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Background: Hydrocephalus among Severe Acquired Brain Injury (SABI) patients remains overlooked during rehabilitation. Methods: A retrospective cohort study was carried out of traumatic and non-traumatic SABI patients with hydrocephalus, consecutively admitted over 9 years in a tertiary referral specialized rehabilitation hospital. Patients were treated with ventriculoperitoneal shunt before or during inpatient rehabilitation and assessed using the Level of Cognitive Functioning Scale and Disability Rating Scale. Logistic regression models were used to identify predictors of post-surgical complications. Linear regression models were used to investigate predictors of hospital length of stay (LOS), disability, and cognitive function. Results: Of the 82 patients, 15 had post-surgical complications and 16 underwent cranioplasty. Shunt placement complication risk was higher when fixed vs. when programmable pressure valves were used. A total of 56.3% achieved functional improvement at discharge and 88.7% improved in cognitive function; of the 82 patients, 56% were discharged home. In multiple regression analyses, higher disability at discharge was related to cranioplasty and longer LOS, while poorer cognitive function was associated with cranioplasty. Increase in LOS was associated with increasing time to shunt and decreasing age. Conclusions: A significant improvement in cognitive and functional outcomes can be achieved. Cranioplasty increased LOS, and fixed pressure valves were related to poorer outcomes.

Pituitary tumors are a heterogeneous group of lesions (usually benign) and proper understanding of the anatomy, physiology, and pathology of the hypothalamic/pituitary region is essential to make an accurate diagnosis and define the essential treatment options (i.e., surgery, medical therapies, and radiotherapy, alone or in combination). Surgery is the primary treatment for acromegaly, Cushing disease, thyroid-stimulating hormone-secreting adenomas, resistant prolactinomas, and nonfunctioning pituitary adenomas causing mass effect. Medical and radiation therapy are reserved in cases in which surgery is not possible or does not provide a complete cure. In the last decades, tremendous innovations (i.e., targeted drugs and refined surgical tools and techniques) have expanded the treatment strategies for pituitary adenomas. We herein report the current indications for and depiction of the surgical techniques in pituitary surgery, review current medical treatments, and provide a glimpse of future possibilities.

BACKGROUND Cavum trigeminale cephaloceles (CTCs) are characterized by a cystic appearance and extension of the posterolateral aspect of Meckel’s cave into the superomedial portion of the petrous apex. A possible mechanism is a transient or sustained increase of intracranial pressure transmitted to Meckel’s cave, leading to its secondary herniation, in the presence of predisposing local factors. The majority of CTCs are incidental findings. Among symptomatic cases, headache, trigeminal neuralgia, cerebrospinal fluid leak, vertigo, ataxia, facial numbness, hearing loss, diplopia, and other visual disturbances have been described. OBSERVATIONS The authors describe a case of an 18-month-old male patient referred to their hospital with drowsiness, vomiting, left cranial nerve VI palsy, and papilledema. Neuroradiological investigation revealed the presence of a CTC with a swollen aspect of the left pontine hemisection and indirect signs of intracranial hypertension. The patient was managed with implantation of a ventriculoperitoneal shunt. LESSONS CTCs are rare lesions that are difficult to recognize on neuroimaging, in which they can be mistaken for tumoral or inflammatory lesions. The most frequent asymptomatic forms should be considered as “leave-me-alone” lesions. In cases of intracranial hypertension, according to a supposed theory on the origin of CTCs, the authors recommend treating only the intracranial hypertension instead of performing more invasive surgical procedures, especially in pediatric patients.

