Search Results (72)

Background/Objectives: Schwannoma is a rare tumor, typical in young adults, originating from the myelin sheath that surrounds Schwann cells. It can occur in any part of the Peripheral Nervous System (PNS). It develops in the head and neck region in 25–48% of cases, and the eighth pair of cranial nerves (vestibulocochlear nerves) are the most hit (vestibular schwannoma). Oral cavity involvement is exceedingly rare, accounting for about 1–2% of all cases. The most affected oral site is the tongue, especially its anterior third, while localization on the lip is one of the least common sites for the development of this lesion. Case Presentation: A lower lip schwannoma on a 17-year-old boy, present for about 7 years, was documented. Material and Methods: PubMed and Google Scholar were used as research engines; English scientific works published in the last 20 years (2005–2024) regarding oral cavity involvement, using the keywords “Schwannoma”, “Oral Schwannoma”, “Pediatric Oral Schwannoma”, and “Schwannoma of the lip”, were considered. Results: In total, 805 and 16,890 items were found on PubMed and Google Scholar search engines, respectively. After title, abstract, full text evaluation, and elimination of duplicates, 26 articles were included in the review process. Discussion: Clinically, oral schwannoma presents as an asymptomatic hard–elastic fluctuating mass, often misdiagnosed on the lip as a traumatic or inflammatory lesion (e.g., mucocele). Biopsy is mandatory, and histological examination reveals positivity to the neuronal marker S-100. Conclusions: Complete excision also prevents recurrence. Malignant transformation is extremely rare. Full article

Background/Objectives: Pain is the most frequently reported symptom in over 90% of patients presenting with traumatic injuries, and three-quarters of patients are discharged from emergency departments experiencing moderate to severe pain. The objective of this study was to compare the frequency of analgesic administration between patients with chest pain presumed to be of cardiac origin and those with suspected bone fractures as well as to assess whether significant differences exist between these two groups. Methods: A retrospective, observational study was conducted. Patients were categorized into two groups: Group 1—patients with angina pectoris, acute myocardial infarction, or non-specific chest pain; and Group 2—patients with a preliminary diagnosis of bone fracture made by the attending physician at the scene. Results: A total of 1189 patients were included in this study, with 503 (42.3%) in Group 1 and 686 (57.7%) in Group 2 (χ² = 28.166; p < 0.001). Analgesic administration was significantly more frequent among patients in Group 1 than in Group 2 (χ² = 23.187; p < 0.001). Within Group 1, the highest rate of analgesic use was recorded in patients diagnosed with acute myocardial infarction. In Group 2, analgesics were administered to 36.4% of patients with suspected trunk bone fractures, while only 7.1% of patients with suspected cranial fractures received analgesic therapy. Pain intensity scores were not available for either group. Conclusions: The administration of analgesic treatment was significantly more common among patients presenting with chest pain of presumed cardiac origin than among those with suspected bone fractures, including fractures involving multiple body regions. Full article

Background and Clinical Significance: Traumatic brain injury (TBI) represents a major public health concern due to its profound neurological, psychological, and socioeconomic consequences. Effective management is essential to optimize patient outcomes and reduce healthcare burden. In cases involving extensive bone loss or complex fractures, particularly when decompressive craniectomy (DC) is considered, secondary cranial reconstruction is typically required. However, DC is associated with prolonged hospitalization, multiple surgical interventions, an increased risk of complications, and higher costs. Case Presentation: We present the case of a 59-year-old male involved in a high-energy bicycle accident, sustaining severe craniofacial trauma with multiple midface fractures, a multifragmented left cranial fracture, and a left-sided epidural hematoma with brain compression. Hematoma evacuation and immediate primary reconstruction of the fractured skull using autologous bone were successfully performed, avoiding the need for DC. The patient recovered under intensive care and was transferred to a neurorehabilitation center. Conclusions: Primary reconstruction of large skull fractures using autologous bone should remain the goal, whenever possible, in order to avoid additional costs, risks, and complications. Full article

