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Abdul Raman M AL-Shudifat,1,2 Babar Kahlon,2 Sarah Bin Abdulqader,2 Wajab Almutairi,2 Khairiah Alsumali,2 Yazeed Aldhfyan,2 Laith Al-Abdallat1 1Department of Neurosurgery, School of Medicine, The University of Jordan, Amman, Jordan; 2Department of Neurosurgery, King Saud Medical City (KSMC), Riyadh, Saudi ArabiaCorrespondence: Laith Al-AbdallatDepartment of Neurosurgery, School of Medicine, The University of Jordan, Queen Rania Street, Amman, 11942, JordanTel +962 797333219Email abdallat97@outlook.comPurpose: To evaluate functional outcomes of severe traumatic brain injuries after insertion of intracranial pressure (ICP) monitor at King Saud Medical City (KSMC) and their correlation to each other.Patients and Methods: A retrospective observational study for all adult patients (age > 18 years) who were diagnosed with severe head injury and underwent ICP insertion at KSMC. Patients diagnosed between 2017 and 2019 were included. Data for measured outcomes, Glasgow outcome scale (GOS), Karnofsky Performance Score (KPS) and length of stay (LOS) and prognostic factors, data like: age, gender and primary Glasgow coma score (GCS) was obtained from patients’ files and direct communication with patients or their caregivers. We also compared patients who underwent ICP monitoring alone with those who underwent ICP with decompressive craniectomy (DC). Follow-up period ranged from 6– 24 months.Results: Seventy-four patients were included in this cohort study. Outcome measurements for patients with decompression and ICP were lower than those with ICP alone. KPS and GOS showed strong correlation (p< 0.01) in whole cohort and in both subgroups (ICP alone and ICP with DC). KPS showed significant correlation with length of stay (p=0.026).Conclusion: ICP monitoring is valid tool in management of severely head injured patients. Patients who underwent DC had a worse outcome. KPS can be used as alternative tool to measure functional outcome in severe traumatic brain injury.Keywords: traumatic brain injury, functional outcome, ICP monitoring, decompressive craniectomy

Background: Obtaining a definitive pathological diagnosis from brain tissue sampling was challenging due to the small, nonrepresentative sample. This study introduced a novel syringe technique for brain biopsy aimed at enhancing diagnostic accuracy by obtaining core tissue samples that better represent the targeted tissue., Methods: The 10 patients with atypical brain lesions underwent the syringe biopsy. After meticulous preoperative planning with neuronavigation, a minimally invasive approach was used: a 3-cm skin incision and a 14-mm burr hole were created. A modified 3-cc syringe was used to create negative pressure and cannulate the brain tissue. The desired sample size (24 cm³) was obtained by controlling the syringe depth and withdrawal. Medical records were reviewed to assess sample analysis results and any complications., Results: The syringe technique successfully yielded adequate tissue samples in 9 of 10 patients. In 1 case, the desired tissue could not be retrieved and required a microsurgical approach for removal. In all 10 cases, a correct diagnosis was made without significant complications., Conclusions: The preliminary findings suggest that the syringe technique is both safe and effective for obtaining substantial volumes of brain tissue, facilitating accurate pathological evaluation in cases of complex neurological disorders., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Petroclival meningioma (PCM) represents a formidable challenge due to its intimate association with the brainstem, basilar artery, perforating arteries, and cranial nerves. Vasospasm is a recognized complication in neurosurgery. Its incidence following skull base surgery is unknown. Here, we present a 33-year-old woman who was diagnosed with PCM and managed surgically with the anterior transpetrosal approach. Two days postoperatively, she developed sudden confusion, blurred vision, and right-sided weakness. Cerebrovascular imaging confirmed the diagnosis of vasospasm. The patient was managed successfully with combined medical and endovascular treatment of vasospasm which resulted in significant clinical improvement. Vasospasm following skull base surgery is rare. Early recognition of such rare complication and prompt response are key to achieving excellent clinical outcomes., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Bin Abdulqader et al.)

Background:  Suprasellar and third ventricle cavernous malformations (CMs) are uncommon. Conventional approaches such as interhemispheric and translamina terminalis approaches are often used to resect these lesions. Here we demonstrate the use of the endoscopic endonasal approach for a third ventricle CM., Case Description:  A 31-year-old man presented with progressive symptoms of headache and visual disturbance as well as short-term memory deficit over a 6-month period. Neurologic examination revealed bitemporal hemianopsia. Radiologic images showed a suprasellar lesion extending into the third ventricle as well as obstructive hydrocephalus. The patient was operated on using an endoscopic endonasal approach and histopathology revealed a diagnosis of CM. Transient diabetes insipidus and adrenal insufficiency were reported postoperatively., Conclusion:  This report demonstrates safe resection of a third ventricle CM via the endonasal route., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: Digital subtraction angiography (DSA) is still considered the gold standard test to evaluate arteriovenous malformation's (AVM) residual after microsurgical resection., Objective: To evaluate the safety and reliability of intraoperative computed tomography angiography (iCTA) as an immediate method of evaluating the surgical results of AVM resection., Methods: We performed a retrospective review for all cases of cerebral AVMs at our institute from January 2015 to April 2020 who underwent surgical resection of cerebral AVM and had iCTA. All included patients underwent a postoperative DSA, and the results were compared with iCTA., Results: Twenty-eight cases were included. All cases showed complete resection (100%) in the iCTA, and the results were consistent with the postoperative DSA results. The sensitivity of iCTA was 100%. The added operative time ranged from 25 to 30 min. There were no complications related to the use of iCTA., Conclusion: Intraoperative assessment of AVMs surgical results with an iCTA is safe and reliable. The sensitivity of iCTA following AVM resection merits further investigations., (© Congress of Neurological Surgeons 2021.)

