Search Results (294)

Background/Objectives: Pulmonary typical carcinoid (TC) is a rare type of primary neuroendocrine neoplasm of the lung with indolent behavior and a good prognosis. The main treatment strategy is surgery, the extent of which is controversial given the nature of the disease. The aim of this study is to assess whether the extent of resection influences survival and recurrence in patients undergoing lung resection and lymphadenectomy for TC and to investigate negative prognostic factors for OS. Methods: A single-centre retrospective study of 15 years’ experience was conducted. Data from all patients who underwent lung resection and lymphadenectomy for TC were collected. Patients were divided into two groups: anatomical and non-anatomical resections. Perioperative and long-term oncological results were analyzed. Results: In total, 115 patients were surgically treated for TC, of whom 83 (72%) underwent anatomical resection and 32 (28%) non-anatomical resection. Univariate analyses showed that age, left lower lobe, and many comorbidities had a detrimental effect on OS, whereas on multivariate analysis, only left lower lobe location and a high Charlson–Deyo comorbidity index (CCI) were confirmed as negative prognostic factors for OS. At a median follow-up of 93 months (IQR 57-129), the OS survival curves show a slightly lower trend for non-anatomical resections (p 0.152), while no differences were found for DFS. Conclusions: The results of this study confirm that in selected patients at risk for major resections, non-anatomical resection can be used to treat TC when R0 is achievable. These data, together with evidence from the literature, highlight the importance of patient-centred care in this rare disease. Full article

Background/Objectives: The aim of our study was to evaluate clinical outcomes in patients with small pleomorphic adenoma (PA) after extracapsular dissection (ED) versus superficial parotidectomy (SP). Methods: Following the PRISMA guidelines, a systematic review covering the years from 1950 to 2025 was conducted using the Pubmed/MEDLINE, Cochrane Library, Scopus, Ovid MEDLINE and Embase databases. A single-arm meta-analysis was performed to evaluate intraoperative capsular rupture, recurrence, transient and permanent facial nerve palsy, Frey’s syndrome, salivary fistula, seroma and hematoma of patients who underwent ED vs. those who underwent SP, and funnel plots were constructed to evaluate the robustness of the findings. Results: Of the 1793 identified papers, 21 articles met the inclusion criteria. The meta-analysis (2507 patients) reported the following: (1) the risk of recurrence is similar in patients treated with ED and SP; (2) the transient facial nerve palsy rate is lower after ED (p < 0.05), while the permanent facial nerve palsy rate is similar with ED and SP; (3) post-operative complications, especially Frey’s syndrome (p < 0.05), are more common after SP. Conclusions: Given the similar recurrence rate and the lower morbidity compared to SP, ED could be considered the treatment of choice for pleomorphic adenomas of the parotid gland that are up to 3 cm in size, mobile and located in the superficial lobe of the parotid gland. Full article

