Sinus pericranii (SP) is a rare vascular malformation characterized by abnormal communication between intracranial and extracranial venous systems. Often asymptomatic and presenting as a soft, nonpulsatile scalp mass, SP can be mistaken for other scalp anomalies, such as scalp arteriovenous malformations (AVMs), due to overlapping clinical features. This case of a 4-year-old girl successfully treated for a giant SP is reported to illustrate the findings of a comprehensive systematic literature review. This review was conducted according to the "Preferred Reporting Items for Systematic Reviews" guidelines. Relevant studies (1985-2025) reporting patients with SP were identified from PubMed/MEDLINE databases. A total of 65 studies reporting 82 SP patients were included in this study. The median age was 8 years, ranging from 4 months to 72 years, with a male predominance of 61.0% ( n  = 50). No contributing factors were reported in most cases (67.1%, n  = 55). However, craniosynostosis and recent trauma were reported as contributing factors to the development of SP in 7.3% ( n  = 6) and 18.3% ( n  = 15), respectively. Frontal (37.8%, n  = 31), parietal (32.9%, n  = 27), and occipital (13.4%, n  = 11) were the most reported locations of SP. The median follow-up duration was 24 months (3-96). This is the first systematic review of the SP, where the authors highlight, by data synthesis, the clinical presentation, dural sinus involvement, management, and outcome of this rare but challenging pathology. Without management guidelines, its treatment choice is still based on the surgeon's experience. This reality calls for action for an evidence-based study.

Background: Rupture of intracranial aneurysm results in a potentially life-threatening subarachnoid hemorrhage (SAH) leading to a 45 % mortality rate with only 30 % returning to their normal life. Thus, the management decision is crucial. This study aimed to improve consistency, patient-centeredness, safety, and effectiveness of the decision-making for microsurgical or endovascular treatments of intracranial aneurysms (IAs) patients by appraisal of clinical, locational, and morphometric factors. Methods: We use the Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines to guide the appraisal of 394 patients with 435 IAs for quality improvement of aSAH treatment decision making. Between January 2013 and December 2022, our team developed a flexible patient selection criterion for microsurgical or endovascular treatments of ruptured IAs. Results: We depicted 312 (71.7 %) and 123 (28.3 %) anterior cerebral circulation IAs and posterior cerebral circulation IAs respectively. About 65.5 %(n = 285) were clipped whereas 34.5 %(n = 150) underwent coiling. Multiple factors (age, location, type, size, dome-to-neck ratio, WFNS grade at admission, and modified Rankin Scale "mRS" score) were found to influence the quality-improving decision-making for microsurgery or endovascular treatment of IAs. There was a statistically significant difference (p < 0.001) between the aneurysmal morphometric factors for clinical decision of endovascular treatments (42 % vs 58 %) or microsurgical clipping (78.9 % vs 21.1 %) of the anterior and posterior cerebral circulation IAs respectively, with an Odds ratio 2.72; 95 %CI [1.76-4.18]. Conclusion: Despite the management of IA's for many decades, reliable indicators for making decisions on microsurgical versus endovascular treatments for IA's are still debated.

Subdural hematoma is a common disease in neurosurgery with specific radiological characteristics. Organized subdural hematoma, albeit less common, was nonetheless reported in literature. In this article we report the case of a misdiagnosed organized subdural hematoma mimicking an epidural hematoma which was observed in an 8-year-old patient that underwent VP shunt for hydrocephalus at 40 days old, complicated with meningitis and who suffered a head trauma 4 years later, presenting with a sudden generalized tonic clonic seizure for which she was stabilized under adequate treatment. A CT scan performed after revealed a biconvex-shaped hypodense mass along the left temporoparietal cerebral convexity, which was interpreted first as a chronic epidural hematoma. As such, and taking in context the clinical situation of the patient, a craniotomy was performed during which no epidural hematoma was discovered and an OSDH was located after incising the dura. A total evacuation was performed and the patient had fully recovered and improved. Thus, it is essential to bring forward such cases where radiological imagery can be misleading and to put forward detailed differential characteristics between OSDH et EDH through more radiological studies.

