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PET imaging with [18F]F-DOPA shows great promise for assessing paediatric gliomas. Manual tumour delineation and parameter extraction are time-consuming and prone to inter-operator variability. We evaluated whether a deep learning model, leveraging transfer learning from adult glioma datasets, could enable a fully automated pipeline for tumour segmentation and PET parameter extraction. Static and dynamic parameters were compared across three approaches: (i) automatic vs semi-automatic, (ii) automatic vs manual, and (iii) manual vs. semi-automatic. Data from 103 paediatric patients (median age 11&#xa0;years; 54 females, 49 males) with static and/or dynamic [18F]F-DOPA PET scans (2011-2024) were retrospectively included for fine-tuning the deep learning model. Statistical and survival analyses were performed on 90 subjects; dynamic analysis included 32 patients. &#xa0;The best model achieved a Dice score of 0.82&#x2009;&#xb1;&#x2009;0.11 and was integrated into the pipeline for extracting static and dynamic indices. Automatic Tumour-to-Striatum ratio showed high reproducibility across comparisons ((i) p&#x2009;=&#x2009;0.660, (ii) p&#x2009;=&#x2009;0.342, (iii) p&#x2009;=&#x2009;0.639), while Tumour-to-Background differed significantly when comparing manual delineations (p&#x2009;<&#x2009;0.01). Dynamic parameters demonstrated good reproducibility with the automatic method (p&#x2009;>&#x2009;0.05). Importantly, both automated static indices correlate significantly with tumour grade, with the overall and progression-free survival (p&#x2009;<&#x2009;0.05). &#xa0;Transfer learning enabled a fully automatic [18F]F-DOPA PET pipeline for paediatric gliomas, providing reproducible static and dynamic parameter extraction and correlating with clinically relevant outcomes. This approach reduces operator dependence and streamlines analysis, supporting potential integration into routine clinical practice.

Condylar screws have broadened fixation options for Craniocervical Fusion techniques and are used when occipital squama anchorage is inadequate. They may also outperform barplate constructs in patients with connective tissue disorders. The condyles are entirely dissected, sacrificing the Posterior Condylar Emissary Vein. An entry 3&#xa0;mm lateral to the foramen magnum is created. Hand drilling converges&#xa0;20&#xb0; medially, aiming toward the basion under&#xa0;fluoroscopy, under continuous hypoglossal EMG monitoring. A 34-mm lag screw is inserted and confirmed by intraoperative CT. Condylar screws provide reliable fixation and are a useful adjunct to contemporary CCF techniques.

The aim of this study is to identify research directions focused on epidural hematoma (EDHs) from past to present using bibliometric approaches, uncover current research trends through keyword analyses, delineate global productivity, and identify impactful studies through citation analyses. The study obtained 1785 articles related to EDH published between January 1, 1980, and December 31, 2023, from the Web of Science database, and comprehensive analyses were conducted using various bibliometric and statistical approaches. These analyses include citation and co-citation analyses, trend keyword analysis, multiple correspondence analysis, thematic evolution analysis, and various other bibliometric analyses. The bibliometric analyses were performed using Biblioshiny and VOSviewer. The top 3 journals contributing the most to the literature were Acta Neurochirurgica (n&#x2005;=&#x2005;56, 3.1%), British Journal of Neurosurgery (48, 2.6%), and Neurosurgery (47, 2.6%). According to the h-index, the most influential top 3 journals were Neurosurgery (h&#x2005;=&#x2005;27), Acta Neurochirurgica (h&#x2005;=&#x2005;23), and Surgical Neurology (h&#x2005;=&#x2005;21). Based on the m-index, the most influential top 3 journals were World Neurosurgery (m&#x2005;=&#x2005;0.9), Medicine (m&#x2005;=&#x2005;0.63), and Neurosurgery (m&#x2005;=&#x2005;0.6). The most active country was the United States of America (n&#x2005;=&#x2005;593), the most active author was Mahapatra AK (n&#x2005;=&#x2005;10), and the most active institution was Harvard University (n&#x2005;=&#x2005;25). Research interest in EDH has evolved over time, with notable increases in publication trends in 1968, 1982, and 1988, peaking in 1996 and 2004. Bibliometric analyses indicate that key topics such as spinal EDH, head injuries, magnetic resonance imaging, spontaneous spinal EDH, computed tomography, spine, complications, epidural, anticoagulants, pediatric cases, and trauma have stood out in EDH research. Trend analysis findings have shown an increasing focus on specific areas such as clinical management approaches, treatment methods, postoperative complications, risk factors, pediatric cases, as well as specific conditions like paralysis and cauda equina syndrome. Multiple correspondence analysis identified 6 core research dimensions, focusing on acute trauma management, surgical interventions, complications management, risk assessment, surgical outcomes, and incidence analysis.

