Atypical teratoid/rhabdoid tumor (AT/RT) of Central Nervous System (CNS) is a rare malignancy, usually confronted in childhood. Although few cases were reported in adults, it seems that there is a preference in supratentorial areas and specifically at the sellar region in middle-aged females with this subgroup presenting distinct features. We share a case report of a rare intracranial ATRT in the sellar area with lung metastasis in an adult female. Patient's medical records (laboratory tests, radiology examinations, histopathology report) were reviewed after retrieving an informed consent. A literature search within Pubmed and further “snowballing” was performed with the use of keywords “sellar”, “adult”, “ATRT” to address the current literature. We present the case of a 51-year-old woman with headaches and left ptosis, diagnosed with a sellar mass, infiltrating the cavernous sinus. She underwent endoscopic transsphenoidal debulking of the lesion. The pathology report showed an aggressive AT/RT and the patient received radio- and chemo-therapy. On follow up imaging studies, lung metastases were shown and the patient died 7 months after the initial diagnosis. Only a few cases of sellar/suprasellar ATRT with lung metastases have been described so far. ATRT should be in the differential diagnosis of fibrous sellar masses in adult women.

Anterior cervical spine surgery has become a widely accepted approach for treating various cervical spine pathologies. This systematic review aimed to evaluate the frequency, etiology and outcomes of complications associated with anterior cervical spine surgery. A comprehensive literature search was conducted using multiple databases (CINAHL Plus, MEDLINE, PubMed, Scopus, and EMBASE) for peer-reviewed articles published in English from January 1st, 1989 to December 31st, 2024. Studies involving adult patients undergoing anterior cervical spine surgery were included. The quality of evidence was assessed using the Newcastle Ottawa Scale. Dysphagia emerged as the most common complication, with rates varying widely (2.3 %–87.5 %) depending on timing of assessment and methodology. Other significant complications included adjacent segment disease with the range varying from 0.4 % to 32 %, recurrent laryngeal nerve palsy (0.1 %–9 %), infection (0.39 %–8.5 %), pseudarthrosis (0.25 %–31 %), esophageal perforation (0.1 %–0.45 %), vertebral artery injury (0.3 %–7.7 %), Horner's syndrome (0.06 %–0.45 %), graft failure (2.7 %–35.5 %), CSF leak (0 %–1 %), postoperative hematoma (0.21 %–7 %) and deteriorating or new neurological deficits (0.37 % −3.3). Multilevel disease, revision surgery and OPLL were associated with higher complication rate. Surgeon's experience and higher case volume were consistently correlated with lower complication rates. While anterior cervical spine surgery is generally safe and effective, it carries risks of various complications ranging from common but typically self-limiting to rare but potentially severe. Μinimizing these complications depends on thorough preoperative planning, careful patient selection, and proper surgical technique.

Transsphenoidal surgery is the primary treatment for patients with Cushing disease (CD). This study assessed the surgical and endocrinologic outcomes of patients with CD following endoscopic pituitary surgery using strict biochemical criteria to guide surveillance in patients not achieving early remission. The medical records of all patients with CD who underwent endoscopic transsphenoidal surgery at a single institution between 2004 and 2025 were reviewed. Remission was defined as a fasting serum cortisol level <50 nmol/L (1.8 μg/dL) either basal or after 1 mg dexamethasone. A total of 125 patients were diagnosed with CD and had a primary endoscopic transsphenoidal surgery during the study period (median age 48 years [range: 14-79 years; M:F 93:32). Fifty-seven patients (45.6%) had a microadenoma, 41 (32.8%) had a macroadenoma, and 26 (20.8%) had no demonstrable focal lesion on pituitary magnetic resonance imaging (MRI) (MRI-negative CD). The median length of follow-up was 3.1 years (range: 1 month to 16.7 years). Initial remission rates 3 months after surgery were: 72.0% for patients with MRI-negative CD, 77.2% for microadenomas, and 48.7% for macroadenomas. Age, male sex, MRI-negative, and single operation were predictors of remission. Patients who achieved remission at 3 months were significantly more likely to be in remission at last follow-up after accounting for patient and tumor characteristics. The 5-year recurrence rate following remission was 6.9%. Endoscopic transsphenoidal surgery is an effective first-line treatment for patients with CD but a significant minority will relapse. Close biochemical surveillance of patients who fail to achieve remission may support the use of early adjuvant radiotherapy.

In some subjects with inherited pheochromocytoma/paraganglioma (PPG) syndromes, hypoxia-inducible factor 1 alpha (HIF1α) stabilization/activation could lead to an increase in angiotensin converting enzymes (ACE). This would result in the stimulation of angiotensin (AT) II production and, hence, reduce the availability of ACE 2. The latter would provide decreased numbers of binding sites for the spike protein of SARS-CoV-2 and, therefore, result in less points of viral entry into cells. Thus, subjects with HIF1α-associated PPG syndromes may benefit from an inherent protective effect against COVID-19. Such an implication of HIF1α vis-à-vis COVID-19 could open ways of therapeutic interventions.

Cerebrospinal fluid (CSF) rhinorrhea is a rare but potentially life-threatening complication of dopamine agonist (DA) therapy in patients with invasive macroprolactinomas. To identify clinical and anatomical risk factors for DA-induced CSF rhinorrhea and to evaluate effective surgical management strategies in patients with prolactinomas. We retrospectively reviewed two adult male patients treated at our center who developed CSF rhinorrhea following cabergoline therapy for prolactinomas. In parallel, a systematic literature review was conducted following PRISMA guidelines, including 105 patients from 38 studies published between 1982 and 2025. Data on demographics, tumor characteristics, prolactin levels, timing of CSF leak, and management strategies were analyzed. Both patients developed CSF rhinorrhea 7–12 months after initiation of DA therapy. Imaging revealed sellar floor erosion. Endoscopic transsphenoidal surgery (ETSS) with sellar reconstruction using a vascularized nasoseptal flap was successfully performed. The postoperative course was uneventful, and no recurrence of CSF leak was observed during follow-up. Literature review confirmed a male predominance, a mean age of 45.6 years, frequent sphenoid sinus or sellar floor involvement and onset of CSF leaks predominantly within the first year of therapy. Endoscopic transsphenoidal multilayer reconstruction was the most employed and effective treatment modality across reported cases. DA-induced CSF rhinorrhea is associated with invasive tumor features and sphenoid sinus involvement. Early recognition and timely surgical intervention in specialized centers are critical to prevent serious complications. Patients receiving DAs should be counseled regarding this risk, and standardized endoscopic skull base reconstruction provides a safe and effective management strategy.