Intracranial Lesions Research Articles

Consideration of Brain CT Imaging Standard for Mild Head Injuries.

It has been reported that various clinical criteria indicate computed tomography (CT) examination for mild head injury (MHI). However, the decision to perform CT for MHI largely depends on the physician. Data on severe head injuries is available in sources such as the Japan Neurotrauma Data Bank, but only a few data has been collected on MHI. A total of 1688 patients with MHI (Glasgow Coma Scale 14 and 15) treated at our hospital from June 2017 to May 2019 were reviewed. CT was performed in 1237 patients (73.28%), and intracranial hemorrhage was detected in 50 patients. Three patients deteriorated, and all were surgically treated. Statistical analysis of the presence or absence of acute intracranial hemorrhage and "risk factors for complications of intracranial lesions in MHI" showed significant differences in unclear or ambiguous accident history (p = 0.022), continued post-traumatic amnesia (p < 0.01), trauma above the clavicles including clinical signs of skull fracture (skull base or depressed skull fracture) (p = 0.012), age <60 years (p < 0.01), coagulation disorders (p < 0.01), and alcohol or drug intoxication (p < 0.01). The 453 patients who did not satisfy these risk factors included only one patient with intracranial hemorrhage, so the negative predictive value was 99.78%. This study shows that the "risk factors for complications of intracranial lesions in MHI" are effective criteria for excluding acute intracranial hemorrhage and CT should be actively considered for patients with the above factors that showed significant differences.

Angiomatoid fibrous histiocytoma: primary intracranial lesion with thoracic spine metastasis and a malignant course. Illustrative case.

Angiomatoid fibrous histiocytoma (AFH) is an exceptionally rare soft tissue neoplasm. This tumor primarily presents as a benign soft tissue lesion in children with an average age of 14 years. The standard treatment regimen is wide local excision with interval follow-up. However, newer reports have demonstrated malignant potential with the possibility of intracranial metastasis. A 45-year-old male with no soft tissue primary tumor presented with a primary intracranial lesion and thoracic spine metastasis refractory to chemotherapy and radiation treatment. This report illustrates the potential for a highly malignant nature of metastatic AFH. In addition, the authors demonstrate an incidence of AFH in a middle-aged male without a primary soft tissue or skin lesion. This report highlights the importance of prompt treatment and excision for AFH, as there is still little understanding of successful options for systemic therapy.

Preventing Post-incisional Dural Shrink in Craniotomy: Introducing the "Roll-up Technique".

Dural dryness makes suturing difficult during dural closure after craniotomy. In this case, dural plasty is often performed using a membrane taken from the surrounding tissue (e.g., fascia or periosteum) or an artificial replacement membrane. Herein, we introduce our novel "roll-up technique" to reduce the utilization of substitute membranes and explore its effectiveness in dural closure. We retrospectively examined the medical records of 50 patients who underwent craniotomy for the first time for supratentorial intracranial lesions between 2015 and 2022. Furthermore, we divided them into two groups: (1) the conventional technique group, which consisted of patients in whom the dura mater was flipped after incision and protected with a moistened gauze (n = 23), and (2) the roll-up technique group, which consisted of patients in whom the dura mater was incised in a U shape, rolled up, and protected with a moist gauze (n = 27). After surgery, we compared the success rates of primary closure, operating time, craniotomy area, and percentage of complications (e.g., cerebrospinal fluid [CSF] leakage or infection) between the groups. Dural closure without dural substitutes using the roll-up technique had a higher success rate than that using the conventional technique (26/27 [96.3%] cases vs. 14/23 [60.9%] cases; P = 0.003). Postoperative CSF leakage or infection did not occur, and no statistically significant difference was observed in the operating time between the groups (P = 0.247). The roll-up technique for dural closure may effectively prevent post-incisional dural shrink after craniotomy.

