Objectives: This study investigates the relationship between the time elapsed from decompressive craniectomy to cranioplasty and surgical complications in patients after traumatic brain injury. Methods: PubMed, Scopus, and Web of Science were systematically searched for references using the PRISMA guidelines. The data were subjected to the first phase of screening, which required the studies to be published between 1990 and 2024, be written in English, and include patients who underwent cranioplasty following decompressive craniectomy due to traumatic brain injury. The second phase of screening assessed whether the studies included at least 10 patients and compared their outcomes based on the time between decompressive craniectomy and cranioplasty. A subgroup analysis was performed for ultra-early cranioplasty patients. Results: This meta-analysis included fifteen studies involving patients who underwent early (n = 666) and late cranioplasty (n = 1214) after decompressive craniectomy. All studies had a retrospective observational design. There was no statistically significant difference in the odds of complications between the groups, although late cranioplasty had slightly elevated odds of developing hydrocephalus (OR 1.66, 95% CI 0.55–4.99, p = 0.36). Interesting results stemmed from a subgroup analysis of the ultra-early cohort; they included favoring the ultra-early group in the odds of overall complications (OR 0.46, 95% CI 0.08–2.56, p = 0.38) and hygroma (OR 0.45, 95% CI 0.15–1.37, p = 0.16). Later cranioplasty had better outcomes in the category of seizure (OR 1.56, 95% CI 0.75–3.28, p = 0.24). Conclusions: Cranioplasty within 90 days, considered early, had no statistically significant differences in complication rates compared to late cranioplasty.

Objectives: Pott’s puffy tumor (PPT) is a rare and life-threatening infection of the frontal sinuses, predominantly affecting children but with less frequent reports in adults. Therefore, we present an analysis of one hundred and eighty-one cases of adult patients diagnosed with PPT, along with a description of one of our cases. The purpose of this research is to identify the most common symptoms, predisposing medical history, predominant microorganisms, commonly used antibiotics, treatment options, long-term outcomes, and possible complications in adults. Despite its rarity, PPT has a dynamic course, necessitating familiarization with appropriate treatment methods to improve patient well-being. Methods: Methods involved a systematic search of PubMed, Medline, Google Scholar, Web of Science, EBSCO, and Scopus, following PRISMA guidelines. A total of 122 articles were screened, providing 180 adult patients aged 18 to 86, alongside 1 additional patient treated at our institution, bringing the total to 181 patients. Results: The results showed that the patients ranged from 18 to 86 years of age (mean age of 47 years), with 72.2% being males. The most common symptoms were forehead swelling (74.7%), frontal headache (67%), fever (59.3%), and acute/chronic rhinosinusitis (39.6%). The risk factors associated with its development include sinusitis (49.5%) and previous head trauma (12.6%). Intracranial involvement was found in 38.1% of patients. Streptococcus spp. (19.3%) and Staphylococcus spp. (16.6%) were the most commonly identified pathogens. Surgical intervention was employed in 87.3% of cases, with a mean hospital stay of 23 days. There was no significant difference in hospital stay or rehospitalization rates between those with and without intracranial involvement. Antibiotic therapy was used in 87.3% of cases, with a mean duration of 61 days. A combination of Cephalosporin, Metronidazole, and Nafcillin was the most common empirical antibiotic therapy. The mean follow-up period was 14 months, with a mortality rate of 1.6%. Conclusions: The conclusion highlights the importance of the prompt initiation of empirical antibiotic therapy, followed by targeted treatment based on microbiological cultures. Recognizing that PPT symptoms are not exclusive to pediatric patients but can also affect adults is crucial. PPT warrants further research to optimize its management and outcomes. It is believed that PPT may be more treatable in adults when identified early, which emphasizes the need for PPT recognition among adults. Timely empirical antibiotics based on microbiological results, along with appropriate surgical intervention, are critical for improving outcomes. Multidisciplinary care involving otolaryngologists, neurologists, and infectious disease specialists is essential. Further studies should be developed for the evaluation of diagnostic protocols and long-term management strategies.

The diffuse large B-cell lymphoma (DLBCL) mimicking an epidural hematoma in the cervical spine is an extremely unique case. We present a case of a 42-year-old man, who presented to the emergency department with symptoms of tetraparesis after a session of spinal manipulation therapy. magnetic resonance imaging visualized a lesion located at C3–C7 causing spinal cord compression with surrounding soft tissue edema suggesting epidural hematoma. The patient was admitted to the Neurosurgery Department and emergent laminectomy was performed. Intraoperatively, an infiltrating tumor was found, which was partially resected and sent for post-op histopathological examination, determining it to be a DLBCL. Our work aims to increase awareness of such cases, which may make it easier to make the proper diagnosis.

