Search Results (27)

Background/Objectives: Oculomotor nerve palsy (OMNP) is a clinically significant condition that may represent the earliest manifestation of life-threatening intracranial pathology, particularly aneurysmal compression or neoplasia. Despite its neurosurgical relevance, comprehensive meta-analytic evidence synthesizing OMNP etiologies, clinical presentation, and contemporary diagnostic pathways remains limited. Methods: Following PRISMA 2020 guidelines, MEDLINE, Scopus, and Web of Science were systematically searched for studies reporting quantitative data on OMNP. Pooled prevalence estimates were calculated using random-effects models for causes and symptoms, while a structured narrative synthesis was performed for diagnostic modalities because outcome reporting was heterogeneous and unsuitable for meta-analysis. Risk of bias was assessed using the Joanna Briggs Institute (JBI) risk of bias tool. Results: Twenty-four studies involving 5541 patients were included. Using a multivariate multilevel model to account for within-study dependence, the most common etiological category was vascular disorders (35.62%), followed by idiopathic (16.47%) and neoplastic (12.10%). Head trauma and aneurysms accounted for 11.26% and 10.08% of cases, respectively. Diplopia (60.63%) and ptosis (54.12%) remained the predominant clinical symptoms, while pupil involvement was identified in 40.62% of the pooled population. Diagnostic paradigms have shifted decisively toward non-invasive neuroimaging, with magnetic resonance imaging reported in 66% of included studies and magnetic resonance or computed tomographic angiography increasingly employed to identify surgically relevant vascular lesions. Conclusions: Although vascular disorders represented the most common etiological category, the notable prevalence of aneurysmal and neoplastic causes underscores the importance of prompt high-resolution neuroimaging and early neurosurgical assessment. Early recognition and etiological stratification remain essential to optimize management and prevent irreversible neurological morbidity. Full article

Background: Schwannomas of the third cranial nerve are exceedingly rare benign tumors, and standardized management guidelines are lacking. Their close relationship with critical neurovascular structures makes diagnosis and treatment challenging, with a significant risk of postoperative neurological deficits. Methods: A systematic review of the literature was conducted according to the PRISMA guidelines, including case reports and clinical studies on oculomotor nerve schwannomas (ONSs). Demographic data, clinical presentation, tumor location, diagnostic methods, treatment strategies, and functional outcomes were analyzed. In addition, an illustrative case treated with a multimodal approach is presented. Results: Ninety-six cases met the inclusion criteria. The mean age at diagnosis was 34 years, with a slight female predominance. The most common presenting symptoms were diplopia and ptosis. Contrast-enhanced magnetic resonance imaging was the diagnostic modality of choice. Surgical resection was the primary treatment in most cases but was associated with worsening oculomotor nerve function in 43.1% of surgically treated patients. Stereotactic radiotherapy demonstrated favorable tumor control with lower neurological morbidity. In the presented case, subtotal resection followed by stereotactic radiotherapy resulted in sustained tumor stability at the one-year follow-up. Conclusions: Management of oculomotor nerve schwannomas should be individualized. For small or mildly symptomatic lesions, stereotactic radiotherapy appears to be an effective and less invasive option, while surgery should be reserved for large tumors causing a mass effect or progressive neurological deterioration. Full article