Background:One of the most serious and potentially life-threatening adverse events associated with anterior cervical spine surgery is postoperative hematoma with acute airway obstruction. The causes of unpredicted delayed bleeding are, however, not fully elucidated. Here, we report a case of delayed arterial bleeding and sudden airway obstruction following a two-level ACDF.Case Description:A 52-year-old male presented with the right paracentral disc herniations at the C4–C5 and C5–C6 levels. A two-level ACDF was performed. Notably, on the 5thpostoperative day, the patient developed an acute respiratory distress due to a large right lateral retrotracheal hematoma requiring emergency evacuation at the bedside. This was followed by formal ligation of a branch of the right superior thyroid artery in the operating room. In addition, an emergency tracheotomy was performed. By postoperative day 15, the tracheotomy was removed, and the patient was neurologically intact.Conclusion:A superior thyroid artery hemorrhage should be suspected if a patient develops delayed neck swelling with or without respiratory decompensation several days to weeks following an ACDF. Notably, these hematomas should be immediately recognized and treated (i.e., decompression starting at the bedside and completed in the operating room) to prevent catastrophic morbidity or mortality.

Purpose: The aim of this study is to highlight the role of the endoscopic endonasal approach (EEA) in pediatric craniopharyngiomas by reviewing our experience and the key lessons learned from the application of this approach in children. Methods: Between 1998 and 2017, 12 pediatric craniopharyngiomas were treated via EEA at our institution. Demographic data, preoperative assessment, tumor features, surgical results, complications, and recurrences were analyzed. Results: Visual defects were the most frequent presenting sign. Seven craniopharyngiomas were infradiaphragmatic, and five were supradiaphragmatic. The EEA was successfully performed in all cases with no complication related to children’s sinonasal anatomy. Gross total resection (GTR) rate was of 75%. Endocrinological disturbances improved in one case (20%) and worsened in three (60%). New onset of diabetes insipidus was observed in four (36%) children. Visual defect improved in 91% of cases, with no new postoperative deficit. Postoperative cerebrospinal fluid (CSF) leak occurred in one patient (8%). Three patients (27%) experienced tumor regrowth, and one craniopharyngioma recurred (mean follow-up, 78 months). Conclusions: The EEA offers a straight route to the sellar-suprasellar, making it the ideal approach for pediatric infradiaphragmatic craniopharyngiomas. In supradiaphragmatic craniopharyngiomas, the extended EEA provides a clearer and close-up visualization of the tumor-hypothalamus interface, which can grant better results in terms of quality of life. The pediatric skull base anatomy should not represent a contraindication for the endoscopic technique. Larger series encompassing a wider spectrum of pediatric craniopharyngiomas are needed to further support the benefits of this surgical approach.

Tra concilio e anticoncilio. Un nodo del presente non solo ecclesiale Il Concilio, Roma e la Chiesa Benedetto XVI e i tradizionalisti cattolici Giudizi sul tempo presente e sulla Chiesa Liturgia e societa nel tradizionalismo di matrice lefebvriana Dal rapporto con Gueranger a quello con Benedetto XVI Si presentano qui alcune riflessioni e approfondimenti in occasione di un seminario sul volume di Giovanni Miccoli, La Chiesa dell’anticoncilio. I tradizionalisti alla riconquista di Roma. L’intervento di Miccoli (Tra concilio e anticoncilio: un nodo del presente non solo ecclesiale) sottolinea la radicalita del rifiuto del concilio da parte di Lefebvre e del suo movimento e analizza le scelte romane, da Paolo VI fino a Benedetto XVI, che rivelano letture diverse del concilio e del significato di svolta che molti testi conciliari proponevano. Un’interpretazione normalizzante del concilio e minimizzante dell’opposizione lefebvriana si e imposta con il pontificato di Giovanni Paolo II e si e accentuata con Benedetto XVI fino alla revoca della scomunica ai quattro vescovi lefebvriani nel gennaio 2009, che ha suscitato forti reazioni. Queste reazioni sono descritte da Bruna Bocchini Camaiani (Il Concilio, Roma, la Chiesa) che sottolinea la crisi profonda provocata dai rapporti di Roma con i lefebvriani, rivelatrice di una divaricazione tra il governo romano, con i suoi interventi autoritativi, e una consapevolezza ecclesiale legata alle aperture e alle speranze suscitate dal concilio. Giovanni Vian (Benedetto XVI e i tradizionalisti cattolici. Giudizi sul tempo presente e sulla Chiesa) analizza le differenziazioni e le convergenze tra le posizioni del pontefice e quelle dei gruppi lefebvriani attraverso una lettura dei giudizi sulla storia contemporanea, a proposito del ruolo della Chiesa nella societa e del rapporto tra la Chiesa e la storia. Maria Paiano approfondisce le motivazioni della polemica contro la riforma liturgica anticonciliare, insieme alla richiesta del ritorno al Messale di Pio V (Liturgia e societa nel tradizionalismo di matrice lefebvriana. Dal rapporto con Gueranger a quello con Benedetto XVI). L’autrice evidenzia come le istanze liturgiche dei tradizionalisti siano collegate a un progetto di riconquista della societa per un ritorno a uno Stato confessionale.