Role of perfusion weighted imaging in the differential diagnosis of intracranial space occupying lesions

Introduction. Magnetic Resonance Imaging (MRI) is a well-established modality for identifying intracranial space-occupying lesions (ICSOLs). However, conventional MRI has limitations in the cerebral glioma accurate grading. Advanced techniques, like Diffusion-Weighted Imaging (DWI), Perfusion MRI, and Magnetic Resonance Spectroscopic Imaging (MRS), have been introduced to address these limitations. Aims and objective. The primary objective of this research is to assess the significance of perfusion-weighted imaging (PWI) in distinguishing intracranial space-occupying lesions (ICSOLs), with a specific emphasis on its capacity to refine diagnostic accuracy and advance the classification of cerebral gliomas. Materials and methods. A prospective observational research involving 38 patients having ICSOLs used a Philips Multiva 1.5 Tesla MRI system. The protocol included DWI, ADC (Apparent Diffusion Coefficient) analysis, and perfusion imaging. Results. The study population (n=38) had a diverse age range (22-70 years), with a majority in the 30-40 age group. High-grade gliomas constituted 43.2% of all the cases. Significant differences in rCBF, rCBV, and MTT have been observed among HGGs &amp; LGGs. Specific cut-off values were used to predict glioma grades. Discussion. Comparisons with existing studies validated these findings, emphasizing the utility of advanced physiological techniques in enhancing diagnostic precision. Discrepancies with certain studies have highlighted the need for a comprehensive approach to lesion characterization. Conclusion. Intracranial lesion diagnosis, especially for meningiomas, demonstrated comparable efficacy between conventional and advanced techniques. While conventional MRI can differentiate lower-grade from higher-grade gliomas to a limited extent, the combination of advanced physiological approaches significantly improves specificity in tumor categorization.

Noninvasive postmortem investigation of cases refusing autopsy using computed tomography

Background: CT is a well-known tool to assess several conditions in living patients. The post-mortem CT (PMCT) has been introduced to determine the cause of death in dead subjects. CT is also the imaging modality of choice for the analysis of autopsy findings including fracture, hematoma, gas collection and gross tumor injury. The rate of standard autopsy is continuing to decline and there are several reasons for refusing autopsy. Objective: The current research endeavor is investigate the usefulness of computed tomography (CT) in cases refusing autopsy. Materials and Methods: In this study, the PMCT were evaluated in 150 subjects in different contexts of death. The causes of death were classified into four categories which include a definite cause of death, a possible cause of death, a minor pathological finding and no fatal findings. For the definite cause of death and the possible cause of death, the specific lesions are described in detail. Results: The definite cause of death was detected in 48 (32%) of the subjects. The possible cause of death was detected in 18 (12%) of the subjects. The remaining 84 subjects were classified into minor pathological findings and no fatal findings in 46 (30.7%) and 38 (25.3%) of the patients, respectively. The fatal lesions of PMCT were found in 93 lesions(48 subjects) that were demonstrated by anatomical locations into the traumatic bone, intracranial, spine, thoracic, heart leak and abdominal lesions. We found definite causes of death in 6 subjects, which had no history of trauma and malignancy and were mentioned about a cardiopulmonary failure as a cause of death at first. Conclusion: The PMCT is a useful tool for identifying the cause of death in many cases that have limitations for conventional autopsy. The morphological change such as intracranial hemorrhage is easily diagnosed with PMCT. The PMCT appears to be an alternative tool to assess the cause of death in any reason of objections.

The efficacy of preoperative warming at prevention of involuntary hypothermia in patients undergoing surgery for intracranial mass lesions

Amaç: Perioperatif hipotermi anestezi uygulaması sırasında sık karşılaşılan bir sorundur. Amacımız intrakraniyal kitle cerrahisinde hipoterminin hasta üzerindeki olumsuz etkilerini önlemek için preoperatif dönemden başlayarak ısıtmanın etkilerini araştırmaktır. &#x0D; Gereç ve Yöntemler: Prospektif, randomize olarak intrakraniyal kitle cerrahisi geçiren hastalar iki gruba ayrıldı. Çalışma grubu aktif ısıtma cihazıyla operasyon öncesi ısıtıldı. Kontrol grubuna ise yalnızca pike örtüldü. Her iki grup da intraoperatif dönemde ısıtıldı. 15 dakikada bir vital bulgular (standart monitörizasyona ek olarak invaziv arteriyel kan basıncı),30 dakikada bir vücut sıcaklığı, saatlik olarak arter kan gazından laktat bakıldı. Titreme skorları, toplam anestezi ve operasyon süresi, tüketilen ilaç miktarları, iv mayi ve kanama miktarı not edildi.&#x0D; Bulgular: Her grupta 36’şar olmak üzere toplam 72 hasta değerlendirildi. Gruplar arasında demografik ve klinik özellikler açısından anlamlı fark yoktu. Gruplar arasında cerrahinin 15-255. dakikaları arasında ölçülen ısı değerleri arasında anlamlı fark bulundu (p