Background and Clinical Significance: Although rupture of aneurysms at the internal carotid-posterior communicating artery (ICA-PCom) junction accounts for a small percentage of all ruptured intracranial aneurysms, they are clinically relevant due to their proximity to perforator-rich cisterns, the optic-carotid-oculomotor pathways and flow-diverting zones, as well as their high likelihood for causing early neurological instability. Additionally, ruptured ICA-PCom aneurysms that have multiple lobulations are associated with increased variability in wall shear stress, local inflammatory remodeling and higher propensity for rupture at smaller sizes compared to other types of aneurysms. Due to the rapidity of early physiological destabilization in most patients with ruptured ICA-PCom aneurysms, clinical–anatomical correlations in these cases are often obscured by neurological deterioration; therefore, the presentation of this patient provides a unique opportunity to correlate the minimal early symptoms, tri-lobulation of the aneurysm and confined cisternal hemorrhage, to better understand rupture behavior, surgical decision-making in an anatomically challenging area, and postoperative recovery. Case Presentation: A 48-year-old hypertensive female experienced an acute “thunderclap” headache accompanied by intense photophobia and focal meningeal irritation, but, unexpectedly, retained a normal neurologic examination. She did exhibit some minor ocular motor micro-latencies, early cortical attentional strain and lateralized pain sensation that suggested localized cisternal involvement despite lack of generalized neurologic impairment. Digital subtraction angiography and three-dimensional CT angiography revealed a ruptured, tri-lobulated aneurysm originating from the communicating portion of the left internal carotid artery proximal to its origin from the posterior communicating artery, oriented toward the perimesencephalic cisterns. The aneurysm was surgically clipped using a standard left pterional craniotomy with direct visualization, after careful dissection through the carotid and optic windows to preserve the anterior choroidal artery, oculomotor nerve, and surrounding perforators. The neck of the aneurysm was reconstructed with a single straight clip, without compromise to the parent vessel lumen. The patient had an uneventful postoperative course without vasospasm or neurologic deficit. At both 3 and 9 months postoperatively the patient remained free of clinical neurologic deficit, and imaging demonstrated continued aneurysm exclusion, preserved ICA-PCom anatomy, and no evidence of delayed ischemic injury or hydrocephalus. Conclusions: The goal of this report is to demonstrate how a ruptured, morphologically complex ICA-PCom aneurysm may present with preserved neurologic function, thereby enabling the study of clinical–anatomical associations before secondary injury mechanisms intervene. The relationship between the configuration of the patient’s symptoms, geometry of the aneurysm and pattern of hemorrhage within the cisterns offers insight into a rare rupture pattern observed during routine clinical experience. Through complete anatomical analysis, timely microsurgical reconstruction and consistent follow-up, the authors were able to achieve long-term recovery of this particular patient. Continued advancements in vascular imaging techniques, aneurysmal wall modeling, and postoperative monitoring will likely help clarify the underlying mechanism(s) responsible for such presentations. Full article

We report the case of a 62-year-old woman with Miller Fisher syndrome (MFS) whose severe bilateral ophthalmoplegia showed no improvement after four weeks of standard care consisting of intravenous immunoglobulin and physiotherapy. High-frequency transcutaneous electrical nerve stimulation (TENS) was applied over the bilateral sternocleidomastoid muscles and immediately followed by eye-movement exercises. Within three days, ocular motility began to improve, and after one month, only minimal left-eye abduction lag remained. Such neuromodulation of TENS might act on central and peripheral tiers of the oculomotor system and may have been temporally associated with faster recovery than expected in the natural course of the disease compared to the median three-month interval. This dramatic, time-associated improvement highlights the novelty of cervical TENS as a potential accelerator for recovery in MFS-related ophthalmoplegia. To the best of our knowledge, research involving the use of TENS in MFS-related ophthalmoplegia is limited, and our case demonstrates the feasibility and safety of TENS for faster recovery. Full article