Malignant mediastinal tumors are a group representing some of the most demanding oncological challenges for early, multi-level, and successful management. The timely identification of any suspicious clinical symptomatology is urgent in achieving an accurate, staged histological diagnosis, in order to follow up with an equally detailed medical therapeutic plan (interventional or not) and determine the principal goals regarding efficient overall treatment in these patients. We report a case of a 24-year-old male patient with an incident-free prior medical history. An initial chest X-ray was performed after the patient reported short-term, consistent moderate chest pain symptomatology, early work fatigue, and shortness of breath. The following imaging procedures (chest CT, PET-CT) indicated the presence of an anterior mediastinal mass (meas. ~11 cm × 10 cm × 13 cm, SUV: 8.7), applying additional pressure upon both right heart chambers. The Alpha-Fetoprotein (aFP) blood levels had exceeded at least 50 times their normal range. Two consecutive diagnostic attempts with non-specific histological results, a negative-for-malignancy fine-needle aspiration biopsy (FNA-biopsy), and an additional tumor biopsy, performed via mini anterior (R) thoracotomy with “suspicious” cellular gatherings, were performed elsewhere. After admission to our department, an (R) Video-Assisted Thoracic Surgery (VATS) was performed, along with multiple tumor biopsies and moderate pleural effusion drainage. The tumor’s measurements had increased to DMax: 16 cm × 9 cm × 13 cm, with a severe degree of atelectasis of the Right Lower Lobe parenchyma (RLL) and a pressure-displacement effect upon the Superior Vena Cava (SVC) and the (R) heart sinus, based on data from the preoperative chest MRA. The histological report indicated elements of a combined, non-seminomatous germ-cell mediastinal tumor, posthuberal-type teratoma, and embryonal carcinoma. The imminent chemotherapeutic plan included a “BEP” (Bleomycin^®/Cisplatin^®/Etoposide^®) scheme, which needed to be modified to a “VIP” (Cisplatin^®/Etoposide^®/Ifosfamide^®) scheme, due to an acute pulmonary embolism incident. While the aFP blood levels declined, even reaching normal measurements, the tumor’s size continued to increase significantly (DMax: 28 cm × 25 cm × 13 cm), with severe localized pressure effects, rapid weight loss, and a progressively worsening clinical status. Thus, an emergency surgical intervention took place via median sternotomy, extended with a complementary “T-Shaped” mini anterior (R) thoracotomy. A large, approx. 4 Kg mediastinal tumor was extracted, with additional RML and RUL “en-bloc” segmentectomy and partial mediastinal pleura decortication. The following histological results, apart from verifying the already-known posthuberal-type teratoma, indicated additional scattered small lesions of combined high-grade rabdomyosarcoma, chondrosarcoma, and osteosarcoma, as well as numerous high-grade glioblastoma cellular gatherings. No visible findings of the previously discovered non-seminomatous germ-cell and embryonal carcinoma elements were found. The patient’s postoperative status progressively improved, allowing therapeutic management to continue with six “TIP” (Cisplatin^®/Paclitaxel^®/Ifosfamide^®) sessions, currently under his regular “follow-up” from the oncological team. This report underlines the importance of early, accurate histological identification, combined with any necessary surgical intervention, diagnostic or therapeutic, as well as the appliance of any subsequent multimodality management plan. The diversity of mediastinal tumors, especially for young patients, leaves no place for complacency. Such rare examples may manifest, with equivalent, unpredictable evolution, obliging clinical physicians to stay constantly alert and not take anything for granted. Full article

The quality of life (QoL) perception has been studied in neurological diseases; however, there is limited information linking brain morphological characteristics, QoL, and cognition. Human behavior and perception are associated with specific brain areas that interact through diffuse electrochemical networking. We used magnetic resonance imaging (MRI) to analyze the brain region volume (BRV) correlation with the scores of Rand’s 36-item Short Form Survey (SF-36) and cognitive domains (memory and dementia status). We analyzed data from 420 adult participants in the Maracaibo Aging Study (MAS). Principal component analysis with oblimin axis rotation was used to gather redundant information from brain parcels and SF-36 domains. Canonical correlation was used to analyze the relationships between SF-36 domains and BRV (adjusted for intracranial cavity), as well as sex, age, education, obesity, and hypertension. The average age (±SD) of subjects was 56 ± 11.5 years; 71% were female; 39% were obese; 12% had diabetes, 52% hypertension, and 7% dementia. No sex-related differences were found in memory and orientation scores, but women had lower QoL scores. The 1st and 2nd canonical correlation roots support the association of SF-36 domains (except social functioning and role emotional) and total brain volume, frontal lobe volume, frontal pole, lateral orbital lobe, cerebellar, and entorhinal areas. Other variables, including age, dementia, memory score, and systolic blood pressure, had a significant influence. The results of this study demonstrate significant correlations between BRV and SF-36 components, adjusted for covariates. The frontal lobe and insula were associated with the mental health component; the lateral-orbital frontal lobe and entorhinal area were correlated with the physical component. Full article