Fusiform posterior inferior cerebellar artery (PICA) aneurysms are technically challenging for both microsurgical and endovascular approaches, particularly when PICA is at high risk for occlusion. Optimal outcomes may be achieved through a collaborative hybrid strategy. We present a single-stage hybrid minimally invasive technique for fusiform PICA aneurysm management, involving microsurgical PICA-PICA revascularization and endovascular coil embolization for definitive aneurysm occlusion in the hybrid operating suite. Combining microsurgical and endovascular modalities allows durable aneurysm exclusion while preserving PICA flow. This hybrid approach leverages the strengths of both techniques, offering a safe and effective option for complex PICA aneurysms.

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The 2023 American Heart Association/American Stroke Association guideline and Wessels et al's 2024 randomized controlled trial highlight the potential benefits of intracranial nicardipine for aneurysmal subarachnoid hemorrhage (aSAH). This study aims to systematically identify the publication trends and research hotspots in this field through bibliometric analysis. Relevant publications were sourced from the Web of Science Core Collection (WoSCC). Bibliometric and visualization analyses were conducted using the online tools of the WoSCC database and CiteSpace 6.2.R6. Analysis of 28 articles published by 158 researchers from 55 institutions across 8 countries revealed an intermittent small-scale growth in annual publication volume from 1994 to 2024, with a continuous rise in annual citation volume since 2005, indicating growing interest in the field. Japan, Germany, and the United States of America (USA) were the most prolific and influential countries. Institutions such as Tokyo Women's Medical University showed particularly significant contributions. Kasuya Hidetoshi was the most prolific author. There was little global collaboration among countries, institutions, and authors, with distinct regional research characteristics: Japan and Germany focused on intracranial implants, while the USA concentrated on intrathecal injections. Major publishing and co-cited journals included Neurocritical Care, Acta Neurochirurgica, Journal of Neurosurgery, and Stroke. Popular keywords in 2024 included "preventing cerebral vasospasm", "delayed cerebral ischemia", "outcome events", and "clinical trials", revealing current research hotspots. This study maps the global clinical research landscape of intracranial application of nicardipine for aSAH from 1994 to 2024, providing valuable references and guidance for future research.

Wilhelm T&#xf6;nnis is considered the founder of postwar neurosurgery in West Germany. He was able to draw on a network of prewar and wartime colleagues and trained young colleagues who took up most of the leading neurosurgical positions in the first postwar decades. Interdisciplinary collaboration was important to him, especially with pathologists, radiologists, and neurologists. He was unable to reconnect with the broad international network of the prewar period. However, he maintained contact with his teacher Olivecrona in Sweden, other Scandinavian colleagues, and students from Italy, southeastern Europe, and South America. The network is illustrated by the description of his clinical and research staff and his colloquia, the authors of the Handbuch der Neurochirurgie (Handbook of Neurosurgery), which he co-founded, and the editors of the neurosurgical journals Zentralblatt f&#xfc;r Neurochirurgie and Acta Neurochirurgica. T&#xf6;nnis' significant influence on the emancipation of neurosurgery in the postwar decades becomes evident.