Background: Temporomandibular joint (TMJ) injections and arthrocentesis are commonly used minimally invasive methods for treating temporomandibular disorders (TMDs). Although considered safe, they can cause neurological complications. The aim of this systematic review was to synthesize all identified evidence for neurological adverse events following intra-articular TMJ interventions. Methods: This review was based on a systematic search with BASE, DOAJ, PubMed, SciELO, and Semantic Scholar on 28 May 2025. It included primary studies involving patients diagnosed with TMDs who underwent intra-articular injections into the TMJ or were treated with arthrocentesis, and in whom neurological adverse effects associated with the intra-articular intervention were reported. Studies reporting non-specific symptoms or unrelated systemic conditions were excluded. The risk of bias was assessed using the Joanna Briggs Institute’s critical appraisal tools. Results were presented in summary tables. Results: The search yielded five eligible studies comprising 319 patients, of whom 320 neurological adverse events were reported. Included studies comprised a randomized controlled trial, two retrospective studies, and two case reports. Four studies had a low risk of bias, and one had a moderate risk of bias according to the Joanna Briggs Institute appraisal tools. The proportion of patients affected ranged from 14% to 65% depending on the study design and intervention type. The most common adverse event was transient facial nerve (cranial nerve VII) paralysis, mainly involving the temporal and zygomatic branches. Less commonly reported complications involved the trigeminal nerve branches (V1, V3). There is also a single case of epidural hematoma with palsy of the oculomotor nerve (III). Most symptoms resolved spontaneously within a few hours to a few days. The use of local anesthesia and large volumes of irrigation (60 mL) during arthrocentesis increases the risk of complications. Attempts to explain the mechanisms of complications include local anesthetic diffusion, compression neuropraxia due to lavage fluid leakage, and corticosteroid neurotoxicity. One of the limitations of the study is the scarcity of data. Conclusions: Although most adverse events are mild and reversible, these findings highlight that precise, real-time guided injection and careful control of lavage volumes can minimize extra-articular spread of anesthetics or fluids, thereby reducing the likelihood of neurological complications. This study received no funding. PROSPERO ID number: CRD420251088170. Full article

Introduction: Acute Myeloid Leukemia (AML) is a hematologic malignancy characterized by the clonal expansion of myeloid progenitors. While it primarily affects the bone marrow, extramedullary relapse occurs in 3–5% of cases, and it is linked to poor prognosis. Central nervous system (CNS) involvement presents diagnostic challenges due to nonspecific symptoms. CNS manifestations include leptomeningeal dissemination, nerve infiltration, parenchymal lesions, and myeloid sarcoma, occurring at any disease stage and frequently asymptomatic. Methods: A 62-year-old man with a recent history of AML in remission presented with diplopia and aching paresthesias in the left periorbital region spreading to the left frontal area. The diagnostic workup included neurological and hematological evaluation, lumbar puncture, brain CT, brain magnetic resonance imaging (MRI) with contrast, and dermatological evaluation with skin biopsy due to the appearance of nodular skin lesions on the abdomen and thorax. Results: Neurological evaluation showed hypoesthesia in the left mandibular region, consistent with left trigeminal nerve involvement, extending to the periorbital and frontal areas, and impaired adduction of the left eye with divergent strabismus in the primary position due to left oculomotor nerve palsy. Brain MRI showed an equivocal thickening of the left oculomotor nerve without enhancement. Cerebrospinal fluid (CSF) analysis initially showed elevated protein (47 mg/dL) with negative cytology; a repeat lumbar puncture one week later detected leukemic cells. Skin biopsy revealed cutaneous AML localization. A diagnosis of AML relapse with CNS and cutaneous localization was made. Salvage therapy with FLAG-IDA-VEN (fludarabine, cytarabine, idarubicin, venetoclax) and intrathecal methotrexate, cytarabine, and dexamethasone was started. Subsequent lumbar punctures were negative for leukemic cells. Due to high-risk status and extramedullary disease, the patient underwent allogeneic hematopoietic stem cell transplantation. Post-transplant aplasia was complicated by septic shock; the patient succumbed to an invasive fungal infection. Conclusions: This case illustrates the diagnostic complexity and poor prognosis of extramedullary AML relapse involving the CNS. Early recognition of neurological signs, including cranial nerve dysfunction, is crucial for timely diagnosis and management. Although initial investigations were negative, further analyses—including repeated CSF examinations and skin biopsy—led to the identification of leukemic involvement. Although neuroleukemiosis cannot be confirmed without nerve biopsy, the combination of clinical presentation, neuroimaging, and CSF data strongly supports the diagnosis of extramedullary relapse of AML. Multidisciplinary evaluation remains essential for detecting extramedullary relapse. Despite treatment achieving CSF clearance, the prognosis remains unfavorable, underscoring the need for vigilant clinical suspicion in hematologic patients presenting with neurological symptoms. Full article

