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Purpose: Brain metastases (BMs) most frequently originate from the primary tumors of the lung and breast. Survival in patients with BM can improve if they are detected early. No studies attempt to consider all potential surgical predictive factors together by including clinical, radiological variables for their recognition. Methods: The study aims to simultaneously analyze all clinical, radiologic, and surgical variables on a cohort of 314 patients with surgically-treated BMs to recognize the main features and differences between the two histotypes. Results: The two groups consisted of 179 BM patients from lung cancer (Group A) and 135 patients from breast cancer (Group B). Analysis showed that BMs from breast carcinoma are more likely to appear in younger patients, tend to occur in the infratentorial site and are frequently found in patients who have other metastases outside of the brain (46 %, p = 0.05), particularly in bones. On the other hand, BMs from lung cancer often occur simultaneously with primitive diagnosis, are more commonly cystic, and have a larger edema volume. However, no differences were found in the extent of resection, postoperative complications or the presence of decreased postoperative performance status. Conclusion: The data presented in this study reveal that while the two most prevalent forms of BM exhibit distinctions with respect to clinical onset, age, tumor location, presence of extra-cranial metastases, and lesion morphology from a strictly surgical standpoint, they are indistinguishable with regard to outcome, demonstrating comparable resection rates and a low risk of complications.

Background: Vertebral arthrodesis for degenerative pathology of the lumbar spine still remains burdened by clinical problems with significant negative results. The introduction of the sagittal balance assessment with the evaluation of the meaning of pelvic parameters and spinopelvic (PI-LL) mismatch offered new evaluation criteria for this widespread pathology, but there is a lack of consistent evidence on long-term outcome. Methods: The authors performed an extensive systematic review of literature, with the aim to identify all potentially relevant studies about the role and usefulness of the restoration or the assessment of Sagittal balance in lumbar degenerative disease. They present the study protocol RELApSE (NCT05448092 ID) and discuss the rationale through a comprehensive literature review. Results: From the 237 papers on this topic, a total of 176 articles were selected in this review. The analysis of these literature data shows sparse and variable evidence. There are no observations or guidelines about the value of lordosis restoration or PI-LL mismatch. Most of the works in the literature are retrospective, monocentric, based on small populations, and often address the topic evaluation partially. Conclusions: The RELApSE study is based on the possibility of comparing a heterogeneous population by pathology and different surgical technical options on some homogeneous clinical and anatomic-radiological measures aiming to understanding the value that global lumbar and segmental lordosis, distribution of lordosis, pelvic tilt, and PI-LL mismatch may have on clinical outcome in lumbar degenerative pathology and on the occurrence of adjacent segment disease.

Frontal sinus (FS) fractures are uncommon and depending on the impact’s force the fracture may involve the anterior table, the adjacent skull, the posterior table and the frontal sinus outflow tract (FSOT). The treatment is based on correcting anti-aesthetic alteration, avoiding the complications, protecting intracranial structures and treating cerebrospinal fluid (CSF) leak. However, the indication and type of treatment of FS fractures is still controversial.The purpose of this study is to evaluate and to propose a surgical algorithm for FS fractures treatment based on relevant data found in current literature.A comprehensive Literature review on FS fractures management was performed to define the most used treatment approaches. In this review, we sought in the Medical Literature for patterns that describe injuries of the FS and evaluated the quality of the classification schemes in terms of validity and reliability, severity assessment, treatment guidance and prognosis estimation. We identified 705 articles on the topic and after the screening process, we included 4 documents. In this 4 papers, the four most used classifications in the modern Literature were proposed. Therefore, we analyzed and discussed these main four classifications and, consequentially, we developed an algorithm that represents an attempt to provide a general guideline for the management of FS injuries.Here an intuitive multidisciplinary algorithm based on both radiological and clinical presentation of the fracture is proposed, trying to guide the surgeon in the correct treatment choice. We believe that a complete classification system must take into account not only the different involvement between anterior and posterior table fractures, but also the involvement of the FSOT and define for each type a therapeutic combined approach between neurosurgeons and maxillofacial surgeons.

