This study explores the role of circadian clock genes in the progression of astrocytic tumors, a prevalent type of brain tumor. The aim was to assess the expression patterns of these genes in relation to the tumor grade. Using microarray analysis, qRT-PCR, and methylation-specific PCR, we examined gene expression, DNA methylation patterns, and microRNA interactions in tumor samples from 60 patients. Our results indicate that the expression of key circadian clock genes, such as clock circadian regulator (CLOCK), protein kinase AMP-activated catalytic subunit alpha 1 (PRKAA1), protein kinase AMP-activated catalytic subunit alpha 2 (PRKAA2), protein kinase AMP-activated non-catalytic subunit beta 1 (PRKAB1), protein kinase AMP-activated non-catalytic subunit beta 2 (PRKAB2), period circadian regulator 1 (PER1), period circadian regulator 2 (PER2) and period circadian regulator 3 (PER3), varies significantly with the tumor grade. Notably, increased CLOCK gene expression and protein levels were observed in higher-grade tumors. DNA methylation analysis revealed that the promoter regions of PER1-3 genes were consistently methylated, suggesting a mechanism for their reduced expression. Our findings also underscore the complex regulatory mechanisms involving miRNAs, such as hsa-miR-106-5p, hsa-miR-20b-5p, and hsa-miR-30d-3p, which impact the expression of circadian clock-related genes. This underscores the importance of circadian clock genes in astrocytic tumor progression and highlights their potential as biomarkers and therapeutic targets. Further research is needed to validate these results and explore their clinical implications.

Chronic subdural hematoma (CSDH) is a common neurological condition, particularly in the elderly, characterized by a complex pathophysiology involving inflammation, angiogenesis, and recurrent microhemorrhages rather than a purely mechanical process. Although surgical evacuation remains the standard treatment, recurrence rates remain considerable, prompting the search for alternative and adjunctive therapies. This narrative review summarizes current evidence on the pathophysiology, diagnostic approaches, and management of CSDH, with particular emphasis on middle meningeal artery embolization (MMAE). A comprehensive literature search of major medical databases, including PubMed, Scopus, and Web of Science, was performed to identify relevant randomized controlled trials (RCTs), observational studies, and meta-analyses. Available evidence suggests that MMAE may reduce recurrence rates and the need for reoperation, particularly when used as an adjunct to surgery. However, results from RCTs remain mixed, and not all studies have demonstrated significant benefit on primary clinical endpoints. While MMAE has emerged as a promising minimally invasive approach targeting the vascular supply of hematoma membranes, further high-quality studies are required to establish standardized indications, optimize procedural techniques, and clarify long-term outcomes and comparative effectiveness.