Social media promotion has become mainstream for neurosurgical publications. Any effect of promotion on citation counts would significantly influence academia and is currently not well-studied. We previously reported that structured social media promotion of neurosurgical articles had no significant effect on citation counts, website visits, or PDF downloads at one- and two-years post promotion. In this study, we assess whether a longer follow-up period has altered these previously reported results, since citation counts typically follow a Poisson-like distribution, increasing gradually and often peaking several years after publication. We followed up the original 177 articles published in Acta Neurochirurgica between May and September 2020 which were randomised either to the social media intervention (single Twitter/X post, n&#x2009;=&#x2009;89) or to the control group (no promotion, n&#x2009;=&#x2009;88). The primary outcome (citation counts) and secondary outcomes (website visits and altmetrics) were reassessed 4.5&#xa0;years post-promotion. Between-group comparisons were performed using Welch's t-tests. A sensitivity analysis was conducted using negative binomial regression models, better approximating the non-linear distribution of citation counts. At 4.5&#xa0;years, there was no significant difference between intervention and control groups for citation counts (12.76&#x2009;&#xb1;&#x2009;12.18 vs. 16.47&#x2009;&#xb1;&#x2009;21.92, p&#x2009;=&#x2009;0.168) and website visits (1448&#x2009;&#xb1;&#x2009;1489 vs. 1503&#x2009;&#xb1;&#x2009;1692, p&#x2009;=&#x2009;0.818). Altmetric scores were significantly higher in the intervention group (5.15&#x2009;&#xb1;&#x2009;3.88 vs. 1.74&#x2009;&#xb1;&#x2009;3.68, p&#x2009;<&#x2009;0.001). The sensitivity analysis confirmed these findings, showing no significant difference in citation counts (IRR 0.78; 95% CI: 0.57-1.05; p&#x2009;=&#x2009;0.101) but a significant increase in Altmetric scores (IRR 2.96; 95% CI: 2.09-4.19; p&#x2009;<&#x2009;0.001). A longer observation time did not result in a significant difference in citation counts or website visits. Promoted articles were consistently associated with increased Altmetric scores. A low-intensity social media promotion may broaden visibility but does not influence long-term citations. More intensive promotion strategies have demonstrated short-term gains, but their ability to produce sustained long-term impact remains uncertain and warrants further investigation.

The incidence of nerve entrapment-related diseases, caused by a variety of factors, has been increasing annually, significantly impairing patients' quality of life. Nerve decompression serves as one of the critical approaches for treating such conditions. However, there remains a scarcity of bibliometric analyses within the field of nerve decompression. The publications related to nerve decompression in the Web of Science database from 2005 to 2024 were collected. Bibliometric methods were used to analyze the basic components of publications, synthesize research trends, and predict future research hotspots. A total of 606 publications were included in our study, with the number of publications ranging from 16 in 2005 to 52 in 2024. In terms of countries, the United States occupies a central position in both the number of publications (213 publications) and the quality (H-index = 34) and works closely with other countries. In terms of publishing institutions, Shanghai Jiao Tong University has the largest number of 18 publications. Acta Neurochirurgica is the journal with the highest number of 27 publications. The focus of research in this field can be divided into 3 main categories: cranial nerves, upper limb nerves, and lower limb nerves. The topic of research has gradually transferred to the lower limb nerve, and the keyword sacral nerve will be a hot topic in this field. This is the first bibliometric study to comprehensively summarize trends and hotspots in nerve decompression research. Our findings shed light on future research directions, international collaborations, and interdisciplinary relationships. The sacral nerve has emerged as a current and potential future research hotspot, warranting further exploration.

Familial cerebral cavernous malformations (fCCMs) are a rare genetic autosomal dominant cerebrovascular disease characterized by multiple cerebral and spinal angiomas. The condition is caused by mutations in KRIT1 (CCM1), CCM2 (malcavernin), or PDCD10 (CCM3) and may lead to intracerebral hemorrhage (ICH) or non-hemorrhagic focal neurological deficits (FNDs), potentially leading to severe disability and even death. To date, little is known about disease progression, and tools to identify patients at higher risk are lacking. Pediatric and adult fCCM patients, whether symptomatic or asymptomatic, will be enrolled and followed annually over a 2-year period. Participants will undergo clinical assessments, blood sampling, and 3&#x202f;T brain MRI scans at baseline, 12&#x202f;months, and 24&#x202f;months. The primary outcome is the new occurrence of symptomatic ICH or FNDs attributable to CCMs over 24&#x202f;months. Patient characteristics will be assessed for the primary and secondary endpoints and illustrated using Kaplan-Meier curves and Cox proportional hazard regressions. This trial is registered with ClinicalTrials.gov, NCT06983132 and is currently recruiting participants. Despite increasing efforts in basic and clinical research and an improved understanding of the pathogenic mechanisms underlying fCCM, tools to predict disease progression, identify at-risk individuals, and pinpoint effective therapeutic targets are still lacking. This study aims to create the largest Italian cohort of fCCM patients, who will be monitored closely over time to collect data that may help identify risk factors and disease trajectories. The collection of standardized information on clinical and radiological evolution, along with results from circulating biomarkers, will help address the complexities of the disease and may suggest potential reliable markers of disease progression. ClinicalTrials.gov, identifier NCT06983132.