Background/Objectives: Resection of tumors invading the cavernous sinus (CS) carries a risk of injury to the cranial nerves and internal carotid artery. Therefore, radical surgery involving lesions around the CS remains challenging, especially for lesions invading the CS, optic sheath, and oculomotor cave. Here, we describe a surgical strategy for meningiomas invading these structures and report on the clinical outcomes. Methods: Surgical resection was indicated in patients with neurological symptoms or rapid tumor growth for the restoration of cranial nerve function. We investigated 13 patients who had preoperative images of CS invasion, underwent surgical resection, and were followed-up with magnetic resonance imaging for at least 1 year between July 2017 and July 2024. Their preoperative symptoms, postoperative course, adjuvant therapy, postoperative complications, degree of resection, and recurrence were evaluated. Results: The mean patient age was 59.1 years (range, 23–73 years), and 10 were female. Major preoperative symptoms included oculomotor nerve paresis in 8 patients (61.5%), abducens nerve paresis in 6 (46.2%), visual disturbance in 7 (53.8%), and brain swelling in 3 (23.1%). These symptoms improved at least partially after surgery in 7 (87.5%), 5 (83.3%), 7 (100%), and 3 (100%) patients, respectively. Major postoperative complications included contralateral visual deterioration in 1 patient (7.7%) and brief transient slight hemiparesis caused by internal carotid vasospasm or dissection in 2 (15.4%). Four patients with residual atypical meningioma in the CS underwent intensity-modulated radiotherapy (IMRT). The lesions in 6 patients recurred or regrew, resulting in additional treatment with stereotactic radiosurgery in 2 patients, IMRT in 3, and resection in 1. Conclusions: Our surgical strategy for the surgical resection of meningiomas in and around the CS for the restoration of cranial nerve function is safe and effective, with only transient acceptable injuries. Even if the tumor in the CS is too stiff to be removed, it is important to open the optic nerve sheath and oculomotor cave widely to effectively remove the tumor. Full article

The ultrastructural organization of the nuclei of the tegmental region in juvenile chum salmon (Oncorhynchus keta) was examined using transmission electron microscopy (TEM). The dorsal tegmental nuclei (DTN), the nucleus of fasciculus longitudinalis medialis (NFLM), and the nucleus of the oculomotor nerve (NIII) were studied. The ultrastructural examination provided detailed ultrastructural characteristics of neurons forming the tegmental nuclei and showed neuro–glial relationships in them. Neurons of three size types with a high metabolic rate, characterized by the presence of numerous mitochondria, polyribosomes, Golgi apparatus, and cytoplasmic inclusions (vacuoles, lipid droplets, and dense bodies), were distinguished. It was found that large interneurons of the NFLM formed contacts with protoplasmic astrocytes. Excitatory synaptic structures were identified in the tegmentum and their detailed characteristic are provided for the first time. Microglia-like cells were found in the NIII. The ultrastructural characteristics of neurogenic zones of the tegmentum of juvenile chum salmon were also determined for the first time. In the neurogenic zones of the tegmentum, adult-type neural stem progenitor cells (aNSPCs) corresponding to cells of types III and IVa Danio rerio. In the neurogenic zones of the tegmentum, neuroepithelial-like cells (NECs) corresponding to cells previously described from the zebrafish cerebellum were found and characterized. In the tegmentum of juvenile chum salmon, patterns of paracrine neurosecretion were observed and their ultrastructural characteristics were recorded. Patterns of apoptosis in large neurons of the tegmentum were examined by TEM. Using immunohistochemical (IHC) labeling of the brain lipid-binding protein (BLBP) and aromatase B (AroB), patterns of their expression in the tegmentum of intact animals and in the post-traumatic period after acute injury to the medulla oblongata were characterized. The response to brainstem injury in chum salmon was found to activate multiple signaling pathways, which significantly increases the BLBP and AroB expression in various regions of the tegmentum and valvula cerebelli. However, post-traumatic patterns of BLBP and AroB localizations are not the same. In addition to a general increase in BLBP expression in the tegmental parenchyma, BLBP overexpression was observed in the rostro-lateral tegmental neurogenic zone (RLTNZ), while AroB expression in the RLTNZ was completely absent. Another difference was the peripheral overexpression of AroB and the formation of dense reactive clusters in the ventro-medial zone of the tegmentum. Thus, in the post-traumatic period, various pathways were activated whose components were putative candidates for inducers of the “astrocyte-like” response in the juvenile chum salmon brain that are similar to those present in the mammalian brain. In this case, BLBP acted as a factor enhancing the differentiation of both radial glia and neurons. Estradiol from AroB+ astrocytes exerted paracrine neuroprotective effects through the potential inhibition of inflammatory processes. These results indicate a new role for neuronal aromatization as a mechanism preventing the development of neuroinflammation. Moreover, our findings support the hypothesis that BLBP is a factor enhancing neuronal and glial differentiation in the post-traumatic period in the chum salmon brain. Full article