Idiopathic Intracranial Hypertension With Transcribriform Plate Intranasal Meningocele Without Cerebrospinal Fluid Rhinorrhea: A Case Report

Idiopathic intracranial hypertension (IIH) is a rare disorder of unclear pathogenesis occurring commonly in obese women of childbearing age and characterized by increased intracranial pressure in the absence of intracranial space-occupying lesion or cerebrospinal fluid outflow obstruction. We report a rare case of a middle-aged obese female with intractable headache referred to the department of radiology for neuroimaging on account of suspected dural sinus thrombosis and brain Magnetic Resonance Imaging (MRI) which revealed signs of IIH with asymptomatic transcribriform plate intranasal meningocele with a view to underscore the quiddity of IIH in middleaged obese females and also emphasize the need for radiologists to diligently review previous patient’s images where available for possible finding that could contribute to a suspected diagnosis.

Surgical Treatment of Complex Craniofacial Fractures

Severe craniofacial fractures may present different needs in treating intracranial lesions over facial injuries. This paper examines the results of our strategy, consisting of a single-stage combined neurosurgical-maxillofacial treatment. A retrospective review was conducted of 33 consecutive patients with complex fractures of the anterior cranial fossa and facial skeleton, who required elective surgery for craniofacial reconstruction. Patients who required emergency surgery for intracranial clots or penetrating wounds were excluded. In all cases, all or almost all the anterior skull-base was injured with compound fractures of the frontal sinus, the orbital roofs, the lamina cribrosa, and the planum sphenoidale. In all cases, the prioritization of treatment was carefully discussed, and surgical timing and strategy were agreed. There was one dead. Olfactory injuries were always found intraoperatively. There were no mucoceles, CSF-leak recurrences, cranial infections, or neurological worsening. The functional and neurological results were highly satisfactory. The one-stage surgical treatment of complex craniofacial fractures has numerous advantages, including the possibility of reducing facial fractures without the risk of CSF leaks. It also eliminates the need for repeated procedures in fragile patients, and the need to dismantle the facial reconstruction if the skull base repair is performed later. The main issue is the surgical timing, considering that the maxillofacial surgeon usually favors early facial repair, whereas the neurosurgeon generally prefers delayed manipulation of the contused frontal lobes. A timeframe of 10-14 days after trauma may be a good compromise for safe procedures with excellent neurological and functional outcomes.

Profiling of circulating glial cells for accurate blood-based diagnosis of glial malignancies.

Here, we describe a blood test for the detection of glial malignancies (GLI-M) based on the identification of circulating glial cells (CGCs). The test is highly specific for GLI-M and can detect multiple grades (II-IV) and subtypes including gliomas, astrocytomas, oligodendrogliomas, oligoastrocytomas and glioblastomas, irrespective of gender and age. Analytical validation of the test was performed as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Real-world performance characteristics of the test were evaluated in four clinical (observational) studies. The test has high analytical sensitivity (95%), specificity (100%) and precision (coefficient of variation [CV] = 13.7% for repeatability and CV = 23.5% for within laboratory precision, both at the detection threshold) and is not prone to interference from common drugs and serum factors. The ability of the test to detect and differentiate GLI-M from non-malignant brain tumours (NBT), brain metastases from primary epithelial malignancies (EPI-M) and healthy individual donors (HD) was evaluated in four clinical cohorts. Across these clinical studies, the test showed 99.35% sensitivity (95% confidence interval [CI]: 96.44%-99.98%) and 100% specificity (95% CI: 99.37%-100%). The performance characteristics of this test support its clinical utility for diagnostic triaging of individuals presenting with intracranial space-occupying lesions (ICSOL).

Chronic subdural hematoma associated with type II and type III Galassi arachnoid cysts: illustrative cases.