Cerebral near-infrared spectroscopy (NIRS) systems have been demonstrated to continuously measure aspects of oxygen delivery and cerebrovascular reactivity. However, it remains unknown whether the prediction of these cerebral physiologic signals into the future is feasible. Leveraging existing archived data sources, four point and interval-forecasting methods using autoregressive integrative moving average (ARIMA) models were evaluated to assess their ability to predict NIRS cerebral physiologic signals. NIRS-based regional cerebral oxygen saturation (rSO₂) and cerebral oximetry index signals were derived in three temporal resolutions (10 s, 1 min, and 5 min). Anchored- and sliding-window forecasting, with varying model memory, using point and interval approaches were used to forecast signals using fitted optimal ARIMA models. The absolute difference in the forecasted and measured data was evaluated with median absolute deviation, along with root mean squared error analysis. Further, Pearson correlation and Bland–Altman statistical analyses were performed. Data from 102 healthy controls, 27 spinal surgery patients, and 101 traumatic brain injury patients were retrospectively analyzed. All ARIMA-based point and interval prediction models demonstrated small residuals, while correlation and agreement varied based on model memory. The ARIMA-based sliding-window approach performed superior to the anchored approach due to data partitioning and model memory. ARIMA-based sliding-window forecasting using point and interval approaches can forecast rSO₂ and the cerebral oximetry index with reasonably small residuals across all populations. Correlation and agreement between the predicted versus actual values varies substantially based on data-partitioning methods and model memory. Further work is required to assess the ability to forecast high-frequency NIRS signals using ARIMA and ARIMA-variant models in healthy and cranial trauma populations. Full article

Background and Aims: Cervical arterial dissections (CeAD) are a common cause of stroke in young adults across both sexes. Whether biological sex plays a role in the pathogenesis and outcome of CeAD remains unclear. Methods: In this retrospective analysis of a cohort of patients with CeAD, clinical, imaging, treatment, and outcome data were compared between females and males using multivariate logistic regressions to identify outcome predictors. Propensity score matching (PSM) was used to adjust for imbalances between the groups. Results: Overall, 135 participants were included (79 males and 56 females, median age 44, interquartile range [IQR] 36, 50.5). Of those, 71 patients (53%) were diagnosed with stroke (median age 46, IQR 39.5, 52, median admission NIHSS 3, IQR 1, 7.5). Males had significantly higher rates of smoking (38% vs. 11%, p = 0.0004) but other baseline characteristics did not differ between the groups. Traumatic dissections were numerically more common in men but the difference between the groups did not reach significance. The presence of flame shaped lesion in the extra cranial vessel was more common among men in the initial analysis of the whole group but did not remain significant after PSM. No differences were observed between the groups regarding treatment strategies including administration of systemic thrombolysis and stent placements. The rates of recurrent stroke and recurrent dissections were similar. Favorable outcomes defined as modified Rankin Score (mRS) ≤ 2 and symptomatic intracranial hemorrhage rates were also similar on the univariate analyses and did not change after PSM. Age (odds ratio [OR] 1.12, 95% confidence intervals [CI] 1.04–1.23) and admission NIHSS (OR 0.74, 95%CI 0.60–0.84) were associated with outcomes on regression analysis whereas female sex was not (OR 0.54, 95% CI 0.03–5.87). Conclusions: CeAD occurs more frequently in males, who are more likely to have associated risk factors and traumatic neck injuries. However, sex does not appear to impact outcome in CeAD patients. Full article

Background: Electric motorized rental scooters (ES) were introduced in Italy in 2019 as an alternative form of urban transportation, aiming to reduce traffic congestion and air pollution. As their popularity has grown, a parallel increase in ES-related injuries has been observed. This study aims to investigate the types and patterns of ES-related injuries and to identify potentially modifiable risk factors. Methods: We conducted a retrospective analysis of all consecutive patients admitted to the Emergency Department of Policlinico Umberto I in Rome between January 2020 and December 2022 following ES-related trauma. Collected data included demographics, injury mechanisms and types, helmet use, Injury Severity Score (ISS), blood alcohol levels, and patient outcomes. Results: A total of 411 individuals presented to the Emergency Department due to ES-related injuries, either as riders or pedestrians. The mean age was 31 years (range: 2–93); 38 patients (9%) were under 18 years of age. Fifty-six accidents (14%) occurred during work-related commutes. Only three riders (0.7%) wore helmets, and nine patients (2%) had blood alcohol levels > 0.50 g/L. Cranial injuries (134 cases, 32%) and upper limb fractures (93 cases, 23%) were the most frequently reported serious injuries. The mean ISS was 4.5; 17 patients (4%) had an ISS ≥ 16. A total of 270 orthopedic injuries and 118 (29%) maxillofacial injuries were documented. Head trauma was reported in 115 patients (28%), with 19 cases classified as severe traumatic brain injuries. Twenty-three patients (5.5%) were hospitalized, three (0.7%) required intensive care, and one patient (0.2%) died. Conclusions: ES-related injuries are becoming increasingly common and present a significant public health concern. A nationwide effort is warranted to improve rider safety through mandatory helmet use, protective equipment, alcohol consumption control, and stricter enforcement of speed regulations. Full article

