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Background Direct carotid cavernous fistulas (CCFs) and sphenoid sinus traumatic aneurysms are well-known pathologies that can present concomitantly in rare cases. Patients with both lesions are usually symptomatic from both the CCF and the traumatic aneurysm. Symptoms include proptosis, chemosis, bruit, epistaxis, visual field defects, and loss of vision. Surgical treatment can be challenging, and for most cases an endovascular approach is the treatment of choice. Case Description We present an unusual case of a direct CCF with an associated large traumatic aneurysm in the sphenoid sinus due to a history of trauma presenting with unusual symptoms that was treated by a combined endoscopic and endovascular approach. Conclusions Concurrent occurrence of a traumatic CCF and traumatic aneurysm of the cavernous segment is extremely rare. Early diagnosis and treatment of these lesions are important considering their high mortality rate. Complete occlusion of the fistula and aneurysm while preserving the patency of the carotid artery via an endovascular approach is the treatment of choice for these lesions.

Povidone-iodine (PVI) is an effective disinfection solution for surgical wounds. However, there is some reports of its adverse effects on wound healing and bone reunion. Here, we evaluate the efficacy and safety of PVI irrigation in the prevention of surgical site infection in spinal surgery.

Background Central nervous system tuberculoma is the most severe manifestation of extrapulmonary tuberculosis with high mortality. Cavernous sinus tuberculoma (CST) is a very rare central nervous system tuberculoma with few cases reported in the literature. Case Description A 57-year-old woman was admitted to our clinic with acute diplopia and headache limited to the right side. There was no specific medical history except for migraine, depression, and anxiety, all of which were controlled by oral medications. Physical examination revealed ptosis and mydriasis in the right eye, which indicated right third and sixth cranial nerve palsies. Pituitary magnetic resonance imaging showed a right parasellar lesion at the cavernous sinus wall and ophthalmic nerve. Laboratory examinations and brain computed tomography scan showed negative findings. Initial differential diagnosis included meningioma, sarcoidosis, tuberculoma, and lymphoma. However, results of further studies, including blood and cerebrospinal fluid cultures and Mycobacterium tuberculosis DNA assay, were negative. Biopsy of the cerebral lesion was performed through the subfrontal approach, and histopathologic study confirmed CST. She was treated with a standard antituberculous regimen. After 12 months of follow-up, no cerebral or clinical findings were seen. Conclusions CST is a rare presentation of M. tuberculosis, and the diagnosis is a difficult challenge. However, accurate diagnosis and timely treatment of CST can result in complete cure.

Carcinosarcomas are tumors comprising part adenocarcinoma and part sarcoma; the presence of carcinosarcoma in the head-and-neck region is very rare. These tumors are typically highly aggressive (G3) and arise most frequently from the salivary gland. Here, we present a case report on a brain metastasis as the primary manifestation of a carcinosarcoma. Magnetic resonance imaging showed a tumor of the pineal region with infiltration of the brainstem and the corpus. The staging following the histopathological diagnosis revealed the origin of the tumor in the left parotid gland. We present an overview of the significance of published treatment strategies in carcinosarcoma.

Identification of genetic copy number changes in glial tumors is of importance in the context of improved/refined diagnostic, prognostic procedures and therapeutic decision-making. Blood-derived biomarkers, therefore, would be useful as minimally invasive markers that could support diagnosis and enable monitoring of tumour growth and response to treatment.The aim of this study was to evaluate the clinical significance of IGFBP-2/3 in glioblastoma multiforme (GBM) and their value as predictors of survival.We examined the plasma levels of IGFBP-2 and IGFBP-3 using ELISA in patient suffering from GBM and controls groups. Furthermore, immunohistochemistry method was used to evaluate the expression levels of these markers.Preoperative plasma levels of IGFBP-2 and IGFBP-3 were markedly higher in glioblastoma patients (mean±SD: 521.5±164.2ng/ml; 402.4±126ng/ml) when compared with healthy controls (301.28±73.12; 244±89.5ng/ml; p0.001). Immunohistochemical results indicated that the median H score for glioblastoma tissues was higher when compared with normal tissues. The mean scores for IGFBP-2 expression in glioblastoma was higher than normal tissues (p0.001). Our result showed that the median H score for glioblastoma tissues was higher when compared with normal tissue for IGFBP-3 expression. The mean scores for glioblastoma tissues was higher than normal tissues (p0.001). We also evaluated whether plasma IGFBP-2 and IGFBP-3 levels were related to clinical features. The plasma IGFBP-2 level was strongly linked to the patient's age (R=0.769, P=0.001) that were strongly increased in patients with older age (65), (mean±SD: 594.36±33.3ng/ml). On the other hand, plasma IGFBP-3 level was not correlated with age (P=0.462), sex (P=0.532), and tumor size (P=0.245). Our findings indicated that the tissue IGFBP-2 level was also markedly correlated with the patient's age (R=0.612, P=0.015). On the other hand, tissue IGFBP-3 expression level was not correlated with age (P=0.472), sex (P=0.512), and tumor size (P=0.241). Kaplan-Meier survival and log-rank analysis suggested that patients with high plasma level of IGFBP-2 and tissue expression of IGFBP-2 had shorter overall survival than those with low levels (log-rank test P=0.027; P0.001). Kaplan-Meier survival and log-rank analysis suggested that patients with high plasma level of IGFBP-3 and tissue expression of IGFBP-3 had shorter overall survival than those with low levels groups (log-rank test P=0.018; P0.001).These data suggest that plasma levels and tissue levels of IGFBP-2 and IGFBP-3 may be as potential biomarkers for predicting the progression and survival in patients with GBM.