Background: Computational fluid dynamics (CFD) models are crucial for examining blood flow and the morphology of brain aneurysms. These models are used to enhance the understanding of the formation, rupture, and post-treatment behavior of aneurysms. The three principal models are non-Newtonian, non-Kolmogorov, and modified Krieger. However, the extent to which these models differ in their ability to predict changes in blood flow within aneurysms remains unclear. This study aimed to compare these models to identify their differences and similarities and to determine which model is most effective for intracranial aneurysm geometry appraisal. Methods: We conducted a qualitative systematic review according to the ENTREQ guidelines. Our search encompassed the MEDLINE/PubMed and American Mathematical Society/MathSciNet databases, from their inception until January 2025. We utilized terms such as “intracranial aneurysm” and “cerebral aneurysm,” along with keywords like non-Newtonian, non-Kolmogorov, modified Krieger CFD models, and IA dynamics. Results: Seventy-four articles were included in this study. Conclusion: CFD simulation accuracy depends on blood vessel mapping, boundary conditions, and fluid model assumptions. Non-Newtonian models, which consider blood shear-thinning behavior, provide better flow depictions compared to Newtonian models. Advanced models, such as non-Kolmogorov and modified Krieger, enhance understanding by capturing turbulence and predicting wall shear stress. Despite these advances, debate continues regarding optimal aneurysm blood flow modeling. The field requires standardized protocols, validation procedures, and uncertainty quantification methods for effective treatment planning.

Background:The management choice for the middle cerebral artery aneurysms (MCAAs) is still controversial. This review aims to describe a single-center "clipping first" policy for MCAA over 40 years of experience and compare the short- and long-term clinical outcomes by aneurysm's location. Methods:This retrospective cohort study reviews the whole series of a single-center intracranial aneurysm mainly based on the micro-neurosurgical experience of the senior authors (EOA and EKA). More than 968 aneurysm patients were treated at the University Hospital "Hôpital des Spécialités" Ibn Sina of Rabat in Morocco since 1983. We have included aneurysmal subarachnoid hemorrhage patients with the World Federation of Neurosurgical Societies (WFNS) Grade ≤III (64.7% clipped; 6.9% coiled) and those with WFNS Grade ≥IV (27.5% clipped; 0.9% coiled). Results:From the database of 1069 IAs in 968 patients, we depicted 218 (22.5%) patients carrying 279 (26.1%) MCAA. About 92.1% (n = 257) of the MCAAs were microsurgically clipped, and 96.3% (n = 210) were discharged with good outcomes (modified Rankin Scale [mRS] ≤2). In the post hoc test, the mean of intracerebral hemorrhage (ICH) (4.178) among the group of poor outcome patients (mRS >2) was significantly (P = 0.001) high compared to that of 0.827 good outcome patients (mRS ≤2). The negative correlation found between the dome/neck ratio and the mRS (Pearson's r = -0.023, 95%confidence interval [CI] 0.110--0.156) at admission (Pearson's r = -0.073, 95%CI 0.061--0.204) and at discharge confirmed that the wider the MCAA neck is, the more susceptible it is to have a poor prognosis. Conclusion:The good clinical outcome from the microsurgically clipped patients is overwhelming and allows us to conclude that microsurgical treatment should be mostly considered for MCAA management. The patient's poor outcome with MCAA at discharge was significantly associated with ICH at admission in the frequency of 68.9%.

Background: The simultaneous presence of a pituitary adenoma and a meningioma is a rare and underreported condition. The randomly encountered cases need to be reported to further allow our understanding of this collision tumors that are still not understood nor fully described. Patients and Method: We report a case of coexisting nonfunctioning pituitary adenoma and a left temporal lobe meningioma revealed by a 1-year history of progressive vision loss and occasional headaches in a 56-year-old woman. Her clinical condition worsened in the last 5 months with ptosis, cavernous sinus syndrome, and ophthalmoplegia of the right eye without papilledema. There was an improvement in the visual symptoms after subtotal resection of both lesions through a right frontotemporal craniotomy. Histology confirmed a collision tumor. The patient was referred for adjuvant treatment with gamma knife radiosurgery. He was doing well and back to his usual duties 6 months later. Conclusion: A gross total or subtotal resection with adjuvant therapy is the gold standard for the surgical management of collision tumors for a favorable patient outcome.

