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Background: The coexistence of intracranial aneurysms and dysraphic cysts is a rare manifestation. The response triggered by the cyst and its proinflammatory content could play a role in the rupture or growth of a neighboring aneurysm. Methods: We performed a systematic review according to the PRISMA guidelines searching PubMed, Medline, Google Scholar and Embase. Additionally, we report a case of one patient with both a dermoid cyst and an ipsilateral anterior cerebral artery aneurysm, illustrating a progressive formation of the vascular lesion during the follow-up of the cyst. Results: Out of 103 papers fulfilling the inclusion criteria for the systematic review, 79 articles were selected for eligibility. Finally, a total of 9 cases, including our own case, were considered for the review. We found that all aneurysms were in the anterior circulation and all cysts were supratentorial. The aneurysms or parent vessels were in proximity or in contact with the dysraphic lesion, presenting a strong adherence to its capsule. The 3 dermoids presented with cysts rupture and showed simultaneous or delayed subarachnoid aneurysmal hemorrhage. Two epidermoid cysts were diagnosed after aneurysm rupture, while the others due to focal mass effect, as in the case of the neurenteric cyst. Conclusions: Coexistence of intracranial aneurysm and disraphic cyst is a rare finding with multiple possible presentations. In managing patients harboring disraphic cyst, the presence of the aneurysm should be ruled out during the standard workup. A coexistence of these pathologies could affect their natural histories, and this could justify a more active management protocol.

Background: The COVID-19 pandemic and its impact on hospitals' activity and organization has imposed a vast change in standard neurosurgical oncology practice to accommodate for shifting resources. Aims: This investigation aims to analyse the nationwide capability in reorganizing the surgical neuro-oncological activity during the COVID-19 pandemic to evaluate whether COVID-19-pandemic influenced the surgical management in these patients. Method: A web-based dataset model organized by the Italian Neurosurgical Society (SINCh) was sent to all the Italian neurosurgical departments in May 2021, requesting to report the types and numbers of surgical procedures performed in the pre-pandemic period (from March 9th 2019 to March 9th 2020) compared to the pandemic period (from March 10th 2020 to March 10th 2021). Results: This multicentre investigation included the surgical activity of 35 Italian Neurosurgical Departments in a pre-pandemic year versus a pandemic year. During the COVID period, 699 fewer neuro-oncological patients were operated on than in the pre-COVID period. We noted a slight increase in urgency and a more severe decrease in elective and benign pathology. None of these differences was statistically significant. Surgically treated patients who tested positive for SARS-CoV-2 were 36, of which 11 died. Death was found to be COVID-related only in 2 cases. Conclusion: The reorganization of the Italian Neurosurgical Departments was able to guarantee a redistribution of the CNS tumors during the inter-pandemic periods, demonstrating that patients even in the pandemic era could be treated without compromising the efficacy and safety of the surgical procedure.