Background: The central variant of posterior reversible encephalopathy syndrome (cvPRES) is an atypical subtype of PRES. Although no unifying definitions exists, it is most often characterized by vasogenic edema involving “central” structures, such as the brainstem, subcortical nuclei, and spinal cord, with relative sparing of the parieto-occipital lobes. Methods: This systematic review and meta-analysis followed the PRISMA guidelines and was pre-registered on PROSPERO [CRD42023483806]. Both the Joanna Briggs Institute and New-Castle Ottawa scale were used for case reports and cohort studies, respectively. The meta-analysis was completed using R-Studio and its associated “metafor” package. Results: A comprehensive search in four databases yielded 70 case reports/series (n = 100) and 12 cohort studies. The meta-analysis revealed a pooled incidence rate of 13% (95% CI: 9–18%) for cvPRES amongst included cohort studies on PRES. Significant heterogeneity was observed (I² = 71% and a τ² = 0.2046). The average age of affected individuals was 40.9 years, with a slightly higher prevalence in males (54%). The most common etiological factor was hypertension (72%). Fifty percent had an SBP >200 mmHg at presentation and a mean arterial pressure (MAP) of 217.6 ± 40.82. Imaging revealed an increased T₂ signal involving the brain stem (88%), most often in the pons (62/88; 70.45%), and 18/100 (18%) cases of PRES with spinal cord involvement (PRES-SCI). Management primarily involved blood pressure reduction, with adjunctive therapies for underlying causes such as anti-seizure medications or hemodialysis. The MAP between isolated PRES-SCI and cvPRES without spinal cord involvement did not show significant differences (p = 0.5205). Favorable outcomes were observed in most cases, with a mortality rate of only 2%. Conclusions: cvPRES is most often associated with higher blood pressure compared to prior studies with typical PRES. The pons is most often involved. Despite the severity of blood pressure and critical brain stem involvement, those with cvPRES have favorable functional outcomes and a lower mortality rate than typical PRES, likely attributable to reversible vasogenic edema without significant neuronal dysfunction. Full article

As designers push engine efficiency closer to thermodynamic limits, the analysis of flow instabilities developed in a high-pressure turbine (HPT) is crucial to minimizing aerodynamic losses and optimizing secondary air systems. Purge flow, while essential for protecting turbine components from thermal stress, significantly impacts the overall efficiency of the engine and is strictly connected to cavity modes and rim-seal instabilities. This paper presents an experimental investigation of these instabilities in an HPT stage, tested under engine-representative flow conditions in the short-duration turbine rig of the von Karman Institute. As operating conditions significantly influence instability behavior, this study provides valuable insight for future turbine design. Fast-response pressure measurements reveal asynchronous flow instabilities linked to ingress–egress mechanisms, with intensities modulated by the purge rate (PR). The maximum strength is reached at PR = 1.0%, with comparable intensities persisting for higher rates. For lower PRs, the instability diminishes as the cavity becomes unsealed. An analysis based on the cross-power spectral density is applied to quantify the characteristics of the rotating instabilities. The speed of the asynchronous structures exhibits minimal sensitivity to the PR, approximately 65% of the rotor speed. In contrast, the structures’ length scale shows considerable variation, ranging from 11–12 lobes at PR = 1.0% to 14 lobes for PR = 1.74%. The frequency domain analysis reveals a complex modulation of these instabilities and suggests a potential correlation with low-engine-order fluctuations. Full article