Introduction: Post-hemorrhagic or post-infectious isolated or trapped fourth ventricles are rare occurrences associated with cystic lesions of the V4. However, the even less frequent arachnoid cyst of the fourth ventricle poses a differential diagnosis challenge and may be easily overlooked during initial medical assessments of V4 cystic lesions. Case Report: An 11-year-old child, previously healthy, presented with symptoms indicative of intracranial hypertension syndrome, including headaches, vomiting, and bilateral Grade II papilledema. Neuroradiological examination revealed a significantly enlarged fourth ventricle (V4) alongside small lateral and third ventricles. Initially suspected as a V4 arachnoid cyst, the patient underwent surgical intervention with a sub-occipital approach for cyst marsupialization, showing positive progress in the first postoperative month. However, one month later, intracranial hypertension symptoms recurred, and imaging indicated cyst recurrence within V4. A second procedure involved a V4-peritoneal shunt, resulting in a favorable postoperative outcome for one month. One month later, headaches and vomiting without papilledema reappeared, and imaging revealed moderate ventricle dilation. The therapeutic approach included ventriculocisternostomy alongside the V4 peritoneal shunt, leading to a favorable outcome with no signs of intracranial hypertension during follow-up consultations and a normal clinical examination. Conclusion: Trapped fourth ventricle is a rare clinico-radiologic entity, with limited cases reported. Treatment options encompass direct microsurgical approaches, fourth ventricle outflow fenestration, and alternative treatments like fourth ventriculoperitoneal shunts. Additionally, the combination of ventriculoperitoneal shunt and endoscopic treatment (VCS) may be considered for comprehensive management.

The coexistence of a meningioma and an unruptured intracranial aneurysm was considered a rare phenomenon, accidentally detected by radiological assessment. The relationship between these 2 entities is complex and represents a neurosurgical challenge. We share our experience of a case involving a 36-year-old male patient with no prior medical history who consulted for chronic unilateral left periorbital headaches. The imaging diagnosis revealed 2 lesions, including a partially calcified jugo-olfactory meningioma and an anterior communicating artery aneurysm. He was successfully treated in a single surgical procedure using a left pterional craniotomy for excision of the meningioma followed by clipping of the aneurysm. The patient was discharged home on the fifth postoperative day in good clinical condition. This experience underlines the importance of preoperative imaging assessment, in order to make the right therapeutic decision and avoid unexpected intraoperative disasters.

BACKGROUND:The resection of the jugum (planum) sphenoidale meningioma (JSM) is challenging, and there is a scarcity of available data in the literature. This study aimed to describe the surgical management and long-term outcome of jugum sphenoidale meningioma. METHODS:This was a retrospective, single-center, cohort study of 91 JSM patients treated in our department from 2005 to 2022. All the included patients have undergone surgical treatment. Clinical, radiologic, and surgical data were extracted with specific attention to the age at onset, family history, duration from symptoms to diagnosis, clinical presentation, quality of excision, recurrence, and treatment outcome. RESULTS:WHO grade I and grade II meningioma were 83.5% (n = 76) and 16.5% (n = 15) respectively. Fronto-lateral 42.9% (n = 39) and pterional approaches 57.1% (n = 52) were the 2 major surgical approaches used for the management of planum sphenoidale meningioma. Twelve patients needed emergency surgical treatment at admission: 4 (4.4%) External CSF Shunt and 8 (8.8%) VP-Shunt. We have found a statistically significant (P = 0.032) association between the quality of excision and the risk of recurrence. The GTR (Hazard ratio = 1) of the planum meningioma protects the patient from recurrence within 60 months of follow-up. Postoperative complications encountered were CSF-Leak in 2.2%, Meningitis 4.4%, surgical site infection 2.2%, and surgical site hematoma 3.3%. The overall postoperative favorable outcome was 68.1% (n = 62). CONCLUSIONS:The pterional approach has allowed the achievement of GTR for jugum sphenoidale meningioma with protective odds from recurrence risk.