La figura di Francesco, soprattutto nel corso dell'ultimo secolo, e divenuta per molti, e in misura crescente, simbolo, emblema, eroe eponimo, genio risolutore per aspetti e problemi cruciali del nostro tempo: problemi religiosi, politici, sociali, rispetto ai quali in vario modo egli assume un ruolo di ispiratore e promotore di soluzioni ireniche, pacificatrici, di modello eccezionale di una volonta e di un'opera di ricomposizione e pacificazione. E un fenomeno che non manca di aspetti arbitrari o stravaganti anche se sarebbe errato ridurlo semplicemente a questi termini. E stato giustamente notato infatti come alla base di esso stiano momenti ed episodi celebri della vita di Francesco che hanno variamente e fortemente segnato l'immaginario collettivo.1

La Vie de saint Francois de Paul Sabatier et ses editions de textes demeurent a l'origine de la « question franciscaine ». Des lors, et pendant des decennies, la discussion aura porte sur la valeur historique qu'il fallait attribuer aux diverses Vitae et aux differents documents biographiques concernant Francois, ainsi que sur leurs relations reciproques de succession et de dependance. Toutefois, c'est grâce a la mise au point de Theophile Desbonnets que ce dernier aspect peut etre considere comme resolu, quant a sa substance, tandis que le premier aspect doit etre aborde en des termes tout a fait differents. En effet, le probleme, qui reste encore ouvert a present, est celui du rapport existant entre la proposition chretienne de Francois, telle qu'elle se realisa dans sa propre experience et dans la fraternitas primitive, et la traduction et les modifications dont cette proposition a ete l'objet au cours de la transformation de la fraternitas en un ordre et suite aux tâches remplies par l'Ordre meme au sein de l'Eglise et de la societe. Cet article a pour but, a la fois, de jeter une lumiere sur les raisons et les aspects qui ont conduit les biographes a interpreter et a classer le choix evangelique de Francois, et de montrer les criteres et les precautions de lecture qu'il faut appliquer dans l'analyse de ces biographies memes, afin que leur temoignage jouisse pleinement de sa juste valeur.

Z - and E -1-bromo-2-phenylthioethenes were cross-coupled stereospecifically with s-alkyl Grignard reagents in the presence of a series of Ni II , Pd II or Fe III catalysts with the aim of finding a catalyst which would not cause s-alkyl → n-alkyl isomerization. With PdCl 2 (dppf) (dppf = 1,1′-bis(diphenylphosphino)ferrocene) and NiCl 2 (dppe) (dppe = 1,2-bis(diphenylphosphino)ethane) there was still some isomerization contribution, but it was completely suppressed by using iron(III) catalysts.

Z - and E -1-bromo-2-phenylthioethenes were cross-coupled stereospecifically with s-alkyl Grignard reagents in the presence of a series of Ni II , Pd II or Fe III catalysts with the aim of finding a catalyst which would not cause s-alkyl → n-alkyl isomerization. With PdCl 2 (dppf) (dppf = 1,1′-bis(diphenylphosphino)ferrocene) and NiCl 2 (dppe) (dppe = 1,2-bis(diphenylphosphino)ethane) there was still some isomerization contribution, but it was completely suppressed by using iron(III) catalysts.