Background: Liver resection of a caudate lobe is a challenging procedure in both open and minimally invasive approaches. The reason is mainly related to its anatomical position: segment 1 (S1) lies on the inferior vein cava, behind the main and the left portal veins, and below the hepatic veins. This meta-analysis aimed to assess the results of laparoscopic liver resection (LLR) versus open liver resection (OLR) for S1 resection. Methods: Available literature up to June 2024 was retrieved from the Medline and Embase databases. A systematic review with a meta-analysis was carried out to investigate the safety and efficacy of LLR for the S1 segment. Results: Six studies including 292 patients (LLR: n = 132; OLR: n = 160) were selected for the meta-analysis. The OLR cohort showed higher estimated blood loss (EBL) (MD: 140.1, 95% CI 49.3–130.8; p = 0.011) and longer length of hospital stay (MD: 3, 95% CI 1.8–4.2; p = 0.001). No differences in severe postoperative morbidity, overall morbidity, R1 resection rates, transfusion rates, operative time, and duration of Pringle maneuvers were shown. Conclusion: LLR for lesions located in S1 is safe and effective and may be associated with lower EBL and shorter length of stay than OLR. Further larger prospective studies are needed to confirm such results. Full article

Background: Surgical resection remains the standard treatment for early-stage non-small-cell lung cancer (NSCLC). Traditionally, lobectomy has been considered the procedure of choice; however, emerging evidence suggests that trisegmentectomy may offer comparable outcomes. This meta-analysis evaluates whether left upper lobe trisegmentectomy provides non-inferior or superior oncologic outcomes compared to left upper lobectomy, with particular attention to recurrence patterns. Methods: Following PRISMA guidelines, we included comparative studies evaluating left upper lobectomy versus trisegmentectomy. Outcomes assessed included recurrence (locoregional and distant), morbidity, and the length of hospital stay. A meta-analysis was conducted using the metabin function from the R meta package. Results: Of 14 identified articles, 9 met the inclusion criteria. No significant differences were observed in locoregional recurrence. However, distant recurrence was significantly lower in the trisegmentectomy group (OR 0.58; 95% CI 0.41–0.82). While overall morbidity showed no significant difference (OR 0.95), analysis of matched studies favored trisegmentectomy (OR 0.73; 95% CI 0.56–0.96). Hospital stay was significantly shorter in the trisegmentectomy group (OR –0.94; 95% CI –1.26 to –0.63). Conclusions: Trisegmentectomy and lobectomy exhibit distinct recurrence patterns, with lobectomy associated with a higher rate of distant recurrence. Trisegmentectomy may provide oncologic and perioperative advantages in appropriately selected patients. The systematic review and meta-analysis are registered in PROSPERO (registration number: CRD420251066445). Full article

Background/Objectives: Acute Fibrinous and Organizing Pneumonia (AFOP) is a rare pulmonary condition histologically characterized by intra-alveolar fibrin deposition and organizing pneumonia without hyaline membranes. This study aims to describe the clinicopathologic and radiologic features of isolated AFOP nodules presenting as solitary pulmonary nodules (SPNs) mimicking malignancy in patients with recent COVID-19 infection. Methods: We retrospectively analyzed consecutive cases of histologically confirmed AFOP (n = 20) and organizing pneumonia (OP; n = 119) presenting radiologically as SPNs suspicious for malignancy from January 2021 to December 2023. Clinical data, COVID-19 status, radiologic features (including nodular characteristics, ground-glass opacity [GGO], and consolidation), and histopathological findings were collected and analyzed. Digital image analysis quantified the intra-alveolar fibrin content. Results: AFOP nodules showed a significant association with previous COVID-19 infection compared to OP (55% vs. 0.8%, p < 0.001). Radiologically, AFOP lesions were predominantly located in the upper lobes, frequently exhibiting a mixed pattern of GGO and consolidation within solitary nodules (8–28 mm diameter), distinctly differing from the predominantly lower-lobe homogeneous consolidations in OP. Histologically, AFOP was defined by prominent intra-alveolar fibrin “balls,” correlating significantly with radiological consolidation patterns (r = 0.991, p < 0.05). Regions of consolidation demonstrated higher fibrin contents compared to areas of predominant GGO. Conclusions: Isolated AFOP nodules presenting as SPNs post-COVID-19 infection strongly mimic malignancy radiologically, highlighting the necessity for multidisciplinary diagnostic approaches integrating radiological and histopathological data to avoid unnecessary interventions. Recognition of this rare but distinctive clinical entity is essential for appropriate patient management. Full article