Arachnoid cysts (ACs) are congenital abnormalities that can be located anywhere within the subarachnoid space along the cerebrospinal axis, although they are most often found on the left side in the temporal fossa and sylvian fissure. ACs comprise approximately 1% of all intracranial space-occupying lesions and are considered potential risk factors for subdural hematoma (SDH) in individuals of all age groups who have experienced traumatic brain injury. Although it is uncommon for an intracystic hemorrhage of an AC to occur without evidence of head trauma, it may be more common among children and young adults. Here, the authors present three cases of spontaneous AC intracystic hemorrhage with chronic SDH. Additionally, they provide a thorough review of the existing literature. All three patients with AC were adolescent males. In all cases, AC was identified using the Galassi classification (type II or III) and associated with spontaneous intracystic hemorrhage and chronic SDH as seen on imaging. Spontaneous intracystic hemorrhage is a rare complication and occurs most commonly on the left side. Surgery is the definitive treatment, requiring either craniotomy or burr hole for hematoma evacuation and microsurgical fenestration to drain the cyst into the subarachnoid cisterns.

Vessel Wall MRI in the Diagnosis and Follow-Up of Nonstenosing Intracranial Atherosclerotic Lesions in Acute Stroke.

Vessel Wall MRI in the Diagnosis and Follow-Up of Nonstenosing Intracranial Atherosclerotic Lesions in Acute Stroke.

Classification and Characterization of Traumatic Brain Injuries in the Northern Region of Sweden.

Traumatic brain injury (TBI) is a common cause of death and disability, the incidence of which in northern Sweden is not fully investigated. This study classifies and characterize epidemiological and demographic features of TBIs in a defined population in Umeå county, Sweden. Specifically, to evaluate frequencies of (1) intracranial lesions detected with computed tomography (CT), (2) need for emergency intervention, and (3) hospital admission, in minimal, mild, moderate, and severe TBI, respectively. The data were gathered from 4057 TBI patients visiting our emergency room (ER) during a two-year period (2015-2016), of whom 56% were men and approximately 95% had minimal TBIs (Glasgow Coma Scale (GCS), score 15). Of all injuries, 97.8% were mild (GCS 14-15), 1.7% were moderate (GCS 9-13), and 0.5% were severe (GCS < 9). CT scans were performed on 46% of the patients, with 28% being hospitalized. A high annual TBI incidence of 1350 cases per 100,000 citizens was found. The mortality rate was 0.5% with the majority as expected in the elderly group (>80 years). Minimal TBIs were not as mild as previously reported, with a relatively high frequency of abnormal CT findings and a high mortality rate. No emergency intervention was required in patients in the GCS 13-15 group with normal CT scans. These findings have implications for clinical practice in the ER with the suggestion to include biomarkers to reduce unnecessary CT scans.

Atypical Sellar Mass: Sellar Tuberculoma in a Young Patient - Case Report

BACKGROUND: Central nervous system involvement, though uncommon, is one of the most severe form of tuberculosis. Its manifestations include tuberculoma and tuberculous meningitis, with the majority of cases affecting children and immunocompromised patients. Overall, tuberculomas account for 0.15–2 % of all intracranial lesions but sellar tuberculoma is extremely rare. THE CASE:18 yr. old female patient presented with complain of generalized weakness ,eye pain, headache since 3-4 months .Brain Magnetic resonance imaging (MRI)showed sellar and suprasellar space occupying lesion. Trans sphenoidal approach was used to remove the lesion completely .The pathological evaluation confirmed a tuberculoma and the patient was put on postoperative anti-tubercular therapy. CONCLUSION: Although rare, intracranial tuberculomas, particularly those that originate in the sellar, are notorious for mimicking pituitary tumours by jeopardizing pituitary hormonal function and applying compressive forces on surrounding intracranial structures. However, a prompt assessment can help overcome this diagnostic difficulty with the timely initiation of anti-tubercular therapy (ATT).

Screening Performance of S100 Calcium-Binding Protein B, Glial Fibrillary Acidic Protein, and Ubiquitin C-Terminal Hydrolase L1 for Intracranial Injury Within Six Hours of Injury and Beyond.