The data available at the national level in Italy regarding elective neurosurgical and neuroradiological procedures are limited. This survey aimed to explore clinical practices across Italian centers, focusing on anesthetic strategies, monitoring, and postoperative management. A nationwide survey was conducted, collecting data from centers performing elective craniotomies and interventional neuroradiology. Questions addressed procedural volumes, anesthesia type, monitoring tools, and intraoperative and postoperative management. Among 49 responding centers, 21 were high-volume (>150 craniotomies/year). Intravenous anesthesia was the preferred anesthesia method, though not uniformly applied across volume groups. Awake craniotomy was rarely performed, even in high-volume centers. Bispectral Index&#x2122; monitoring was reported in 71.7% of centers, but without correlation to center volume. Anti-epileptic prophylaxis was routinely used in 73.9% of high-volume centers. Practices regarding intraoperative awakening and postoperative computer tomography scans varied widely: 53.5% performed them routinely in the postoperative period. In addition, 42.5% of physicians still adopted delayed awakening for neuroprotection purposes. Intensive care unit admission was not universally applied, reflecting a growing trend toward selective monitoring and enhanced recovery protocols. Large-volume centers do not always align with the best evidence available, albeit the limitation in the literature. In many centers, there is still indiscriminate use of anti-epileptic prophylaxis, admission to the critical care unit after craniotomy, and computed tomography in conscious patients in the immediate postoperative period: habits and preferences, however, for which there are no clear and consistent answers in the literature. This survey reveals significant heterogeneity in the anesthetic and perioperative practices across Italian centers, independent of surgical volume. The absence of a dedicated national database limits broader analysis. Establishing such a registry could guide protocol standardization, training, and resource optimization in elective neurosurgical and neuroradiological care.

Introduction. Moral Distress in the nursing profession represents an increasingly important issue. Patients undergoing dialysis treatment have a long and complex clinical path and the nurse is required to express clinical decisions balancing the obligations of care not only towards patients and family members, but also towards himself and the organization. It therefore happens that the nurse finds himself in situations in which he is not able to translate his moral beliefs into ethically concrete actions causing a sense of anguish and frustration. Objective. To identify and describe the predisposing factors and strategies to address the phenomenon of Moral Distress in nurses who work in dialysis. Method. A literature review was conducted from 01/01/2024 to 09/30/2024 by consulting four databases: PubMed, Embase, CINAHL and Scopus. The study included primary experimental, quasi-experimental, observational, qualitative studies and secondary studies such as reviews, meta-analyses and scoping reviews, which described the phenomenon of Moral distress, its predisposing factors and the related strategies to deal with it in the context of dialysis. Results. The studies confirmed that the phenomenon of Moral Distress is very prevalent in the context of dialysis. The predisposing factors are related to: direct assistance with the dialysis patient (a), the work and organizational context (b) hierarchical barriers and impaired communication between nurses and the ward team (c). The strategies used suggest promoting the well-being of dialysis nursing staff; strategies such as: open communication with patients and relatives; opening of services that provide support on ethical reasoning and stress management; implementation of training activities regarding palliative care and end-of-life management. Discussion. Moral distress causes nursing staff working in dialysis to feel helpless, which can evolve into emotional exhaustion with physical and psychological repercussions that can affect the quality of care provided and increase abandonment of the profession. Conclusions. This literature review has identified the factors that determine the onset of Moral distress in the context of dialysis with the aim of outlining strategies to limit this phenomenon. In light of the results achieved, it becomes essential to implement research within nephrological contexts to prevent and contain the problem with the aim of ensuring high-quality care and at the same time the well-being of the professional.

Spontaneous intracerebral hemorrhage (ICH) accounts for 9-27% of all strokes worldwide and is associated with high mortality and disability. The main causes include vascular malformations, small- and large-vessel angiopathies, and coagulation disorders. Mortality rates reach approximately 40% at 1&#xa0;month and 54% at 1&#xa0;year, largely influenced by early management decisions. Rapid intervention, particularly within the first hour, is crucial, especially for patients initially treated in peripheral hospitals. This consensus document, developed by SIAARTI with the endorsement of multiple medical societies, aims to standardize ICH management based on hospital capabilities, aligning with the "time is brain" principle and the 2022 AHA guidelines. A multidisciplinary panel of experts-including neurointensivists, neuroanesthesiologists, neurologists, neuroradiologists, emergency physicians, and neuroscience nurses-developed this consensus document. The process combined a systematic literature review with a modified Delphi method, prioritizing clinical questions using the UCLA-RAND appropriateness methodology. Literature searches were conducted on PubMed following PRISMA 2020 guidelines. Statements were formulated based on both evidence and expert consensus, and the final document underwent external peer review. Computer tomography (CT) angiography, with over 90% sensitivity and specificity, is a key tool for identifying macrovascular abnormalities and detecting active bleeding, a critical factor in poor outcomes. Prognostic models, such as the ICH score, assist in clinical decision-making. Strict blood pressure control (target 130-140&#xa0;mmHg) and early intubation in appropriate cases help mitigate hematoma expansion. Anticonvulsants are recommended only for patients with documented seizures. In cases of anticoagulant-related hemorrhage, prothrombin complex concentrates are effective for rapid reversal, though their long-term impact remains uncertain. Intensive care unit (ICU) admission is determined by ICH severity, with severe cases benefiting from specialized neurocritical care. A multidisciplinary and inter-societal discussion provided key recommendations for the immediate management of ICH, based on the available literature. While only a few topics are supported by robust evidence, experts strongly recommend early brain angio CT, risk stratification using scoring systems, clear communication of patient data, and intubation for impaired consciousness. Blood pressure should be controlled with alpha- and beta-blockers, avoiding hypotension. Anticoagulant reversal should be appropriately managed, and eligible patients should be centralized in ICU and neurosurgical centers using dedicated scoring systems.