Background: Idiopathic pulmonary fibrosis (IPF) and emphysema often coexist in patients with lung cancer (LC), forming a syndrome with combined pulmonary fibrosis and emphysema (CPFE). The three share the pathogenic mechanisms of smoking, chronic inflammation, and oxidative stress. The clinical management of CPFE patients is challenging, but its impact on tumor characteristics, acute exacerbation (AE), and prognosis is still controversial. The purpose of this study was to clarify the effect of CPFE on tumor biological behavior, AE risk, and survival outcome in patients with IPF-LC so as to optimize individualized treatment strategies. Methods: This was a retrospective and single-center study. Newly diagnosed LC patients with IPF, COPD, and normal lungs were recruited in the west China hospital. Patients with IPF were further categorized into CPFE-LC and isolated IPF-LC groups based on the presence of emphysema. Clinical and tumor features, lung function parameters, and prognosis were obtained and compared. Results: Patients with IPF and LC were more common in older men and heavy smokers. IPF-associated tumors had a higher proportion of carrying EGFR wild-type, occurring in the lower lobe of the lung and developing adenocarcinoma and squamous cell carcinoma. Among IPF-LC patients, 68.2% (103/151) met CPFE criteria. Pulmonary function tests demonstrated preserved VC% but significantly reduced FEV1/FVC in CPFE versus non-emphysema IPF (76.3% vs. 80.7%, p = 0.004), alongside elevated CPI and impaired DLCO. CPI ≥ 40 (HR = 2.087, 95%CI: 1.715–6.089, p = 0.012), combined with COPD (HR = 2.281, 95%CI: 1.139–4.569, p = 0.040), isolated IPF (HR = 5.703, 95%CI: 2.516–12.925, p < 0.001), and CPFE (HR = 6.275, 95%CI: 3.379–11.652, p < 0.001), were independent prognostic risk factors in LC patients. The incidence of treatment-induced AEs (49.5% vs. 29.2%, p = 0.038) and AE-related mortality (28.0% vs. 11.8%, p = 0.045) were significantly higher in the CPFE group than in the isolated IPF group. Logistic regression analysis showed that CPFE (OR: 3.494, 95%CI: 2.014–6.063, p = 0.001) was independently associated with the risk of AE-related mortality in patients with LC and IPF. Conclusions: Compared to LC patients with solely IPF, the presence of emphysema had no significant impact on overall survival, but CPFE increased the risk of treatment-triggered AE and was associated with AE-related mortality. In patients with LC, CPFE with AEs had a worse prognosis than IPF with AEs. Full article

Thyroid scintigraphy is a key tool for diagnosing and staging hyperthyroidism in cats, but follow-up scintigraphic studies after radioiodine treatment are limited. This multicentric study evaluated ^99mTc-pertechnetate scintigraphy findings in 234 hyperthyroid cats before and 6 months after radioiodine treatment. Based on serum T4 and TSH concentrations, 165 (70.5%) became euthyroid, 54 (23.1%) had subclinical hypothyroidism, and 15 (6.4%) developed overt hypothyroidism. On post-treatment scintigraphy, all cats showed reduced size and radionuclide uptake of “hot” thyroid nodules. Of 99 cats with unilateral nodules, 60 (61%) recovered function in the contralateral lobe. Among 135 cats with bilateral nodules, both lobes remained visible in 108 (80%). Persistent “hot” nodules with high thyroid/salivary (T/S) ratios or thyroidal pertechnetate uptake (TcTU) occurred in 26 (11%) cats, all of which were euthyroid. Conversely, 24 (10.4%) cats had minimal or absent thyroid tissue with 17 (71%) being hypothyroid, but seven (29%) were euthyroid. As a diagnostic test for iatrogenic hypothyroidism, TcTU showed the highest sensitivity (62.3), with the T/S ratio (7.3) and background-corrected T/S ratio (30.4) being much lower (p < 0.01). While follow-up scintigraphy aids in assessing thyroid tumor destruction and residual function, its diagnostic utility for differentiating euthyroidism and hypothyroidism is limited, especially for cats with mild (subclinical) hypothyroidism. Full article