Ossifying fibroma (OF) is an uncommon benign fibro-osseous lesion. Based on its clinical, morphological, and radiological features, OF is further divided into cemento-ossifying fibroma (COF), juvenile psammomatoid ossifying fibroma (JPOF), and juvenile trabecular ossifying fibroma (JTOF). JPOF rarely involves the cranial base, with limited reports published on spheno-orbital JPOF. In this paper, we report a case of JPOF of the greater wing of the sphenoid bone and lateral orbital wall in an 11-year-old child and show a surgical video. Although rare, JPOF should be considered in the differential diagnosis of fibro-osseous lesions of the spheno-orbital region., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.)

Background: Angiomatoid fibrous histiocytoma (AFH) is a rare, fibrohistiocytic, soft-tissue neoplasm. Intracranial AFH is extremely rare. Here we present 2 pediatric cases of intracranial AFH and perform a literature review on this disease entity., Case Description: We present 2 cases. The first case is a 10-year-old boy who presented with seizures and hemiparesis. The second case is an 11-year-old girl who presented with 2-year history of seizures. Radiologic images demonstrated right frontal lesions in both patients. Complete surgical resection was achieved. Histopathological findings established the diagnosis of intracranial AFH confirmed with fluorescence in situ hybridization and reverse transcriptase polymerase chain reaction testing that demonstrated EWSR1 gene rearrangement in both cases., Conclusions: Twenty-two cases of intracranial AFH have been previously documented, with the majority of lesions located in the frontal lobe. Most cases occurred in adolescents and young adults, with a slight female predilection. Headaches and seizures constituted the most common clinical presentation. Complete surgical resection remains the standard of care in the management of this pathology., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose: Optic pathway gliomas (OPGs) are low-grade neoplasms that primarily affect children. The management of OPGs remains controversial. Reports on the use of the endoscopic endonasal approach (EEA) in OPGs are extremely limited, and no such reports exist on its utility for pediatric OPGs. Here, we report our results and experience with OPGs treated with the EEA., Methods: We retrospectively reviewed the medical records of OPG patients who were treated surgically via the EEA at our institutions from 2015 to 2017. Data on the demographics, clinical presentation, surgical complications, clinical outcomes, radiological imaging, and visual outcomes were recorded for each patient., Results: Four cases were identified, with visual disturbances being the predominant complaint. The mean patient age was 15.5 years. Three cases showed normal preoperative hormonal profiles, but one patient had hypothyroidism. All tumors identified in this study were World Health Organization grade I pilocytic astrocytomas. Surgical complications included hypopituitarism in two patients, meningitis in two patients, cerebrospinal fluid leak in one patient, and transient diabetes insipidus in one patient. No patient experienced worsening neurological or visual symptoms postoperatively., Conclusions: Although our data are preliminary, the EEA provides a direct corridor to OPG with acceptable results in terms of tumor resection and visual outcomes. Hypothalamic-pituitary axis dysfunction remains a limitation of any treatment modality for OPGs and should be considered whenever possible. Definitive conclusions are pending as the learning curve of this approach is steep. Further work is needed to understand patient selection for such an approach.

Background: Organ transplantation is the optimal treatment for end-stage organ diseases. The demand for organs has exceeded the available supply, which becomes a major obstacle worldwide. Identifying the factors affecting this gap will help in overcoming this obstacle. The purpose of the work was to study the knowledge, attitudes, and beliefs of organ donation and to determine the knowledge of brain death among social media users., Methods: A cross-sectional study was conducted among social media users living in Saudi Arabia. A pre-designed self-administrated questionnaire was distributed online randomly on social media networks in 2015. Of the total 1368 participants, only 913 met the criteria., Results: Most respondents were between 18 and 29 years of age (61.2%) and living in the central region of Saudi Arabia (64.5%). The majority of respondents received their information from television (57%) and social media (50%) networks; 46.4% of respondents knew that the religious fatwa allowed organ donation; 51% of respondents were willing to donate their organs; 46.5% considered the brain-dead to be deceased, whereas 37.7% considered it a coma; 33.3% did not know if someone who was brain-dead would ever wake up; on the other hand, 323 (35.4%) said yes., Conclusions: Our study showed that the vast majority of our sample had enough information about organ donation. On the contrary, they had minimal knowledge about brain death. Moreover, a fair percentage of the participants had positive attitudes toward organ donation. Also, the media had a significant effect on the information about organ donation and brain death., (Copyright © 2016 Elsevier Inc. All rights reserved.)