Despite serving over 10 million inhabitants, neurocritical care across the Lombardy region of Italy (from here on Lombardia) remains fragmented and insufficiently mapped, underscoring the need for a structured regional network. This study aimed to evaluate current resources and explore pathways for integration and development. In 2024, along with other initiatives, a web-based survey was performed, focusing on hospitals with neurosurgical capabilities and intensive care units (ICUs) to identify variations in service delivery and adherence to evidence-based practices, guiding quality improvement across centers. Responses were obtained from 19 acute care hospitals with neurosurgical facilities within the regional health service. Ten hospitals (52%) host dedicated neuro-ICUs, including five (26%) that also admit pediatric patients, accounting for a total of 85 beds. In the remaining nine hospitals (47%), neurocritical care is delivered within general ICUs without dedicated beds. Continuous in-house neurosurgical coverage is available in 9 centers (47%), while the others rely on a 24/7 on-call model. All 19 centers (100%) report 24/7 availability of neurologists and neuroradiologists, either in-house or on call. However, access to advanced diagnostic and monitoring technologies remains heterogeneous across sites. Participating centers identified a clear need for standardized protocols and clinical pathways to improve care quality and support evidence-based practices. Priority areas defined by the clinicians include neuroprognostication, end-of-life care and donor management, pediatric neurocritical care, neurointerventional procedures, management of delayed cerebral ischemia following subarachnoid hemorrhage, and post-discharge follow-up. To address these gaps, several multidisciplinary working groups have been established. Neurocritical care in Lombardia remains highly heterogeneous, with bed availability significantly below international benchmarks. The establishment of a regional network seeks to enhance the quality and equity of care for neurocritical patients, while also fostering clinical research, data sharing, and multidisciplinary collaboration across centers.

Isolated oculomotor nerve palsy (ONP) following mild traumatic brain injury (TBI) is rare and often presents diagnostic challenges. Typically associated with diffuse axonal injury and poor prognosis, ONP lacks comprehensive radiological documentation when no skull base fractures along the course of the 3rd Nerve or brainstem injuries are evident. This study explores the diagnostic utility of contrast-enhanced magnetic resonance imaging (CEMRI) in identifying ONP cases in mild TBI patients. A retrospective analysis was conducted on six patients diagnosed with isolated ONP after mild TBI, with no evident skull base fractures along the course of the 3rd Nerve or brainstem findings. All patients underwent CE-MRI to identify structural or vascular anomalies along the course of the third cranial nerve. Clinical presentations, imaging findings, and outcomes were meticulously documented and reviewed by a neuroradiologist. CE-MRI findings revealed consistent abnormalities in all cases. Thickening, blooming, and post-contrast enhancement of the cisternal portion of the third cranial nerve were observed, with two cases demonstrating extension into orbital segments. Despite the absence of fractures or direct injuries, partial recovery was noted in most cases, facilitated by targeted steroid therapy in some instances. These imaging patterns suggest indirect mechanisms such as traction, vascular compromise, or intraneural hemorrhage as potential causes of ONP. High-resolution CE-MRI proves instrumental in diagnosing isolated ONP in mild TBI patients, even without conventional radiological indicators. Early imaging and intervention may improve recovery outcomes. This study underscores the significance of including CE-MRI in evaluation protocols for ONP. It highlights the importance of further research to unravel the underlying pathophysiology and optimize therapeutic approaches for these patients.