Introduction: Acute subdural hematoma (aSDH) represents one of the most lethal and debilitating forms of traumatic brain injury (TBI) encountered in neurosurgical emergency settings, carrying high mortality rates and severe long-term functional deficits. Historically, the timing of surgical decompression has been considered a critical modifiable prognostic factor. However, contemporary evidence regarding the relationship between time to surgery and clinical outcomes remains inconsistent. This systematic review and meta-analysis evaluates the impact of surgical timing on mortality and functional status in adult patients undergoing evacuation for acute subdural hematoma. Methods: A systematic review was conducted according to the PRISMA 2020 guidelines and registered in PROSPERO. A database search was performed across PubMed, Scopus, Embase and Web of Science for relevant studies published between 2009 and 2026. Peer-reviewed cohort studies and clinical trials including adults (>18 years) with CT- or MRI-confirmed aSDH were included. Data extraction focused on baseline characteristics, surgical timing thresholds, and primary outcomes of mortality and functional status assessed using the Glasgow Outcome Scale (GOS). Methodological quality was assessed using the Newcastle-Ottawa Scale. Relative risks (RR) and risk differences (RD) with 95% confidence intervals (CI) were calculated using a random-effects model. Results: The search identified 1815 records, of which six studies, including 926 patients, met the inclusion criteria. Meta-analysis found no statistically significant association between time to surgery and mortality (RR 1.01, 95% CI [0.69, 1.48], p = 0.96; RD −0.02, 95% CI [−0.19, 0.15]). High statistical heterogeneity was observed (I² = 80%) across the included cohorts. Most studies indicated that patients who underwent rapid neurosurgical intervention frequently presented with significantly worse baseline neurological status, which acts as a primary confounding factor and drives poorer prognostic trends. Conclusions: While historical paradigms emphasize a 4h period for subdural hematoma evacuation, our meta-analysis indicates that a straightforward linear relationship between time to intervention and improved survival or functional outcome is absent in contemporary clinical studies. Surgical timing thresholds must be interpreted cautiously, as the decision-making process is heavily guided by clinical triage bias, where rapidly deteriorating patients are prioritized for urgent decompression. Crude timing thresholds do not reflect a lack of causal benefit of early intervention but rather highlight the profound confounding by indication embedded in contemporary neurotrauma literature. Future multicenter investigations adjusting for admission severity, pupillary reactivity, associated intracranial pathology and other confounding factors are crucial to isolate the true prognostic value of surgical timing in aSDH.

Background: Intracranial pressure (ICP) monitoring remains the cornerstone of neurocritical care in severe traumatic brain injury (TBI), yet its prognostic value as a standalone metric is limited. The Pressure Reactivity Index (PRx), a continuous measure of cerebrovascular reactivity derived from ICP and arterial blood pressure, may offer additional or complementary prognostic information. This systematic review aimed to compare the prognostic performance of PRx-derived metrics versus standard ICP monitoring for mortality and functional outcome in patients with TBI. Methods: A systematic search of PubMed, Web of Science, and Scopus was conducted for studies published between January 2000 and December 2025. Studies were eligible if they included adult TBI patients with continuous multimodal monitoring and reported comparative prognostic data for PRx- and ICP-based metrics. Risk of bias within the studies was appraised via the QUIPS tool, and the GRADE system was used to rate the strength of the evidence. Due to methodological heterogeneity, findings were synthesized narratively. Results: Nine studies were included. Applying a maximum-cohort estimation to account for overlapping registries, the pooled sample comprised a minimum of 1240 unique patients. In the majority of included studies, direct within-cohort head-to-head comparisons demonstrated that specific PRx-derived metrics—such as the individualized ICP threshold (iICP), Longest Continuous Duration of Autoregulatory Impairment (LCAI), Lower Limit of Reactivity (LLR), and time-integrated burdens (%Time > Threshold)—yielded stronger prognostic discrimination compared to standard ICP thresholds for both mortality (PRx: AUC 0.747–0.648 and ICP: AUC 0.660–0.614) and functional outcome. When added to established predictive models, PRx-derived metrics provided clinically meaningful incremental improvements in prognostic accuracy, with descriptive incremental AUC gains ranging from +0.039 to +0.170 across the six studies reporting model augmentation. Due to heterogeneity in baseline models, PRx-derived metrics, and patient populations, these findings are presented strictly as a descriptive range. Conclusions: PRx and PRx-derived cerebrovascular reactivity metrics-namely iICP, LCAI, LLR, and time-integrated burdens of autoregulatory failure—show potential to offer additive prognostic value beyond standard ICP monitoring in severe TBI. However, because current evidence is strictly observational and likely influenced by institutional confounders, it cannot currently support definitive clinical recommendations. Further prospective, multicenter studies utilizing standardized thresholds are necessary to confirm these associative findings and isolate their true prognostic value.

Background: Disseminated intracranial and spinal dysembryoplastic neuroepithelial tumors (DNETs) are exceptionally rare, with only five prior cases reported. Methods: This study presents a case of a 47-year-old woman with DNETs in the right hippocampus and lumbar spine, treated surgically, and systematically reviews the existing literature (total n = 6). Results: While primary tumors occurred in both locations, secondary lesions were predominantly spinal (83%). The key features included frequent obstructive hydrocephalus (67%, often requiring shunting) but rare epilepsy (n = 1, 17%). Two fatal outcomes were possibly associated with West Nile virus infection (the S100B protein pathway). MRI was performed in all cases, and surgical intervention (craniotomy/laminectomy) constituted the primary treatment modality (67%). Conclusions: This multifocal presentation poses significant challenges, underscoring the potential need for spinal MRI in intracranial DNET cases and multidisciplinary management. Further molecular studies and case registries are crucial to understand pathogenesis and optimize care.