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Normal Pressure Hydrocephalus (NPH) is a syndrome in predominantly older adults, differential diagnoses include primary neurodegenerative diseases. The key radiological finding is ventricular enlargement, different from increased ventricular size associated with cerebral atrophy. After definitive surgical cerebrospinal fluid (CSF) shunting there appears to be increased brain tissue volume in patients’ follow-up images which could indicate that imaging findings usually interpreted as cerebral atrophy may be reversible with appropriate treatment. A cross-sectional study was performed comparing pre and postoperative brain volume in magnetic resonance imaging (MRI) studies of NPH patients who underwent ventriculoatrial shunting at our institution between April 2016 and February 2022. Brain volumes were obtained using volBrain and vol2Brain software. 30 patients were included, and 60 MRI studies reviewed. The average age was 80.4 years (54–92 years). 20 patients (66.6%) were men and 10 women. Following CSF shunting, patients had a statistically significant increase in white matter ( p  = 0.043), gray matter ( p  = 0.002), and total brain parenchyma ( p  = 0.032). The brain volume increased in postoperative MRI. We call this finding cerebral pseudoatrophy, which has not been previously described. Further studies are required to confirm this finding, which poses relevance for the accurate diagnosis of NPH.

To determine the role of early acquisition of blood oxygen level-dependent (BOLD) signals and diffusion tensor imaging (DTI) for analysis of the connectivity of the ascending arousal network (AAN) in predicting neurological outcomes after acute traumatic brain injury (TBI), cardiopulmonary arrest (CPA), or stroke. A prospective analysis of 50 comatose patients was performed during their ICU stay. Image processing was conducted to assess structural and functional connectivity of the AAN. Outcomes were evaluated after 3 and 6 months. Nineteen patients (38%) had stroke, 18 (36%) CPA, and 13 (26%) TBI. Twenty-three patients were comatose (44%), 11 were in a minimally conscious state (20%), and 16 had unresponsive wakefulness syndrome (32%). Univariate analysis demonstrated that measurements of diffusivity, functional connectivity, and numbers of fibers in the gray matter, white matter, whole brain, midbrain reticular formation, and pontis oralis nucleus may serve as predictive biomarkers of outcome depending on the diagnosis. Multivariate analysis demonstrated a correlation of the predicted value and the real outcome for each separate diagnosis and for all the etiologies together. Findings suggest that the above imaging biomarkers may have a predictive role for the outcome of comatose patients after acute TBI, CPA, or stroke.

Background and Objective: The discovery of novel molecular biomarkers via next-generation sequencing technologies has revolutionized how glioblastomas (GBMs) are classified nowadays. This has resulted in more precise diagnostic, prognostic, and therapeutic approaches to address this malignancy. The present work examines the applications of single-cell RNA sequencing (scRNA-seq) in GBM, focusing on its potential to address tumor complexity and therapeutic resistance and improve patient outcomes. Methods: A scoping review of original studies published between 2009 and 2024 was conducted using the PUBMED and EMBASE databases. Studies in English or Spanish related to single-cell analysis and GBM were included. Key Findings: The database search yielded 453 publications. Themes related to scRNA-seq applied for the diagnosis, prognosis, treatment, and understanding of the cancer biology of GBM were used as criteria for article selection. Of the 24 studies that were included in the review, 11 focused on the tumor microenvironment and cell subpopulations in GBM samples, 5 investigated the use of sequencing to elucidate the GBM cancer biology, 3 examined disease prognosis using sequencing models, 3 applied translational research through scRNA-seq, and 2 addressed treatment-related problems in GBM elucidated by scRNA-seq. Conclusions: This scoping review explored the various clinical applications of scRNA-seq technologies in approaching GBM. The findings highlight the utility of this technology in unraveling the complex cellular and immune landscapes of GBM, paving the way for improved diagnosis and personalized treatments. This cutting-edge approach might strengthen treatment strategies against tumor progression and recurrence, setting the stage for multi-targeted interventions that could significantly improve outcomes for patients with aggressive, treatment-resistant GBMs.

BackgroundTrigeminal schwannoma is a rare type of tumor that arises from the Schwann cells of the trigeminal nerve.MethodWe present a case of a patient with a giant V2 trigeminal schwannoma with painful swelling in the left maxilla. A complete resection using a combined open maxillectomy and endoscopic endonasal approach was performed.ConclusionThis case highlights the importance of a multidisciplinary approach to perform a combined open and endoscopic approach for safe resection while preserving adequate speech and swallowing.