Arachnoid cysts are abnormal collections of fluids within the arachnoid membrane after a doubling of the structure. These benign lesions represent only 1% of all intracranial space-occupying lesions. The affected patient can remain asymptomatic for several years, which is an incidental finding in most cases. Cysts have been reported to rupture after a minor head trauma, causing subdural hygroma or hematoma; however, spontaneous rupture complicated with subdural hygroma has been rarely reported. Herein, we report a rare case of a 10-year-old boy whose pregnancy follow-up, delivery, and parent’s medical history were unremarkable. The patient was admitted for a temporal arachnoid cyst complicated with subdural hygroma, which was determined to be caused by intracranial hypertensive syndrome. He was successfully treated through endoscopic arachnoid cyst fenestration, wherein a pathway was created for the cyst to communicate with the subarachnoid space through the basal cisterns. The choice of treatment for arachnoid cysts remains controversial. Endoscopic treatment is considered when an ipsilateral subdural hygroma is present. Intracranial hypertensive syndrome subsided immediately after surgery. No post-operative complications occurred. The child recovered uneventfully in the post-operative period and was discharged 5 days after surgery. He underwent a follow-up computed tomography 1 month later, confirming a progressive regression of the hygroma as well as arachnoid cyst.

Background: They are rare glial tumors that share characteristics with astrocytomas, ependymomas and sometimes other glial neoplasms, and can be difficult to diagnose. Method: We present the case of a 57-year-old female patient admitted with subacute headache, seizures, visual disturbances associated with 2/5 left hemiparesis for 2 weeks Result: Cerebral MRI showed a voluminous left parietal-rolandic lesion with dual tissue and cystic components taking up contrast in a heterogeneous fashion, suggesting a cystic glioma or an atypical meningioma. The patient underwent total excision via a direct approach, with histological examination favouring an Astroblastomea proliferation Ki67 estimated at 10%, with postoperative follow-up radiotherapy. The patient is alive and being followed up at the consultation. The radiological and histopathological features and treatment of this case are described, with a review of the literature. Conclusion: In addition to their own histological features, Astroblastomas share certain molecular and histological findings with other, possibly ontologically related, cortical-based gliomas, mainly in children and young adults. Importantly, the presence of BRAFV600E mutations in a subset of Astroblastomas suggests the potential clinical utility of targeted anti-BRAF

Plasmacytoma is a rare plasma cell neoplasm. Whether solitary or associated with multiple myeloma (MM), it rarely involves the skull base, particularly the sphenoid bone. We present a unique case of sphenoid bone plasmacytoma secondary to MM, highlighting diagnostic and therapeutic challenges. A 56-year-old female presented with headaches, vomiting, epistaxis, and cranial nerve deficits. Cerebral imaging revealed a 65-mm tumor infiltrating the sphenoid bone and adjacent structures. Subtotal resection was performed using an endoscopic nasal approach. Histopathology revealed plasmacytoma, and diagnostic workup confirmed MM. By the end of biological exploration, relapse of the sphenoid plasmacytoma was observed, and the patient was successfully treated with radiotherapy, immunochemotherapy, and autologous stem cell transplantation. After 18-month follow-up, sustained complete remission was confirmed. Although rare, the diagnosis of plasmacytoma should be considered in cases of skull base tumors. This localization is highly predictive of MM, warranting comprehensive investigations to initiate prompt and adequate management.

Introduction: Hemangioblastomas are highly vascularized tumors of unclear origin. Most hemangioblastomas arise in the posterior fossa. Although spontaneous hemorrhage from these tumors is extremely rare, despite their vascular nature, we describe a case of a bulbo- medullary hemangioblastoma revealed by hemorrhage. Case report: This is a 12-year-old child, with no past-history, presented with a picture of subarachnoid hemorrhage (sudden, intense, thunderclap headaches associated with vomiting and stiff neck, for which the Neuroradiological investigation was in favor of a bulbo-medullary lesion which infracentimetric lesion was found, with anapath was in favor of a hemangioblastoma. Conclusion: Hemangioblastomas are rare tumors that can be revealed by hemorrhage. Imagery can be misleading. In the case with very small lesion, careful neurovascular appraoch is recommended.