The Scandinavian NeuroTrauma Committee (SNC) guidelines recommend S100 calcium-binding protein B (S100B) as a screening tool for early detection of Traumatic brain injury (TBI) in patients presenting with an initial Glasgow Coma Scale (GCS) of 14-15. The objective of the current study was to compare S100B's diagnostic performance within the recommended 6-h window after injury, compared with glial fibrillary acidic protein (GFAP) and UCH-L1. The secondary outcome of interest was the ability of these biomarkers in detecting traumatic intracranial pathology beyond the 6-h mark. The Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) core database (2014-2017) was queried for data pertaining to all TBI patients with an initial GCS of 14-15 who had a blood sample taken within 6 h of injury in which the levels of S100B, GFAP, and UCH-L1 were measured. As a subgroup analysis, data involving patients with blood samples taken within 6-9 h and 9-12 h were analyzed separately for diagnostic ability. The diagnostic ability of these biomarkers for detecting any intracranial injury was evaluated based on the area under the receiver operating characteristic curve (AUC). Each biomarker's sensitivity, specificity, and accuracy were also reported at the cutoff that maximized Youden's index. A total of 531 TBI patients with GCS 14-15 on admission had a blood sample taken within 6 h, of whom 24.9% (n = 132) had radiologically confirmed intracranial injury. The AUCs of GFAP (0.86, 95% confidence interval [CI]: 0.82-0.90) and UCH-L1 (0.81, 95% CI: 0.76-0.85) were statistically significantly higher than that of S100B (0.74, 95% CI: 0.69-0.79) during this time. There was no statistically significant difference in the predictive ability of S100B when sampled within 6 h, 6-9 h, and 9-12 h of injury, as the p values were >0.05 when comparing the AUCs. Overlapping AUC 95% CI suggests no benefit of a combined GFAP and UCH-L1 screening tool over GFAP during the time periods studied [0.87 (0.83-0.90) vs. 0.86 (0.82-0.90) when sampled within 6 h of injury, 0.83 (0.78-0.88) vs. 0.83 (0.78-0.89) within 6 to 9 h and 0.81 (0.73-0.88) vs. 0.79 (0.72-0.87) within 9-12 h]. Targeted analysis of the CENTER-TBI core database, with focus on the patient category for which biomarker testing is recommended by the SNC guidelines, revealed that GFAP and UCH-L1 perform superior to S100B in predicting CT-positive intracranial lesions within 6 h of injury. GFAP continued to exhibit superior predictive ability to S100B during the time periods studied. S100B displayed relatively unaltered screening performance beyond the diagnostic timeline provided by SNC guidelines. These findings suggest the need for a reevaluation of the current SNC TBI guidelines.

Dual trained endovascular neurosurgeons. A boon or a necessity?

Objective: The aim of this research study is to emphasize the necessity to train neurosurgeons in both endovascular procedures as well as microsurgical clipping in the management of intracranial vascular lesions. Material and methods: In this study, the retrospective data collected from our institution from 2021-2022 is presented. Here we present six cases of intracranial vascular lesions that were initially planned for endovascular procedure and later ended up being managed by microsurgical clipping/ excision. Written informed consent was obtained from relevant individuals for publishing the data. Results: All six patients recovered well in the postoperative period. Therefore, a neurosurgeon who is adequately trained in vascular neurosurgery along with endovascular tutoring shall have an extensive grasp of cerebral vascular diseases and all the available treatment alternatives. Since we live in a result-oriented scenario - patients shall be best served by a hybrid neurosurgeon in the long run. Conclusion: This study provides the intra-operative difficulties faced during endovascular management of intracranial vascular lesions. These difficulties require real-time management. Any delay in the process of intra-procedural decision-making making, the non-availability of trained neurosurgeons can have devastating consequences. Hence, this study further fortifies the want for a dual-trained neurosurgeon to handle cerebrovascular lesions.