Objective: The aim of this case report is to show the surgical treatment of cranial fasciitis in a 2-year-old patient. Cranial fasciitis is an uncommon, nonmalignant, and swiftly proliferating lesion that primarily involves the cranium, predominantly in the temporoparietal area. It mostly comprises smooth muscle tissue, connective tissue, and diverse immune cells. The lesion often manifests as an indurated, asymptomatic mass, averaging approximately 2.5 cm in size, although it may exceed 15 cm. Cranial fasciitis predominantly manifests in children below the age of 6. The diagnosis is validated via histological investigation, which identifies a benign tumor defined by the proliferation of spindle-shaped cells organized in a myxoid matrix, frequently displaying a storiform pattern. Methods: We present a case of cranial fasciitis in a 2-year-old pediatric patient, characterized by an atypical manifestation in the maxillary region. The lesion underwent surgical intervention resulting in total excision. Results: Three years after the surgery, the patient is asymptomatic and shows no signs of recurrence. Regular clinical follow-up and imaging are scheduled biannually, and the patient is anticipated to have a favorable long-term prognosis. Conclusions: Cranial fasciitis is a very rare benign lesion that occurs more commonly in childhood. In this case, surgical resection was effective, and three years later, the patient remains asymptomatic and free of recurrence, with a favorable long-term prognosis. Full article

Cranioplasty enables the restoration of cranial defects caused by traumatic injuries, brain tumour excisions, or decompressive craniectomies. Conventional methods rely on Computer-Aided Design (CAD) for implant design, which requires significant resources and expertise. Recent advancements in Artificial Intelligence (AI) have improved Computer-Aided Diagnostic systems for accurate and faster cranial reconstruction and implant generation procedures. However, these face inherent limitations, including the limited availability of diverse datasets covering different defect shapes spanning various locations, absence of a comprehensive pipeline integrating the preprocessing of medical images, cranial reconstruction, and implant generation, along with mechanical testing and validation. The proposed framework incorporates a robust preprocessing pipeline for easier processing of Computed Tomography (CT) images through data conversion, denoising, Connected Component Analysis (CCA), and image alignment. At its core is CRIGNet (Cranial Reconstruction and Implant Generation Network), a novel deep learning model rigorously trained on a diverse dataset of 2160 images, which was prepared by simulating cylindrical, cubical, spherical, and triangular prism-shaped defects across five skull regions, ensuring robustness in diagnosing a wide variety of defect patterns. CRIGNet achieved an exceptional reconstruction accuracy with a Dice Similarity Coefficient (DSC) of 0.99, Jaccard Similarity Coefficient (JSC) of 0.98, and Hausdorff distance (HD) of 4.63 mm. The generated implants showed superior geometric accuracy, load-bearing capacity, and gap-free fitment in the defected skull compared to CAD-generated implants. Also, this framework reduced the implant generation processing time from 40–45 min (CAD) to 25–30 s, suggesting its application for a faster turnaround time, enabling decisive clinical support systems. Full article