This study aims to describe resting state networks (RSN) in patients with disorders of consciousness (DOC)s after acute severe traumatic brain injury (TBI). Adult patients with TBI with a GCS score <8 who remained in a coma, minimally conscious state (MCS), or unresponsive wakefulness syndrome (UWS), between 2017 and 2020 were included. Blood-oxygen-level dependent imaging was performed to compare their RSN with 10 healthy volunteers. Of a total of 293 patients evaluated, only 13 patients were included according to inclusion criteria: 7 in coma (54%), 2 in MCS (15%), and 4 (31%) had an UWS. RSN analysis showed that the default mode network (DMN) was present and symmetric in 6 patients (46%), absent in 1 (8%), and asymmetric in 6 (46%). The executive control network (ECN) was present in all patients but was asymmetric in 3 (23%). The right ECN was absent in 2 patients (15%) and the left ECN in 1 (7%). The medial visual network was present in 11 (85%) patients. Finally, the cerebellar network was symmetric in 8 patients (62%), asymmetric in 1 (8%), and absent in 4 (30%). A substantial impairment in activation of RSN is demonstrated in patients with DOC after severe TBI in comparison with healthy subjects. Three patterns of activation were found: normal/complete activation, 2) asymmetric activation or partially absent, and 3) absent activation. •Impaired consciousness following severe traumatic brain injury is a major cause of disability.•No tests or scales can accurately predict disorders of consciousness (DOC) prognosis.•rsfMRI reveals resting state networks linked to DOC severity.•Key brain networks might predict DOC outcomes.

Establish the evolution of the connectome before and after resection of motor area glioma using a comparison of connectome maps and high-definition differential tractography (DifT). DifT was done using normalized quantitative anisotropy (NQA) with DSI Studio. The quantitative analysis involved obtaining mean NQA and fractional anisotropy (FA) values for the disrupted pathways tracing the corticospinal tract (CST), and white fiber network changes over time. We described the baseline tractography, DifT, and white matter network changes from two patients who underwent resection of an oligodendroglioma (Case 1) and an IDH mutant astrocytoma, grade 4 (Case 2). Case 1. There was a slight decrease in the diffusion signal of the compromised CST in the immediate postop. The NQA and FA values increased at the 1-year follow-up (0.18 vs. 0.32 and 0.35 vs. 0.44, respectively). Case 2. There was an important decrease in the immediate postop, followed by an increase in the follow-up. In the 1-year follow-up, the patient presented with radiation necrosis and tumor recurrence, increasing NQA from 0.18 in the preop to 0.29. Fiber network analysis: whole-brain connectome comparison demonstrated no significant changes in the immediate postop. However, in the 1-year follow up there was a notorious reorganization of the fibers in both cases, showing the decreased density of connections. Connectome studies and DifT constitute new potential tools to predict early reorganization changes in a patient’s networks, showing the brain plasticity capacity, and helping to establish timelines for the progression of the tumor and treatment-induced changes. •Differential NQA and FA values are subjective measurements of the preservation of function postoperatively.•Our study sheds light on how the connectome undergoes sequential reorganization in an evolving manner, varying on a case-by-case basis.•The reorganization of the fibers and changes in the values may not necessarily correlate with clinical outcomes, particularly in high-grade gliomas.•DfT directly reflects brain plasticity; however, functionality prediction requires more sophisticated methods, such as predictability models.

Background Intracranial aneurysms (IAs) pose a significant clinical threat due to their potential to rupture, often resulting in subarachnoid hemorrhage and high mortality. While imaging and computational models have improved aneurysm characterization, accurate rupture risk prediction remains elusive. MicroRNAs (miRNAs), which are short non-coding RNA molecules that modulate gene expression after transcription, have gained attention as promising, non-invasive biomarkers with the potential to detect molecular changes that occur prior to aneurysm rupture. This review synthesizes current evidence on miRNAs’ diagnostic and pathophysiological relevance in IA rupture risk assessment. Methods A scoping review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A systematic search of six databases (PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, and Google Scholar) identified human studies comparing miRNA expression profiles in ruptured versus unruptured intracranial aneurysms using blood, serum, plasma, cerebrospinal fluid, or aneurysmal tissue. The search was performed from 2010 until March 2025. Eligible studies reported differential expressions or diagnostic performance metrics. Extracted data included study design, biological matrix, analytical techniques, evaluated miRNA targets, and correlation with rupture risk. Results A total of 21 studies were included. Upregulated miRNAs in ruptured intracranial aneurysms (IAs) included miR-29a, miR-574-5p, miR-151a-3p, and miR-652-3p, whereas miR-143, miR-145-5p, miR-21, and miR-125b-5p were commonly downregulated. These dysregulations were linked to extracellular matrix remodeling, vascular inflammation, and apoptosis. Diagnostic analyses identified strong discriminatory performance for plasma miR-574-5p, miR-151a-3p, and miR-652-3p (AUCs 0.92–0.99). Additional candidates such as miR-126 (AUC 0.897) and circulating miR-16/25 (AUCs 0.85–0.88) also showed high accuracy, while tissue-based studies revealed that downregulation of miR-125b-5p, miR-143-3p, and miR-199a-5p correlated with poor WFNS grade. Overall, selected miRNAs, most notably miR-125b-5p, miR-574-5p, miR-29a, miR-126, and miR-16/25, emerged as promising minimally invasive biomarkers for rupture risk prediction. Conclusions Circulating and exosomal miRNAs offer a compelling non-invasive IA rupture risk stratification strategy. However, clinical translation demands standardized methodologies, larger cohorts, and imaging and computational tools.