Traumatic penetrating injuries to the internal carotid artery (ICA) resulting in the formation of a traumatic pseudoaneurysm are potentially devastating injuries. Previously treatment included, open surgical occlusion of the affected vessel or endovascular embolization. However, with the advent of flow diverter stents, endoluminal reconstruction has become a viable treatment option. In this case report we describe the successful managment of an ICA pseudoaneurysm due to a transorbital stab injury. Endoluminal reconstruction in a traumatic aneurysm is a feasible option. Considering the risk of hemorrhagic complications due to dual antiplatelet therapy required after flow diverter placement, this treatment should only be chosen if insufficient collateral supply is found and occlusion of the affected vessel is not a viable option.

Background:Vertebroplasty has become a common treatment for relieving pain in osteoporotic vertebral fractures. However, there is contradictory evidence regarding its efficacy. The aim of this study was to determine the degree of pain relief offered by percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures (OVCFs) in patients with or without an intravertebral cleft. Material and Methods: In this multicenter, randomized, placebo-controlled trial all patients who had one or multiple painful, unhealed compression fractures were randomly assigned to undergo vertebroplasty or a sham procedure. The patients in the vertebroplasty group were divided into two subgroups: A - with intravertebral cleft, and B - without intravertebral cleft. They were followed up for the mean pain reduction assessed by visual analogue scale (VAS), and changes in the quality of life using the osteoporosis and Roland-Morris disability questionnaire scores (RDQ) at 1, 6, and 12 months, and two years after the procedure. Results: A total of 1,311 patients were studied (vertebroplasty 661, sham 650). The data showed that those with intravertebral clefts had significantly less severe back pain (p = 0.01) and functional disability (p=0.03) at month 12 compared to those without intravertebral cleft. However, the study groups did not differ significantly with respect to the pain score or the RDQ score at other measurement points (p>0.05). There was a trend in the RDQ score toward less pain in patients with filled clefts compared with patients without clefts after one and two years after surgery, this difference did not approach statistical significance. Conclusion: We found no significant benefit of percutaneous vertebroplasty (PVP) over a sham procedure in patients with vertebral compression fractures with or without vertebral clefts 6 months after surgery. One and two years after surgery, there was a trend toward less pain.

Background Vertebral fractures (VFs) are the most usual convolution of metastatic tumors and the vertebral column is the third most ordinary site for painful bone metastases and remains a chief factor of morbidity in cancer patients. Methods In this paper, we investigated the previous literature on the status of clinical and prospects for the use of percutaneous vertebroplasty (PVP) with polymethylmethacrylate as a remedial alternative for the therapy of refractory pain resulting from malignant vertebral compression and pathologic fractures associated with metastatic tumors of various sites in numerous studies. The scientific document for this remedy, containing safety, immediate and long-term efficacy, and outcome measures, and also the risks of complications, was analyzed in detail. Results PVP is a safe, feasible, reliable, effective, and useful procedure, a minimally invasive treatment, and a significant tool for reduction of pain and the relief of pain symptoms. Conclusions This method can be employed as a further or narcotic remedy in elected patients. The techniques of PVP present a novel alternative therapy for diverse metastases with potentially large application.

Meningoencephlocele is a relatively rare deformity, usually characterized by penetration of brain or meningeal tissues through a defect in skull. This protruding tissue may affect facial structure and subtle to severe facial deformities may appear. Surgical treatments of these deformities are usually done by a team including a neurosurgeon and craniofacial surgeon. The conventional treatments includes several complicated operations to relocate herniating tissues, then correcting malformed facial structure. The nasal framework osteotomy, is an innovative approach that uses transfacial incisions to gain access to herniating tissue. Then, by completing the osteotomy around the nose, the entire nasal structure is lifted and transposed to it is original position. The authors believe that this technique may considerably reduce the complexity and risks of conventional approaches, while aesthetic demands are readily achieved at the same stage.

In this study, immunohistochemical analysis was used to evaluate the expression of ALDH1 and NDRG2 in astrocytoma tissue samples and normal brain tissues. ALDH1 protein staining displayed that AlDH1 expression was not detectable in eight astrocytoma tissues (8/36) and in all of normal brain tissues. There was a significant difference between ALDH1 expression and WHO grades (P = 0.03). Furthermore, no correlation was determined between expression levels of ALDH1 and other clinicopathological characteristics including age, sex, and tumor size. Immunohistochemistry showed that a high level of NDRG2 protein expression was markedly detected in normal brain tissues and expression of NDRG2 protein was significantly decreased in astrocytoma tissues. There was a significant association between pathological grading and NDRG2 expression level (P