Spinal epidermoid cysts are rare benign tumors. The etiology can be acquired or congenital. We present a rare case of an 18-month-old girl presented 4 months ago with spontaneous intergluteal swelling fistulized to the skin and lower limbs weakness. Magnetic resonance imaging of the spine demonstrated an intradural tumor from L3 to L5 levels, isointense on T1, hyperintense on T2-weighted images with contrast enhancement after gadolinium injection without any coexistent spinal dysraphism suggested the diagnosis of the dermal sinus. The patient underwent triple-level laminectomy for biopsy and tumor resection. A pearly white tumor was encountered, with a subsequent biopsy confirming it to be an epidermoid tumor. At 6-month follow-up, the neurologic deficit was improved. Spinal epidermoid cysts are rare tumors that evolve slowly. Complete total removal is the treatment of choice.

IMPORTANCE Testing new medical devices or procedures in terms of safety, effectiveness, and durability should follow the strictest methodological rigor before implementation. OBJECTIVES To review and analyze studies investigating devices and procedures used in intracranial aneurysm (IA) treatment for methods and completeness of reporting and to compare the results of studies with positive, uncertain, and negative conclusions. DATA SOURCES Embase, MEDLINE, Web of Science, and The Cochrane Central Register of Clinical Trials were searched for studies on IA treatment published between January 1, 1995, and the October 1, 2022. Grey literature was retrieved from Google Scholar. STUDY SELECTION All studies making any kind of claims of safety, effectiveness, or durability in the field of IA treatment were included. DATA EXTRACTION AND SYNTHESIS Using a predefined data dictionary and analysis plan, variables ranging from patient and aneurysm characteristics to the results of treatment were extracted, as were details pertaining to study methods and completeness of reporting. Extraction was performed by 10 independent reviewers. A blinded academic neuro-linguist without involvement in IA research evaluated the conclusion of each study as either positive, uncertain, or negative. The study followed Preferring Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MAIN OUTCOMES AND MEASURES The incidence of domain-specific outcomes between studies with positive, uncertain, or negative conclusions regarding safety, effectiveness, or durability were compared. The number of studies that provided a definition of safety, effectiveness, or durability and the incidence of incomplete reporting of domain-specific outcomes were evaluated. RESULTS Overall, 12 954 studies were screened, and 1356 studies were included, comprising a total of 410 993 treated patients. Therewas no difference in the proportion of patients with poor outcome or in-hospital mortality between studies claiming a technique was safe, uncertain, or not safe. Similarly, there was no difference in the proportion of IAs completely occluded at last follow-up between studies claiming a technique was effective, uncertain, or noneffective. Less than 2% of studies provided any definition of safety, effectiveness, or durability, and only 1 of the 1356 studies provided a threshold under which the technique would be considered unsafe. Incomplete reporting was found in 546 reports (40%). CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis of IA treatment literature, studies claiming safety, effectiveness, or durability of IA treatment had methodological flaws and incomplete reporting of relevant outcomes supporting these claims.

Background: The association of moyamoya disease and posterior cerebral artery aneurysms is relatively rare and the prognosis is poor. The management is extremely challenging for neurosurgeons. Case Report: We report a case of a 58-year-old man with a history of moyamoya disease who admitted complaining of sudden-onset headaches, vomiting, and seizure and the investigations revealed a subarachnoid hemorrhage, intracerebral hematoma, posterior cerebral artery aneurysms on a moyamoya disease field. The patient was treated surgically by the clipping of the aneurysm, but developed three days later a complication of the MMD and died. Conclusion: The prognosis of this association is very poor, explain the fact that a therapeutic strategy should be done to reduce the mortality and to determine the best management which is surgery versus embolization and revascularization.

-BACKGROUND: Brain metastases (BMs) are the most common expansive intracranial lesions in adults. Approx-imately 50% of patients diagnosed with new BMs will have >1 BM at the diagnosis. We report our experience with BMs treated with Leksell Gamma Knife stereotactic radi-osurgery (GKSR) and evaluate the outcomes. -METHODS: Patients treated by GKSR in our institution between 2008 and 2021 for BMs were evaluated retrospectively. -RESULTS: A total of 205 patients (56.6% women) were included, with a median age of 59 years (range, 25-83 years). The breast (n = 85; 42.5%) and lung (n = 76; 38%) were the most common original locations for the primary tumors. Of the 205 patients, 103 (50.3%) had a single BM and 102 (49.7%) had & DDAG;2 BMs. The median number of mul-tiple BMs treated was 4 (range, 2-43). The mean overall survival (OS) time was 6.00 months (95% confidence in-terval [CI], 5.07-6.93 months) for all BMs. The median rate of tumor control after radiosurgery was 65% (range, 20%-99%) during a median follow-up of 6.00 months (95% CI, 3-84 months). In the overall population, the 1-, 2-, and 5-year OS rate was 37.55%, 25.12%, and 18.51%, respectively. The mean OS time was longer for those with multiple BMs than for those with a single BM (mean, 10 months [95% CI, 6.67-13.33 months] vs. mean, 5 months [95% CI, 4.21-5.70 months]; P = 0.03). Retreatment, tumor stability (control), and progression influenced the OS of patients with BMs, whether single or multiple (P < 0.001). -CONCLUSIONS: GKSR provides good results in terms of OS and better quality of life for patients with BMs, whether single or multiple. Tumor stability and retreatment influ-enced the OS of patients with BMs.