Acute intracranial stenting in acute ischemic stroke with underlying atherosclerosis: A two-center retrospective study

Objective In patients with large vessel occlusion, successful reperfusion is a predictor of favorable outcome. However, patients with underlying intracranial atherosclerotic disease (ICAD) show higher rates of immediate reocclusion, frequently requiring rescue stenting. We aimed to investigate the safety, efficacy, and outcome of acute stenting in acute stroke patients with underlying ICAD. Methods Prospective databases from two centers between 2012 and 2021 were reviewed. Adult patients who underwent ICAD-related acute intracranial stenting, after mechanical thrombectomy (MT) were included. Clinical and procedural data, technical success measured by Modified Thrombolysis in Cerebral Infarction score, periprocedural complications, stent restenosis, and follow up mRS at three months were evaluated. Results During a 10-year period, a total of 96 patients with acute stroke and intracranial atherosclerotic steno-occlusive lesions underwent stenting after MT. Mean age was 63 (SD 14) and 54 patients were male (56.3%). Successful reperfusion (TICI ≥ 2b) was achieved in 86 patients (89.6%) following rescue stenting; favorable clinical outcome (mRS &lt; 3) was observed in 32 patients (37.6%). Symptomatic intracranial hemorrhage and mortality were observed in 9.5% and 22.4% of patients, respectively. Multivariate regression yielded older age (OR: 0.477, 95% CI: 0.933–0.999, p=0.046) as an independent negative predictor of favorable functional outcome after acute intracranial stenting. Conclusion Our results suggest that acute intracranial stenting is safe and effective as a rescue treatment after MT in acute stroke patients with underlying ICAD. Younger age was found as an independent predictor of good outcome. Nevertheless, ICAD still carries a high mortality and poor functional clinical outcome.

10214-COT-24 A RARE CLINICAL CASE OF LUMBAR METASTASIS FROM GLIOSARCOMA

Abstract Gliosarcoma (GS) is a variant of glioblastoma (GBM) and has been shown to be prone to extracranial metastasis. We report a rare case of lumbar metastasis of Gliosarcoma (GS) based on histopathological findings.37-year-old male.He underwent emergency surgery for a left frontal subcortical hemorrhage. Pathological diagnosis confirmed GS. Postoperatively, the patient underwent conventional radiation chemotherapy. Later, in conjunction with cranioplasty, the remaining lesion was additionally excised and maintenance therapy was administered for 9 months. Subsequently, a follow-up MRI revealed an intracranial disseminated lesion, although the primary site was not affected. At the same time, he had difficulty moving due to back pain, and MRI revealed extracranial metastases in the second lumbar vertebra and retroperitoneum. Lumbar biopsy confirmed the diagnosis of metastasis. Pathological findings at the initial surgery showed that the tumor consisted of GS and gemistocyte-like components, and immunostaining and genetic findings showed IDH wild type GBM. Additional tissue samples showed predominantly gemistocyte-like components and no GS component, and the genetic profile was similar.Lumbar biopsies showed predominantly GS and no gemistocyte-like components. MGMT methylation changed from methylation-negative to positive and then negative by immunostaining and MS-PCR. In a previous report, Feldheim et al. performed a meta-analysis of MGMT methylation changes in relapsing GBM and reported increased methylation after relapse. In addition, Jimenez et al. quantitatively analyzed MGMT methylation in recurrent GBM by pyrosequencing and found an increased rate of methylation in about half of the cases. These reports indicate that MGMT methylation is altered following therapeutic intervention. In the present case, it was hypothesized that an intracranial lesion that was initially unmethylated was methylated by the intervention, but an unmethylated, treatment-resistant GS component metastasized to the extracranial space. The clinical course of this case was a rare example of evidence of a change in MGMT methylation due to therapeutic intervention.

Chimeric Exosomes Functionalized with STING Activation for Personalized Glioblastoma Immunotherapy.

A critical challenge of existing cancer vaccines is to orchestrate the demands of antigen-enriched furnishment and optimal antigen-presentation functionality within antigen-presenting cells (APCs). Here, a complementary immunotherapeutic strategy is developed using dendritic cell (DC)-tumor hybrid cell-derived chimeric exosomes loaded with stimulator of interferon genes (STING) agonists (DT-Exo-STING) for maximized tumor-specific T-cell immunity. These chimeric carriers are furnished with broad-spectrum antigen complexes to elicit a robust T-cell-mediated inflammatory program through direct self-presentation and indirect DC-to-T immunostimulatory pathway. This chimeric exosome-assisted delivery strategy possesses the merits versus off-the-shelf cyclic dinucleotide (CDN) delivery techniques in both the brilliant tissue-homing capacity, even across the intractable blood-brain barrier (BBB), and the desired cytosolic entry for enhanced STING-activating signaling. The improved antigen-presentation performance with this nanovaccine-driven STING activation further enhances tumor-specific T-cell immunoresponse. Thus, DT-Exo-STING reverses immunosuppressive glioblastoma microenvironments to pro-inflammatory, tumoricidal states, leading to an almost obliteration of intracranial primary lesions. Significantly, an upscaling option that harnesses autologous tumor tissues for personalized DT-Exo-STING vaccines increases sensitivity to immune checkpoint blockade (ICB) therapy and exerts systemic immune memory against post-operative glioma recrudesce. These findings represent an emerging method for glioblastoma immunotherapy, warranting further exploratory development in the clinical realm.

