Federico Di Rocco

Introduction: Head trauma during infancy represents a distinctive clinical entity due to the rapid developmental changes in the first year of life. Skull fractures are a clinically relevant marker of traumatic head injury in infants and frequently prompt hospital admission and specialist evaluation. Understanding mechanisms and clinical characteristics is essential for improving diagnostic assessment and prevention strategies. Materials and Methods: This retrospective study included infants <12 months admitted to our Institution between 2021 and 2025, diagnosed with a skull fracture. Birth-related trauma was excluded. Demographic, radiological, and clinical data were analyzed. Trauma mechanisms were classified as accidental, non-accidental, medical condition–related, or other. Accidental mechanisms were further subdivided according to the circumstances of the fall. Results: A total of 156 infants were included. Accidental trauma accounted for 89.7% of cases; 4.5% were classified as non-accidental trauma. The fractures were mostly parietal (72.4%); intracranial hemorrhage occurred in 43.6%. Seventeen patients (10.9%) required neurosurgical intervention; 24 (15.4%) required intensive care admission. Fundoscopic abnormalities were identified in six infants, predominantly in cases of non-accidental trauma. Analysis by developmental age groups demonstrated clear age-related patterns of injury mechanisms, with caregiver-related falls predominating during the first months of life and supervision-related injuries increasing with the onset of mobility. Conclusions: Head trauma resulting in skull fractures during the first year of life demonstrates distinct developmental patterns of injury. These findings highlight the importance of developmental context in clinical assessment and suggest that many injuries may be preventable through targeted caregiver education and improved domestic safety measures.

Objective: This study aimed to compare the efficacy, safety, and diagnostic yield of three biopsy approaches for pineal tumors: endoscopy-, stereotaxic-, and neuronavigation-guided techniques. Methods: A systematic review and meta-analysis were conducted, encompassing relevant studies published between 1973 and 2023. Data were collected on biopsy success rates, complications, diagnostic accuracy, and procedural variables. Results: A total of 93 studies met the inclusion criteria, comprising 1798 patients. We did not find any article considering only neuronavigation. This technique was always associated with the endoscopic or the stereotactic way, so we did not present isolated results. The overall biopsy success rates were comparable for both techniques, ranging from 25% to 100% (We note that three studies reported very low success rates (25%–50%) compared with the remaining 45 studies, which reported success rates ranging from 81.1% to 100%. These studies are discussed, along with our interpretation of these exceptions: (1) Kraichoke et al. (Am J Surg Pathol 12(9):655–660, 1988), success rate = 25% (n = 4); this result is probably due to the early stage of adoption of the technique. (2) Cunliffe et al. (J Neurooncol 93(2):269–274, 2009), success rate = 50% (n = 1); a second biopsy was performed for the same patient because the first one only provides hemorrhagic tissue fragments. (3) Kim et al. (Childs Nerv Syst 39(9):2367–2375, 2023), success rate = 50% (n = 2); one endoscopic procedure had to be stopped because of hemorrhage resulting in poor visualization.). However, endoscopic biopsies demonstrated a slightly lower diagnostic yield (87%) compared to stereotaxic-guided techniques (94.6%). Complication rates were also similar, with minor complications occurring in 4.3%–14.9% of cases and major complications in 0.5%–1.6%. Conclusion: Endoscopic-, stereotaxic-, and neuronavigation-guided biopsy techniques exhibit similar efficacy and safety profiles for sampling pineal tumors. Endoscopy may offer a significant advantage due to the possibility to perform an endoscopic third ventriculostomy (ETV) in the same surgical time, but the choice of technique should consider individual patient factors, tumor characteristics, and surgeon expertise. Further prospective studies are warranted to validate these findings and optimize biopsy strategies for pineal tumors.

'Pineal Tumours: Results, Follow-Up and Sequelae in Children and Adults According to the French Registry of Pineal Tumours and the Lyonnais Registry' published in 'Pineal Tumors and Pineal Region Tumors'

This chapter provides a comprehensive exploration of pineal cysts, covering their clinical significance, diagnostic approaches, and management strategies. By integrating current research findings with clinical expertise, the chapter aims to offer valuable insights for healthcare professionals involved in the care of patients with pineal cysts.

Hydrocephalus is a common complication associated with pineal lesions, including tumors and cysts. This structured abstract aims to provide a comprehensive overview of the pathophysiology, diagnostic evaluation, and management strategies for hydrocephalus in the context of pineal lesions. A review of relevant literature was conducted to gather current insights into hydrocephalus secondary to pineal lesions. PubMed, Google Scholar, and academic databases were searched for articles published between 2014 and 2024. Keywords included "hydrocephalus," "pineal lesion," "pineal tumor," "cyst," "diagnosis," "treatment," and "management." Pineal lesions, by obstructing CSF pathways, often lead to hydrocephalus due to impaired CSF flow dynamics. Neuroimaging, particularly MRI and CT scans, plays a pivotal role in diagnosing both the pineal lesion and associated hydrocephalus. Treatment strategies for hydrocephalus in pineal lesions include surgical interventions such as endoscopic third ventriculostomy (ETV), ventriculoperitoneal shunt (VPS) placement, and tumor resection. Nonsurgical options, including medical therapy and observation, may also be considered depending on the patient's clinical status and lesion characteristics. Hydrocephalus in pineal lesions presents a complex clinical scenario requiring a multidisciplinary approach for optimal management. Early diagnosis, accurate characterization of the lesion and associated hydrocephalus, and timely intervention are crucial for improving patient outcomes. Further research is needed to refine treatment algorithms and enhance our understanding of the underlying mechanisms of hydrocephalus in pineal lesions.

Medical observations can often be of important help for basic research and conversely. Here we review advances in basic and applied neuroscience that provide both theoretical and practical tools for neurosurgery. To this end, in the first two sections, we address the increased precision of functional brain mapping in clinical contexts and the processes of how the brain dynamically adapts to structural changes following surgery to optimize recovery. In the third section, we focus on the more recently studied field of social/affective neuroscience and how it results to neurosurgery advances, pointing out theoretical advances but also future challenges of primary interest for the sake of neurosurgical practices and better patients’ outcome.

Background: Some pathogenic variants in Smad6 are implicated in midline craniosynostosis, particularly in metopic synostosis. These variants increase the risk of both nonsyndromic and syndromic presentations. Craniosynostosis, whether treated surgically or not, can be associated with developmental delays. Methods: The authors aimed to assess developmental outcomes in children with craniosynostosis carrying a Smad6 variant. A cohort of children who underwent craniosynostosis surgery at the national reference center for craniosynostosis at Lyon University Hospital (2018–2023) was studied. Children with Smad6 variants were followed postsurgery to evaluate their neuropsychological development. Evaluations were conducted by a multidisciplinary team comprising neurosurgeons, clinical geneticists, and neuropsychologists. Results: Among 249 patients with craniosynostosis, 11 were identified with Smad6 variants. Of these, 7 presented with trigonocephaly, 2 with scaphocephaly, and 2 with oxycephaly. Patients with SMAD6 gene variants followed by the department were between 18 and 121 months, with a sex ratio of 6 girls to 5 boys. None of these children exhibited cardiac abnormalities. Mild walking and/or language acquisition delays are observed in 8 children, 5 of them benefit from ambulatory-specific care, and only one cannot benefit from a normal schooling. Conclusion: Neuropsychological follow-up is crucial for children with craniosynostosis. Most patients with SMAD6 variants show mild to moderate effects, with developmental scores normalizing with appropriate therapies. However, the impact of Smad6, especially in cases with additional variants, requires further study. Early intervention remains key to optimizing cognitive and behavioral outcomes.