Herpes zoster ophthalmicus results from the reactivation of the latent varicella zoster virus, affecting the first branch of the trigeminal nerve. In 20–70% of cases, Zoster Ophthalmicus can lead to ocular involvement, affecting various orbital structures. Orbital myositis is a rare but severe complication of herpes zoster ophthalmicus. We present a case of a 52-year-old man with no significant medical history who developed zoster-associated right ocular myositis and dacryocystitis. He was treated with intravenous acyclovir and oral steroids. A review of the literature identified 29 patients across 19 studies. The median age was 61 years, with a slight female predominance. In 55% of cases, the patients had no notable medical history. The most common presentation of myositis involved all oculomotor muscles. There were 22 cases who were treated with intravenous antiviral therapy and 19 received steroids. A full resolution of symptoms was achieved in 51.7% of patients. Zoster-related orbital myositis is a rare complication that should be considered even in immunocompetent individuals. It may occur either before or after the appearance of a vesicular rash. Magnetic resonance imaging is the preferred radiological exam for assessing orbital involvement. Intravenous antiviral therapy should be started within 72 h of symptom onset, and its combination with systemic corticosteroids appears to be an effective treatment for zoster-related ocular myositis. Full article

Background: This report aims to supplement the existing knowledge on the inferior oblique muscle. In particular, this study presents detailed anatomical and histological data concerning the muscle’s entry point (or entry zone) of the nerve to the inferior oblique muscle. Particular attention was paid to the topographical relationships of the nerve to the inferior oblique muscle (NTIO), including the location of its entry point to the muscle’s belly and its anatomical variations. Methods: Sixty orbits from cadaveric hemi-heads fixed in 10% formalin were studied. The course of the NTIO was traced along the lateral border of the inferior rectus muscle as far as its entry point to the inferior oblique muscle. Particular attention was paid to the various ways in which the NTIO’s muscular sub-branches penetrated between the fibers of the inferior oblique muscle. Results: Three types of NTIO entries to the inferior oblique muscle’s belly were distinguished. In the most common type (48.3%), the nerve entered the muscle’s inferior (orbital) surface. In the next most common type (36.7%), terminal muscular sub-branches of the NTIO joined the superior (also referred to as ocular or global) surface of the inferior oblique muscle. In the remaining four cases (15%), the terminal sub-branches of the NTIO were divided into two main groups (superior and inferior) that joined both the superior and inferior surfaces of the muscle. Histological examination confirmed that the distal part of the NTIO shows a characteristic arcuate course (angulation) just before reaching the muscle’s belly. The process for splitting and forming separate muscular sub-branches of the NTIO was observed for all the examined histological specimens at the level of the nerve’s angulation. Conclusions: The presented findings enhance the understanding of the anatomical variations and precise distribution of motor sub-branches reaching the inferior oblique muscle, which may deepen anatomical knowledge and potentially enhance the management of ocular motor disorders. Full article

