral centre in Romania, approved by the local Ethics Committee. Demographic, clinical, environmental, and treatment-related data were collected. Associations were assessed using univariable analyses and logistic regression models. Results: 89 patients were included. The most common phenotypes were cervical dystonia (53.9%) and blepharospasm (36.0%). Disease progression was present in 75.3% of cases. No statistically significant associations were observed between disease progression and environmental or lifestyle factors. Isometric occupational activity was associated with acute onset (p=0.023). Evolution to Meige syndrome occurred exclusively in patients with late-onset blepharospasm. Conclusions: AOIFD is a heterogeneous multifactorial disorder. While the assessed environmental factors were not significantly associated with disease progression, certain phenotype-specific patterns were observed.

Background/Objectives: The independent contribution of extent of resection (EOR) to early recurrence in diffuse gliomas remains debated, as crude analyses are confounded by tumor biology, and real-world data from Eastern European centers are scarce. Methods: We retrospectively studied 283 consecutive adults with surgically treated diffuse gliomas (2021–2024) at a Romanian tertiary center. Primary endpoints were recurrence-free survival (RFS) at 1 and 2 years, evaluated as landmark endpoints; secondary endpoints were overall recurrence, reoperation, and reirradiation. Clinical, histopathological, surgical, imaging, and treatment variables were analyzed with complete-case Firth-penalized logistic regression. Results: Among evaluable patients, 70.6% (132/187) were recurrence-free at 1 year and 64.2% (120/187) at 2 years; overall recurrence occurred in 53.7% (139/259). After adjustment, gross total resection (GTR) was independently associated with higher odds of remaining recurrence-free at 1 year (OR 12.37, 95% CI 3.23–52.58; p < 0.001) and 2 years (OR 10.56; p < 0.001), as was subtotal resection (STR) at both time points (OR 4.15, 95% CI 1.17–16.16, p = 0.027; and OR 3.93, p = 0.027), versus partial resection/biopsy. Conclusions: EOR was independently associated with early RFS, supporting maximal safe resection as a primary surgical objective. The landmark endpoints were not evaluable in 96 of 283 patients, almost all of whom underwent biopsy or partial resection, so the odds ratios indicate the direction of the effect and not its precise magnitude. Overall recurrence, evaluable in 91.5% of the cohort, showed a concordant gradient. External validation is needed.

Background and Objectives: Magnetic resonance imaging (MRI) is essential for monitoring patients with diffuse gliomas after surgery and adjuvant therapy. However, the prognostic significance of imaging findings observed on the first post-treatment MRI remains incompletely defined in routine clinical practice. This study aimed to evaluate whether MRI features identified on the first post-treatment examination are associated with recurrence-free survival after near-total resection (NTR), defined for this real-world cohort as ≥80% volumetric tumor removal (which differs from the RANO Resect Group definition of GTR). Materials and Methods: Consecutive adult patients with histologically confirmed diffuse gliomas diagnosed between 2021 and 2024 were screened for eligibility (n = 283) and classified according to the 2021 WHO Classification of Tumors of the Central Nervous System. The first post-treatment MRI was defined as the earliest follow-up examination performed after completion of all initially planned therapy (surgery alone in patients without indication for adjuvant therapy; post-radiotherapy ± chemotherapy in the remaining patients), and not the immediate postoperative scan. Patients with available first post-treatment MRI were included (n = 149), resulting in a final cohort of 139 cases after exclusion of outliers. The evaluated MRI corresponded to the first follow-up examination after treatment (mean interval ~120 days after surgery). Logistic regression models were used to assess associations between post-treatment MRI features and recurrence-free survival at one and two years after NTR, with exploratory analyses for reoperation and reirradiation. Results: Residual tumor identified on the first post-treatment MRI was associated with lower odds of recurrence-free survival (RFS) at one and two years after NTR. Postoperative functional status also demonstrated an independent association with tumor control. Other imaging variables showed associations in univariable analyses but did not remain independent predictors after adjustment. Exploratory analyses of reoperation and reirradiation suggested additional clinical influences, including patient age. Conclusions: In this real-world cohort with heterogeneous tumor subtypes and treatment regimens, residual tumor on first follow-up MRI was the most consistent imaging correlate of reduced RFS, alongside postoperative functional status. These hypothesis-generating findings should be validated in stratified, prospective cohorts.