Background/Objectives: Childhood hemophilia, a hereditary bleeding disorder predominantly affecting males, arises due to gene mutations encoding clotting factors VIII or IX. Intracranial hemorrhage represents a significant and life-threatening complication in pediatric patients with hemophilia. The incidence of intracranial hemorrhage in children with hemophilia, although relatively low, is notably higher compared to the general pediatric population. Methods: In this study, the objective is to examine patients with hemophilia who have experienced intracranial hemorrhage retrospectively. This study is a multicenter, retrospective analysis using data from three tertiary care centers in a provincial city in Turkey. Data were obtained from the participants’ hospital records. The presence of inhibitors against FVIII in the participants and the prophylaxis used against them were included in the analysis. Trauma history was queried, with types of traumas examined, including traffic accidents, falls, and a traumatic vaginal delivery. The duration and causes of complaints among the participants were investigated. The causes of complaints were categorized as fever, hematoma, convulsions, loss of consciousness, and hemiparesis. The participants’ Physical Examination Findings were classified as fever, hematoma, and loss of consciousness. The duration of hospital stays was evaluated. The hemorrhage location was classified into five groups: parenchymal, subdural, scalp, subarachnoid, and multiple hemorrhagic foci. The recurrence of bleeding, the need for transfusion, surgical intervention, and mortality were also examined. Results: A significant difference was identified between the participants’ survival rates and age variables, as well as transfusion in <36 months. A total of 9 participants had spontaneous intracranial bleeding, 2 experienced cranial trauma as a result of traffic accidents, and 25 participants were exposed to head trauma due to falls. Of the remaining individuals, one suffered head trauma from a severe impact, and one had cranial trauma following a traumatic vaginal delivery. Fourteen participants required transfusion, and three underwent surgical intervention. Conclusions: According to the results of the statistical analyses, the variables Factor Level, Physical Examination Findings, Transfusion, Recurrent Bleeding, Inhibitor, and Prophylaxis were found to affect survival significantly. No significant relationship was determined between the other analyzed variables and survival. During our study, five of the participants examined died. Accordingly, the mortality rate identified in our study is 13.1%. Full article

According to the Centers for Disease Control and Prevention (CDC), the national public health agency of the United States, traumatic brain injury is among the leading causes of mortality and disability worldwide. The consequences of TBI include diffuse brain atrophy, local post-traumatic atrophy, arachnoiditis, pachymeningitis, meningocerebral cicatrices, cranial nerve lesions, and cranial defects. In 2019, the economic cost of injuries in the USA alone was USD 4.2 trillion, which included USD 327 billion for medical care, USD 69 billion for work loss, and USD 3.8 trillion for the value of statistical life and quality of life losses. More than half of this cost (USD 2.4 trillion) was among working-age adults (25–64 years old). Currently, the development of new diagnostic approaches and the improvement of treatment techniques require further experimental studies focused on modeling TBI of varying severity. Full article

Traumatic Brain Injury (TBI) is a significant global health concern, particularly in low- and middle-income countries (LMICs) where access to medical resources is limited. Decompressive craniectomy (DHC) is a common procedure to alleviate elevated intracranial pressure (ICP) following TBI, but the cost of subsequent cranioplasty can be prohibitive, especially in resource-constrained settings. We describe challenges encountered during the beta-testing phase of CranialRebuild 1.0, an automated software program tasked with creating patient-specific cranial implants (PSCIs) from CT images. Two pilot clinical teams in the Philippines and Ukraine tested the software, providing feedback on its functionality and challenges encountered. The constructive feedback from the Philippine and Ukrainian teams highlighted challenges related to CT scan parameters, DICOM file arrays, software limitations, and the need for further software improvements. CranialRebuild 1.0 shows promise in addressing the need for affordable PSCIs in LMICs. Challenges and improvement suggestions identified throughout the beta-testing phase will shape the development of CranialRebuild 2.0, with the aim of enhancing its functionality and usability. Further research is needed to validate the software’s efficacy in a clinical setting and assess its cost-effectiveness. Full article

Background: Augmentative and Alternative Communication (AAC) improved communicative skills in adults with post-stroke aphasia demonstrating the effectiveness in speech disorders and consequent improvement of patients’ communication skills. This study aimed to report the efficacy of AAC in the rehabilitation of cognitive disorders and to estimate how the changes in cognitive and communicative functions could enhance the quality of life in patients affected by severe acquired brain injury. Methods: Three patients with pontine cerebral ischemia, traumatic brain injury (TBI), and meningioma expressed in the posterior cranial fossa, respectively, were submitted to rehabilitative training with AAC for 6 months. Patients underwent to neuropsychological and mood evaluations at the beginning of AAC treatment (T0) and after rehabilitative training (T1). Results: The results support the efficacy of AAC in the improvement of cognitive functions, particularly in memory, attention, and language domains. In addition, we described also an improvement in the quality of life and a decrease in depressive symptoms. Conclusions: The AAC seems to be an important rehabilitative technique for the recovery of cognitive functions with a consequent effect in improvement of psychological aspects and quality of life in patients with Acquired Brain Injury (ABI). Full article