The potassium–chloride cotransporter KCC2 is the main extruder of Cl^- in neurons. It plays a fundamental role in the activity of the inhibitory neurotransmitters (GABA and glycine) since low levels of KCC2 promote intracellular Cl^- accumulation, leading to the depolarizing activity of GABA and glycine. The downregulation of this cotransporter occurs in neurological disorders characterized by hyperexcitability, such as epilepsy, neuropathic pain, and spasticity. KCC2 is also downregulated after axotomy. If muscle reinnervation is allowed, the KCC2 levels recover in motoneurons. Therefore, we argued that target-derived neurotrophic factors might be involved in the regulation of KCC2 expression. For this purpose, we performed the axotomy of extraocular motoneurons via the monocular enucleation of adult rats, and a pellet containing either VEGF or BDNF was chronically implanted in the orbit. Double confocal immunofluorescence of choline acetyl-transferase (ChAT) and KCC2 was carried out in the brainstem sections. Axotomy led to a KCC2 decrease in the neuropil and somata of extraocular motoneurons, peaking at 15 days post-lesion, with the exception of the abducens motoneuron somata. VEGF administration prevented the axotomy-induced KCC2 downregulation. By contrast, BDNF either maintained or reduced the KCC2 levels following axotomy, suggesting that BDNF is involved in the axotomy-induced KCC2 downregulation in extraocular motoneurons. The finding that VEGF prevents KCC2 decrease opens up new possibilities for the treatment of neurological disorders coursing with neuronal hyperactivity due to KCC2 downregulation. Full article

Background: The cavernous sinus (CS) is a highly vulnerable anatomical space, mainly due to the neurovascular structures that it contains; therefore, a detailed knowledge of its anatomy is mandatory for surgical unlocking. In this study, we compared the anatomy of this region from different endoscopic and microsurgical operative corridors, further focusing on the corresponding anatomic landmarks encountered along these routes. Furthermore, we tried to define the safe entry zones to this venous space from these three different operative corridors, and to provide indications regarding the optimal approach according to the lesion’s location. Methods: Five embalmed and injected adult cadaveric specimens (10 sides) separately underwent dissection and exposure of the CS via superior eyelid endoscopic transorbital (SETOA), extended endoscopic endonasal transsphenoidal-transethmoidal (EEEA), and microsurgical transcranial fronto-temporo-orbito-zygomatic (FTOZ) approaches. The anatomical landmarks and the content of this venous space were described and compared from these surgical perspectives. Results: The oculomotor triangle can be clearly exposed only by the FTOZ approach. Unlike EEEA, for the exposure of the clinoid triangle content, the anterior clinoid process removal is required for FTOZ and SETOA. The supra- and infratrochlear as well as the anteromedial and anterolateral triangles can be exposed by all three corridors. The most recently introduced SETOA allowed for the exposure of the entire lateral wall of the CS without entering its neurovascular structures and part of the posterior wall; furthermore, thanks to its anteroposterior trajectory, it allowed for the disclosure of the posterior ascending segment of the cavernous ICA with the related sympathetic plexus through the Mullan’s triangle, in a minimally invasive fashion. Through the anterolateral triangle, the transorbital corridor allowed us to expose the lateral 180 degrees of the Vidian nerve and artery in the homonymous canal, the anterolateral aspect of the lacerum segment of the ICA at the transition zone from the petrous horizontal to the ascending posterior cavernous segment, surrounded by the carotid sympathetic plexus, and the medial Meckel’s cave. Conclusions: Different regions of the cavernous sinus are better exposed by different surgical corridors. The relationship of the tumor with cranial nerves in the lateral wall guides the selection of the approach to cavernous sinus lesions. The transorbital endoscopic approach can be considered to be a safe and minimally invasive complementary surgical corridor to the well-established transcranial and endoscopic endonasal routes for the exposure of selected lesions of the cavernous sinus. Nevertheless, peer knowledge of the anatomy and a surgical learning curve are required. Full article