Background: Nodal dendritic cells (DCs) and CD169-positive macrophages, possibly monocyte-derived, cross-present cancer antigens earlier in the proximal node than in the distal node. Methods: We performed immunohistochemical and morphometric analyses to show differences in the distributions of DC-SIGN-, CD68-, and CD169-positive cells in the paratracheal, subcarinal, and hilar nodes from 25 non-small cell lung cancer patients without metastasis. Results: CD169-positive and DC-SIGN-positive cells were colocalized in the subcapsular and paracortical sinuses, whereas CD68-positive, self-renewal alveolar macrophages were present in the medullary sinus. This complementary distribution was more evident in nodes other than hilar nodes. In hilar nodes, the proportion of CD68-positive macrophages usually exceeds 50%. Notably, the proportion of the overlapped cluster between CD169-positive cells and DC-SIGN-positive cells, which likely corresponds to the cross-presentation activity, was almost the same between the hilar and “next-upstream” node (i.e., the paratracheal node for the upper lobe and the subcarinal node for the lower lobe). Monocyte-derived cells occupied a significantly larger area in the hilar nodes of patients with upper lobe cancer than in patients with lower lobe cancer (p = 0.002–0.009). Conclusion: The specific site occupying the lung hilum with collateral vessels seemed to determine the hilar node composite cells. Full article

Personalized medicine, including targeted and immunotherapy, has substantially changed the landscape of non-small cell lung cancer (NSCLC). About 30% of NSCLC tumors have targetable mutations, like EGFR, and 28% of tumors will have a PD-L1 score or tumor mutation burden high enough to warrant immunotherapy; a molecular test prior to therapy assesses eligibility. However, the congruence between testing and treatment, and the effect of treatment without testing on outcomes, is understudied. We extracted a cohort of NSCLC patients from the Surveillance, Epidemiology and End Results (SEER)-Medicare-linked data. The primary outcome was survival. Demographic and clinical characteristics of those receiving vs. not receiving a molecular test were compared, and a Kaplan–Meier curve along with a multivariable Cox proportional hazards regression assessed the association of survival with the receipt of molecular diagnostic testing, adjusting for sex, race, age, income tract, metro/urban/rural region, histology, and stage. There were 911 NSCLC patients treated with personalized therapy, of which 513 (56.3%) had received prior molecular testing. Black patients were less likely than White patients to receive testing (36.4% vs. 59.9%; p < 0.001). Testing was significantly more frequent in patients with fewer comorbidities (p < 0.001), adenocarcinoma (p = 0.004), tumors in the lower lobe (p = 0.037), or diagnosed at a later stage (p = 0.026). Only 39.9% of patients receiving EGFR inhibitors were initially tested for an EGFR mutation. Among NSCLC patients treated with personalized therapy, untested patients were at increased mortality risk compared to tested patients (median survival 8.22 vs. 12.79 months, p = 0.024). After adjustment, treated patients not tested beforehand had a significantly higher mortality risk (HRadj: 1.20; 95% CI: 1.04–1.40). Substantial incongruence between receipt of molecular testing and personalized therapies exists according to nationwide claims data, with only about half of treated patients having had an appropriate molecular diagnostic workup. This could explain, in part, the higher mortality among treated patients who did not undergo testing. Before expanding personalized therapies, further addressing these issues through standardized, reflexive testing protocols and improved clinician education is critical to optimizing the integration of molecular diagnostics into treatment planning. Full article