Despite continuous medical advancements, traumatic brain injury (TBI) remains a leading cause of death and disability worldwide. Consequently, there is a pursuit for biomarkers that allow non-invasive monitoring of patients after cranial trauma, potentially improving clinical management and reducing complications and mortality. Aquaporins (AQPs), which are crucial for transmembrane water transport, may be significant in this context. This study included 48 patients, with 27 having acute (aSDH) and 21 having chronic subdural hematoma (cSDH). Blood plasma samples were collected from the participants at three intervals: the first sample before surgery, the second at 15 h, and the third at 30 h post-surgery. Plasma concentrations of AQP1, AQP2, AQP4, and AQP9 were determined using the sandwich ELISA technique. CT scans were performed on all patients pre- and post-surgery. Correlations between variables were examined using Spearman’s nonparametric rank correlation coefficient. A strong correlation was found between aquaporin 2 levels and the volume of chronic subdural hematoma and midline shift. However, no significant link was found between aquaporin levels (AQP1, AQP2, AQP4, and AQP9) before and after surgery for acute subdural hematoma, nor for AQP1, AQP4, and AQP9 after surgery for chronic subdural hematoma. In the chronic SDH group, AQP2 plasma concentration negatively correlated with the midline shift measured before surgery (Spearman’s ρ −0.54; p = 0.017) and positively with hematoma volume change between baseline and 30 h post-surgery (Spearman’s ρ 0.627; p = 0.007). No statistically significant correlation was found between aquaporin plasma levels and hematoma volume for AQP1, AQP2, AQP4, and AQP9 in patients with acute SDH. There is a correlation between chronic subdural hematoma volume, measured radiologically, and serum AQP2 concentration, highlighting aquaporins’ potential as clinical biomarkers. Full article

Pediatric basilar skull fractures (BSFs) are a rare type of traumatic head injury that can cause debilitating complications without prompt treatment. Here, we sought to review the literature and characterize the clinical features, management, and outcomes of pediatric BSFs. We identified 21 relevant studies, excluding reviews, meta-analyses, and non-English articles. The incidence of pediatric BSFs ranged from 0.0001% to 7.3%, with falls from multi-level heights and traffic accidents being the primary causes (9/21). The median presentation age ranged from 3.2 to 12.8 years, and the mean age of patients across all studies was 8.68 years. Up to 55% of pediatric BSFs presented with intracranial hematoma/hemorrhage, along with pneumocephalus and edema. Cranial nerve palsies were a common complication (9/21), with the facial nerve injured most frequently (7/21). While delayed cranial nerve palsy was reported in a few studies (4/21), most resolved within three months post-admission. Other complications included CSF leaks (10/21) and meningitis (4/21). Management included IV fluids, antiemetics, and surgery (8/21) to treat the fracture directly, address a CSF leak, or achieve cranial nerve compression. Despite their rarity, pediatric skull base fractures are associated with clinical complications, including CSF leaks and cranial nerve palsies. Given that some of these complications may be delayed, patient education is critical. Full article

Near-infrared spectroscopy (NIRS) regional cerebral oxygen saturation (rSO₂)-based cerebrovascular reactivity (CVR) monitoring has enabled entirely non-invasive, continuous monitoring during both acute and long-term phases of care. To date, long-term post-injury CVR has not been properly characterized after acute traumatic neural injury, also known as traumatic brain injury (TBI). This study aims to compare CVR in those recovering from moderate-to-severe TBI with a healthy control group. A total of 101 heathy subjects were recruited for this study, along with 29 TBI patients. In the healthy cohort, the arterial blood pressure variant of the cerebral oxygen index (COx_a) was not statistically different between males and females or in the dominant and non-dominant hemispheres. In the TBI cohort, COx_a was not statistically different between the first and last available follow-up or by the side of cranial surgery. Surprisingly, CVR, as measured by COx_a, was statistically better in those recovering from TBI than those in the healthy cohort. In this prospective cohort study, CVR, as measured by NIRS-based methods, was found to be more active in those recovering from TBI than in the healthy cohort. This study may indicate that in individuals that survive TBI, CVR may be enhanced as a neuroprotective measure. Full article