The superior cerebellar artery (SCA) arises from the distal part of the basilar artery and passes by the oculomotor, trochlear, and trigeminal nerves. SCA is known to play a crucial role in the development of trigeminal neuralgia. However, due to its anatomical variability, it may also trigger other neurovascular compression (NVC), including hemifacial spasm, oculomotor nerve palsy, and ocular neuromyotonia. Additionally, it may be associated with ischemic syndromes and aneurysm development, highlighting its clinical significance. The most common anatomical variations of the SCA include duplication, a single vessel origin from the posterior cerebral artery (PCA), and a common trunk with PCA. Rarely observed variants include bifurcation and origin from the internal carotid artery. Certain anatomical variants such as early bifurcation and caudal course of duplicated SCA trunk may increase the risk of NVC. In this narrative review, we aimed to examine the impact of the anatomical variations of SCA on the NVCs based on papers published in Pubmed, Scopus, and Web of Science databases with a snowballing approach. Our review emphasizes the importance of a thorough understanding of the anatomical variability of SCA to optimize the management of patients with NVCs associated with this artery. Full article

Medial sphenoid wing meningiomas (MSWM) are surgically challenging skull base tumors. Irregular tumor shapes are thought to be linked to histopathology. The present study aims to investigate the impact of tumor shape on postoperative functioning, progression-free survival, and neuropathology. This monocentric study included 74 patients who underwent surgery for primary sporadic MSWM (WHO grades 1 and 2) between 2010 and 2021. Furthermore, a systematic review of the literature regarding meningioma shape and the MIB-1 index was performed. Irregular MSWM shapes were identified in 31 patients (41.9%). Multivariable analysis revealed that irregular shape was associated with postoperative cranial nerve deficits (OR: 5.75, 95% CI: 1.15–28.63, p = 0.033). In multivariable Cox regression analysis, irregular MSWM shape was independently associated with tumor progression (HR:8.0, 95% CI: 1.04–62.10, p = 0.046). Multivariable regression analysis showed that irregular shape is independently associated with an increased MIB-1 index (OR: 7.59, 95% CI: 2.04–28.25, p = 0.003). A systematic review of the literature and pooled data analysis, including the present study, showed that irregularly shaped meningiomas had an increase of 1.98 (95% CI: 1.38–2.59, p < 0.001) in the MIB-1 index. Irregular MSWM shape is independently associated with an increased risk of postoperative cranial nerve deficits and a shortened time to tumor progression. Irregular MSWM shapes might be caused by highly proliferative tumors. Full article

Guillain-Barré syndrome (GBS) is a severe peripheral neuroinflammatory demyelinating disease characterized by symmetrical progressive limb weakness, which can be accompanied by cranial nerve and sensory disturbances. There is usually a history of bacterial or viral infection prior to onset. GBS is rarely seen after traumatic brain injury (TBI). We report a case of a 66-year-old male patient who presented with dilated pupils, followed by respiratory failure and symmetrical quadriplegia during a conservative treatment for TBI. He was eventually diagnosed with GBS and was treated with intravenous immunoglobulin, followed by rehabilitation therapy with a good recovery. We summarize previous similar cases and analyze possible causes. It is suggested that the possibility of GBS should be considered when unexplained symptoms occurred in patients with TBI, such as respiratory failure, dilated pupils, and limb weakness. Full article