Background/Objectives: Understanding sex-based differences in both the pathophysiology and clinical presentation of diseases is necessary to improve health care towards precision medicine. The endocrine system is deeply involved in human health, and endocrine diseases may be influenced by steroidal hormone exposure. Thyroid nodular disease and differentiated thyroid cancer, in particular, show a high prevalence in the female sex; however, little is known about sex-related differences in risk factors and clinical presentation. This study aims to assess whether morphological differences, which can be detected by ultrasound examination, can be related to sex in order to refine diagnostic approaches and oncological risk classification. Methods: A retrospective observational study on 1355 ultrasound images of thyroid nodules obtained from 2017 to 2020 at a single university center was conducted. The images were reviewed by a single observer blinded to the patient’s sex and the cytological nature of the nodules. The qualitative description, size, anatomical location and oncological risk classification were assessed. Results: A taller-than-wide shape (anteroposterior/craniocaudal axis ratio > 1) was found to be more frequent in men than in women (6.7% vs. 3.6%, p = 0.027); the nodular volume was significantly larger in males (p << 0.01) than in females. Significant tropism for the upper lobe and isthmus was described in women (26% vs. 16.5%, p = 0.011) and for medium–lower thyroid lobes in men (83.5% vs. 73.8%, p = 0.011). Background thyroiditis was more common in women, while the number of cytological diagnoses of malignant or likely malignant nodules was higher than expected in men (9% vs. 6%, p = 0.01). Conclusions: Thyroid nodules show different distributions, in terms of a larger volume, more frequent taller-than-wide shape and lobular caudal location, in men vs. women. These results should be confirmed by further investigations, and the underlying mechanism should be clarified. However, our explorative research is of interest due to its novelty and possible future clinical implications. Full article

Objective: Focal epilepsy is the most frequent type of epilepsy in childhood, particularly after the first year of life. This study aims to analyze the clinical aspects, electrophysiological and neuroimaging findings, and genetic predispositions in pediatric focal epilepsy. Specifically, we investigate the association between these parameters and evaluate their impact on therapeutic decisions. Methods: This is a retrospective study, in which we enrolled 39 patients currently receiving follow-up in our unit, 20 male and 19 female. Using the Chi-squared test, we compared them considering several genetic traits, pre/peri/postnatal risk factors, family history, clinical and instrumental features, and treatments. Differences are considered significant with a p value < 0.005. Results: Our findings highlight the multifactorial nature of focal epilepsy, with a combination of genetic and environmental contributions. EEG demonstrated the highest sensitivity among diagnostic tools, being non-significant in only 12.8% of cases, while MRI (p < 0.001), CT (p < 0.04), and brain ultrasound had lower detection rates. MRI findings were significant in 43.6% of patients, predominantly showing vascular malformations (35.8%). MRI-negative findings were more common in temporal and occipital epilepsy, whereas MRI-positive results were observed in 100% of frontal seizures. Importantly, some MRI-negative cases may still be lesional, particularly in temporal lobe epilepsy, where focal cortical dysplasia could be present but undetected with standard imaging. Valproic acid remains the most commonly used anti-seizure medication, and, despite guideline recommendations, it was still prescribed as a first-line treatment in 34.3% of cases and is being used in 23.5% of female patients, raising concerns about its appropriateness. Conclusions: This study highlights the role of genetic and environmental risk factors in pediatric focal epilepsy. EEG showed superior diagnostic sensitivity over MRI, particularly in MRI-negative cases. While high-resolution MRI (3T or 7T) could improve lesion detection, its cost limits accessibility. Valproate was the most prescribed drug, despite its recommended use in generalized epilepsy, emphasizing the need for improved adherence to treatment guidelines. Together with other studies, these findings can contribute to optimizing diagnostic and therapeutic strategies for pediatric focal epilepsy. Full article