Background/Aim. Nerve transfers in cases of directly irreparable, or high level extensive brachial plexus traction injuries are performed using a variety of donor nerves with various success but an ideal method has not been established. The purpose of this study was to analyze the results of nerve transfers in patients with traction injuries to the brachial plexus using the thoracodorsal and medial pectoral nerves as donors. Methods. This study included 40 patients with 25 procedures using the thoracodorsal nerve and 33 procedures using the medial pectoral nerve as donors for reinnervation of the musculocutaneous or axillary nerve. The results were analyzed according to the donor nerve, the age of the patient and the timing of surgery. Results. The total rate of recovery for elbow flexion was 94.1%, for shoulder abduction 89.3%, and for shoulder external rotation 64.3%. The corresponding rates of recovery using the thoracodorsal nerve were 100%, 93.7% and 68.7%, respectively. The rates of recovery with medial pectoral nerve transfers were 90.5%, 83.3% and 58.3%, respectively. Despite the obvious differences in the rates of recovery, statistical significance was found only between the rates and quality of recovery for the musculocutaneous and axillary nerve using the thoracodorsal nerve as donor. Conclusion. According to our findings, nerve transfers using collateral branches of the brachial plexus in cases with upper palsy offer several advantages and yield high rate and good quality of recovery.

Intracranial schwannomas are benign tumors that arise from Schwann cells. Since it is well known that optic and olfactory nerves do not have a Schwann cell sheath, schwannoma shouldn't develop from these nerves. We report a very unusual case of a 73-year-old female who presented with generalized seizures and had radiological features of an intracranial aneurysm. Additional imaging showed an extracerebral mass 2.5 x 2.0cm in size, which most likely corresponded to a meningioma. It was resected in total. Subsequent histological analysis revealed that the tumor was in fact ancient schwannoma WHO grade I. Only about 41 case of olfactory schwannoma have been reported in the literature. Olfactory groove schwannomas are extremely rare tumors, occurring less frequently than any other intracranial nerve schwannoma. As in this case, the schwannoma should be included in the differential diagnosis of the anterior cranial fossa tumor. Further research on the pathogenesis and the origin of olfactory groove schwannoma is needed.

Background/Objective: Craniosynostosis, the premature fusion of one or more cranial sutures, is the second most common craniofacial defect and poses significant diagnostic and therapeutic challenges. Our objective was to systematically evaluate current diagnostic imaging modalities for craniosynostosis and to propose a novel radiation-free ARCANA Protocol as an alternative to conventional screening. Methods: Following PRISMA guidelines, we conducted a systematic review of the literature using PubMed and Cochrane databases from 2015 onwards, restricted to English-language and full-text articles. Inclusion criteria encompassed studies evaluating diagnostic accuracy, radiation exposure, and neurocranial outcomes associated with imaging modalities in craniosynostosis. Quality assessment was performed using QUADAS-2. To evaluate the certainty of evidence supporting each imaging modality, we applied the GRADE framework. Given the extensive number of included studies (n = 70), findings were categorized by diagnostic modality rather than individual studies. Results: Analysis of 70 selected studies demonstrated a continued reliance on 3D computed tomography (3DCT) as the diagnostic gold standard, despite recognized risks of cumulative radiation exposure in pediatric populations. Alternative radiation-free imaging techniques including high-resolution ultrasonography (US), three-dimensional stereophotogrammetry (3DSPG), and advanced magnetic resonance imaging (MRI) have emerged, offering substantial benefits such as eliminating ionizing radiation and providing comprehensive neurocranial assessments. 3DCT demonstrates approximately 90% sensitivity and 90–100% specificity for detecting suture closure; ultrasound achieves 71–100% sensitivity and 86–100% specificity, while advanced MRI techniques such as GA-VIBE report up to 97% sensitivity and 96% specificity. Conclusions: The proposed ARCANA Protocol integrates clinical assessment, 3DSPG, US, and advanced MRI sequences into a unified multimodal framework that eliminates radiation exposure while ensuring comprehensive evaluation of cranial and intracranial anatomy. The protocol emphasizes patient safety and diagnostic accuracy. The main limitations of this study are the heterogeneity of the included studies and the lack of prospective validation, which is essential to confirm diagnostic and clinical effectiveness and to support a potential paradigm shift toward radiation-free assessment of craniosynostosis.