Surgical treatment of multiple bilateral brain abscesses and subdural empyas in a 6-year-old child with purulent rhinosinusitis

Introduction. Bacterial brain abscesses and subdural empyema are often rare complications of rhinosinusitis, which is especially important in pediatric practice. Intracranial purulent clusters are life-threatening diseases which require urgent, and as a rule, surgical management.&#x0D; Purpose. To illustrate successful surgical treatment of a patient with multiple bilateral brain abscesses and subdural empyemas as a result of purulent inflammation - paranasal sinusitis, which had not been diagnosed at the prehospital stage.&#x0D; Material and methods. A case of a 6-year-old boy with multiple bilateral brain abscesses and subdural empyemas is described in the article. The patient had antibacterial therapy; paranasal sinuses were sanitized; all intracranial purulent foci were removed with minimally invasive approaches and accurate calculations based on findings of MRI examination.&#x0D; Results. It had been confirmed that abscesses and subdural empyemas in the described patient was a complication of purulent inflammation in paranasal sinuses. To control treated foci and to exclude development of new purulent intracranial clusters in dynamics, multiple MRI examinations of the brain were performed. For successful management of purulent foci, the technique of incision, drainage, sanitation with antiseptic solutions and intraoperative exudate aspiration was applied.&#x0D; Conclusion. Abscesses and empyemas of children’s brain are serious, life-threatening pathologies that always require hospitalization and emergency measures. Multiple abscesses and subdural empyemas is, as a rule, complication of rhinosinusitis. Multiple dynamic CT/MRI examinations of the brain is of a key importance, both for controlling removed foci and for excluding development of new purulent intracranial clusters. Active surgical tactics in the combination with antibacterial therapy leads to successful outcomes in patients with intracranial purulent lesions complicating the course of rhinosinusites.

Cerebral Hydatid Disease Patients Admitted to Duhok City Hospitals: Management and Outcome

Background and objectives: The human systemic infestation with Echinococcus granulosus affects the brain in 2% of cases, cerebral hydatid cyst, which presents clinically as slowly growing intracranial mass lesion leading to variable symptomatology of raised intracranial pressure, neurological deficit, and epilepsy. The condition, when occurs, needs prompt surgical removal in order to avoid fatal consequences. The aim of this article is to report clinical data and our experience concerning cerebral hydatid cyst presentation, surgical management, complications, and outcome. Methods: A retrospective case-series study encompassing 8 patients, four females and four males, whose ages ranged between 3.5-35 years, harboring cerebral hydatid cysts, including one cerebral hydatid abscess. The current study was conducted at Duhok Teaching Hospitals, during January 2005-May 2021. The diagnosis was established on clinical and radiological, computed tomography and magnetic resonance imaging backgrounds, and confirmed by operative findings, and histopathology (abscess cyst). Via appropriate craniotomies, all cerebral hydatid cysts, and abscess, were successfully removed, except, the recurrent hydatid cysts which needed an additional posterior fossa craniectomy to achieve total removal. There was no need for the use of advanced statistical system. Results: Compared to their original neurological deficit at presentation, seven cases could achieve complete recovery, except, the patient with recurrence, whose recovery was delayed and suboptimal due to repeated surgeries; there was no mortality. Conclusion: The operating surgeon should practice meticulous care avoiding the possible risk of an accidental rupture during cyst delivery. Various opinions address the pre-operative, intra-operative and post-operative use of Albendazloe, however, we are not sure whether the use of this medication could have prevented the recurrence of CHC which followed the accidental rupture.