Background: Glioblastoma (GBM) contacting the Subventricular Zone (SVZ) may display a more aggressive pattern of invasiveness with higher potential to recruit migratory progenitor cells. We aims to determine the relationships between the location of the lesion and the clinical, molecular characteristics and outcome in patients affected by GBM. Methods: The surgical, radiological and clinical outcomes of patients have been retrospectively reviewed for the present study. All patients have been classified according their anatomical relationship with SVZ in SVZ + and SVZ-. A review of our surgical series was conducted to compare the results of SVZ tumors in regards to clinical and molecular characteristics, localization, and Extent of Resection (EOR). Uni- and Multivariate ANOVA and survival analyses were performed to investigate the cohort. Results: A total of 177 patients were included in the final cohort. A statistical analysis by means of multivariate analyses to demonstrate that SVZ + tumors were significantly associated to a greater volume at presentation, a lesser EOR, lesser functional postoperative outcome and a short overall survival. Conclusions: There are specific characteristics to consider the SVZ + GBMs a specific clinical entity how greater tumors at presentation, clinical associated with Headache and Sensory Disturbances, which are associated to a higher risk of partial resection and with a less satisfactory functional outcome in the early postoperative period. Our multivariate analysis demonstrated a clear and statistically significant survival advantage of cortical GBM over V-SVZ GBM.

Background: Slow progression and good prognosis are the usual characteristics of papillary thyroid carcinoma (PTC). The presence of brain metastases (0.4–1.2%) is suggestive of a worse prognosis. RET/PTC rearrangements were particularly prevalent in PTCs developed after Chernobyl nuclear accident. Case description: A 50-year-old woman born in Slovakia, exposed to radiation resulting from the accident at the Chernobyl nuclear power plant, affected since 2017 by papillary thyroid cancer and in therapy at our hospital, experimented cerebral hemorrhagic metastasis. Biopsy analyses revealed a RET/PTC3 rearrangement, so our aim was to find possible morphological relation between hemorrhagic metastasis and RET/PTC3 translocation. Results: Immunohistochemical analysis showed diffuse and intense positivity for VEGF in endothelial cells of the neoplasm’ vascular network. Transmission electron microscopy images showed vessels with unorganized pattern and uneven diameters. In particular, metastasis endothelial cells (MECs) showed irregular shape and size, thickened cytoplasm and swelling of endoplasmic reticulum. MECs organized in irregular monolayers or multiple layers, surrounded by a thickened but unstructured extracellular matrix. Absence of strong junctional complexes among MECs resulted in a further weakened vessels wall. Conclusion: RET/PTC3 translocation causes VEGF overexpression via STAT3 signaling cascade and the increased amount of VEGF adds to the greater amount of VEGFRs expressed by MECs. Our ultrastructural investigation show that this condition creates a massive growth of altered vessels prone to bleeding. The clinical significance of our study consists in alert oncologist and surgeons on possible arising of hemorrhagic brain metastases in patients with PTC and RET/PTC3 translocation exposed to ionizing radiation as people living in areas caught up in Chernobyl or Fukushima disasters.

Objective: Despite combined approaches the prognosis of Glioblastoma remains poor. However, different variants of this tumor might show different prognostic characteristics. Aim of the study is to investigate the role of molecular prognostic factors in predicting clinical outcomes in patients treated for glioblastoma. The study focuses on therapeutic and prognostic value of IDH1 gene mutations and MGMT promoter methylation status. Methods: 115 patients diagnosed and treated for glioblastoma at our institution within a period of five years (2013–2018) were included. All patients received pre-operative MRI, gross-total surgical resection and adjuvant treatments (chemotherapy and radiotherapy). Immunohistochemical analysis of histological samples was performed for IDH1 gene R132H mutations and MGMT promoter methylation status. Follow-up was conducted through clinical examination and MRI scans for a period of 60 months. Results: Mean population age was 59.21 ± 13.9 [19–85]. Overall median survival was 14 months, range 12–16. IDH1 gene mutation was identified in 30 patients (26%) and positively correlated with survival (IDH1 mutated: 32 months 95%C.I. [12–16] vs IDH1 wild type: 12 months, 95%C.I. [11–14]; p