ObjectiveRadiation therapy is often advocated for residual or recurrent craniopharyngioma following surgical resection to prevent local recurrence. However, radiation therapy is not always effective and may render tumors more difficult to remove. If this is the case, patients may benefit more from reoperation if gross total resection can be achieved. Nevertheless, there is little data on the impact of radiation on reoperations for craniopharyngioma. In this study, we sought to analyze whether a history of previous radiation therapy (RT) affected extent of resection in patients with recurrent craniopharyngiomas subsequently treated with reoperation via endoscopic endonasal approach (EEA).MethodsThe authors reviewed a prospectively acquired database of EEA reoperations of craniopharyngiomas over 13 years at Weill Cornell, NewYork-Presbyterian Hospital. All procedures were performed by the senior author. The operations were separated into two groups based on whether the patient had surgery alone (group A) or surgery and RT (group B) prior to recurrence.ResultsA total of 24 patients (16 male, 8 female) who underwent surgery for recurrent craniopharyngioma were identified. The average time to recurrence was 7.64 ± 4.34 months (range 3–16 months) for group A and 16.62 ± 12.1 months (range 6–45 months) for group B (p < 0.05). The average tumor size at recurrence was smaller in group A (1.85 ± 0.72 cm; range 0.5–3.2) than group B (2.59 ± 0.91 cm; range 1.5–4.6; p = 0.00017). Gross total resection (GTR) was achieved in 91% (10/11) of patients in group A and 54% (7/13) of patients in group B (p = 0.047). There was a near significant trend for higher average Karnofsky performance status (KPS) score at last follow-up for group A (83 ± 10.6) compared with group B (70 ± 16.3, p = 0.056).ConclusionsWhile RT for residual or recurrent craniopharyngioma may delay time to recurrence, ability to achieve GTR with additional surgery is reduced. In the case of recurrent craniopharyngioma, if GTR can be achieved, consideration should be given to endonasal reoperation prior to the decision to irradiate residual or recurrent tumor.

In recent years, the endoscopic endonasal approach (EEA) for craniopharyngiomas has proven to be a safe option for extensive tumor resection, with minimal or no manipulation of the optic nerves and excellent visualization of the superior hypophyseal branches when compared to the Transcranial Approach (TCA). However, there is an ongoing debate regarding the criteria for selecting different approaches. To explore the current results of EEA and discuss its role in the management of craniopharyngiomas, we performed MEDLINE, Embase, and LILACS searches from 2012 to 2022. Baseline characteristics, the extent of resection, and clinical outcomes were evaluated. Statistical analysis was performed through an X2 and Fisher exact test, and a comparison between quantitative variables through a Kruskal–Wallis and verified with post hoc Bonferroni. The tumor volume was similar in both groups (EEA 11.92 cm3, -TCA 13.23 cm3). The mean follow-up in months was 39.9 for EEA and 43.94 for TCA, p = 0.76). The EEA group presented a higher visual improvement rate (41.96% vs. 25% for TCA, p < 0.0001, OR 7.7). Permanent DI was less frequent with EEA (29.20% vs. 67.40% for TCA, p < 0.0001, OR 0.2). CSF Leaks occurred more frequently with EEA (9.94% vs. 0.70% for TCA, p < 0.0001, OR 15.8). Recurrence rates were lower in the EEA group (EEA 15.50% vs. for TCA 21.20%, p = 0.04, OR 0.7). Our results demonstrate that, in selected cases, EEA for resection of craniopharyngiomas is associated with better results regarding visual preservation and extent of tumor resection. Postoperative CSF leak rates associated with EEA have improved compared to the historical series. The decision-making process should consider each person’s characteristics; however, it is noticeable that recent data regarding EEA justify its widespread application as a first-line approach in centers of excellence for skull base surgery.