Abstract BACKGROUND Brain metastases (BMs) are the most common expansive intracranial lesions in adults. Approximately 50% of patients diagnosed with new brain metastases have more than one brain metastasis at the time of diagnosis. OBJECTIVE We report our experience of brain metastases treated with GKSR and evaluate the outcome. METHODS Patients treated by Gamma Knife stereotactic radiosurgery (GKSR) in our institution between 2008 and 2021 for BM were recorded retrospectively. RESULTS A total of 205 patients (56.6% females) were included, with a median age of 59 (25-83) years old. Breast (n=85, 42.5%) and lung (n=76, 38%) were the common original locations for the primary tumors (Table 1). There were 103 patients (50.3%) with single BM and 102 patients (49.7%) with multiple BM⩾2. The median number of multiple BM treated was 4 (2-43). The overall mean survival time was 6.00(95% CI, 5.07-6.93) months for all BM. The median percentage of tumor control after radiosurgery treatment was 65% (20-99) over the median follow-up time of 6.00(3-84) months. In the overall population, the 1-year OS rate was 37.55%, the 2-year OS rate was 25.12%, and the 5-year OS was 18.51%. The mean survival time among patients with BM was higher in those with multiple BM than those with single BM ([10 (95%CI 6.67-13.33) months vs 5(4.21-5.70) months, P (0.03)]). Retreatment, tumor stability (control), and progression influence the overall survival of BM, whether single or multiple (P<0.001). CONCLUSION Stereotaxic Radiosurgery provides good results in terms of Overall survival and better Quality of Life for BM, whether single or multiple. Stability and retreatment influenced the overall survival of BM.

Abstract INTRODUCTION Transsphenoidal endoscopic surgery (TS) is currently the reference method for the treatment of pathologies affecting the sellar region. It is a relatively safe technique, with low per and postoperative morbidity. We report through this retrospective study the experience of the neurosurgery department of the HSR in this field. PATIENTS AND METHODS We have collected the records of 176 patients operated endoscopically (TS), since the advent of the technique in the service in January 2016 until March 2022. Epidemiological, radiological and endocrine clinical data were analyzed by jamovi software version 1.6. RESULTS Over 6 years, 176 interventions were performed endoscopically transsphenoidal, these were 66 men and 110 women sex ratio = 1.66. The average age at surgery was estimated at 42 years. Several pathologies were treated by TS route, namely: pituitary adenoma (80%), and the other pathologies were divided between meningiomas; craniopharyngiomas; chordomas; pituitary abscess and OMB. Symptoms were dominated by: intracranial hypertension syndrome, optochiasmatic syndrome, endocrine syndrome. The diagnosis was based on imaging all our patients benefited from an injected brain MRI, as well as the anatomo-pathological examination the endocrine balance was disrupted in 9 patients (5.3%) Postoperative follow-up was favorable in 128 patients (75%),15 patients required revision surgery, 8 patients developed transient or prolonged diabetes Insipidus (4%), 5 cases of rhinorrhea (2%), 11 patients had meningitis (6%), new pituitary deficiency constituted 3.20%, hemorrhages and Epistaxis found in 6% of patients, no cases of ophthalmic complication were reported, deploring the death of 2 patients postoperatively. CONCLUSION The usage of Endoscopic Surgery (TS) in our department is the result of several efforts developed by different generations of neurosurgeons. Currently we operate about thirty patients per year by adopting this technique, with a significant reduction in hospitalization days as well as complications.