Yusor Al-Nuaimy

Objective: Giant thrombosed intracranial aneurysms (GTIAs) are aneurysmal dilatations containing partial or complete intraluminal thrombus. Representing approximately 2–5% of intracranial aneurysms, GTIAs present diagnostic and therapeutic challenges. Optimal management remains controversial and may involve microsurgical, endovascular, or hybrid strategies. Methods: A systematic review was performed in accordance with PRISMA guidelines using PubMed and Embase to identify relevant studies published between January 2000 and August 2025. Eligible studies reported clinical, anatomical, or treatment-related data for patients with GTIAs. Extracted variables included patient demographics, aneurysm characteristics, treatment modality, and outcomes. Data were standardized and analyzed using Python. Complication and recurrence rates were pooled in subsets of studies reporting explicit event counts; comparisons between treatment modalities were assessed using chi-square analysis. Results: In total, 101 studies including 536 patients met our criteria. Mean patient age was 50.2 years. Most aneurysms arose from the anterior circulation (88.2%) involving the internal carotid artery (46.6%) and middle cerebral artery (39.9%). The unweighted mean aneurysm diameter was 39.0 mm, with a patient-weighted mean of 24.3 mm. Hybrid treatment strategies were most frequently reported (62.7%), followed by endovascular (23.3%) and microsurgical (14.0%) approaches. Among studies reporting explicit counts, the pooled complication rate was 17.0% and the recurrence rate was 21.0%. Complication rates did not differ significantly between treatment modalities (p = 0.48), whereas recurrence differed significantly (p = 0.00013). Conclusions: Management of GTIAs remains heterogeneous, with increasing reliance on multimodal and hybrid treatment strategies. However, inconsistent outcome reporting and the predominance of retrospective studies limit definitive comparisons between treatment modalities.

Disclosing a cancer diagnosis, particularly to individuals in family-centric cultures, is a complex process that directly impacts patient-centered care. This study explores the factors that influence attitudes toward truth disclosure of a terminal cancer diagnosis in the diverse population of the United Arab Emirates and compares these findings with practices in other nations and regions. A descriptive cross-sectional study was conducted using an online self-administered questionnaire. The questionnaire comprised 4 sections: 9 questions collected demographic data, 6 questions assessed respondents’ perceptions regarding the diagnosis of terminal-stage cancer, 7 questions evaluated their perceptions of its prognosis, and 7 questions focused on their views on truth disclosure in terminal-stage cancer. The questionnaire was developed based on existing literature and expert input. The study targeted healthcare providers, as well as all students (undergraduate or postgraduate), faculty members, and staff at universities in the United Arab Emirates. Multivariate logistic regression models were applied to determine the factors influencing participants’ attitudes and perceptions. A total of 495 participants were recruited, with 73.7% being female and 26.3% being male. The majority (45.9%) were aged 18 to 24 years. The average attitude scores were 87.8% for the diagnosis of terminal-stage cancer, 85.8% for its prognosis, and 69.7% for truth disclosure to family. Logistic regression analysis showed that female participants had more positive attitudes toward diagnosis (odds ratio [OR] = 1.85; 95% confidence interval [CI]: 1.1–3.1), while participants from the Middle East and North Africa had less positive attitudes toward both diagnosis (OR = 0.653; 95% CI: 0.48–0.87) and prognosis (OR = 0.652; 95% CI: 0.47–0.86). More positive attitudes toward truth disclosure were observed among participants from South Asia (OR = 1.52; 95% CI: 1.25–1.85) and Southeast Asia/Oceania (OR = 2.1; 95% CI: 1.63–2.70), as well as among nurses (OR = 5.15; 95% CI: 2.64–10.03) and Christian participants (OR = 4; 95% CI: 1.02–15.6), whereas single participants exhibited less positive attitudes (OR = 0.560; 95% CI: 0.38–0.82). These results highlight the complex interaction between cultural and demographic factors in determining perceptions of terminal-stage cancer. They emphasize the value of customized treatments and communication techniques to address different points of view, which will ultimately improve patient support and care in situations involving terminal illness.

Pediatric brain arteriovenous malformations (AVMs) are rare but high-risk vascular anomalies associated with substantial morbidity and mortality due to their elevated lifetime risk of rupture. Over the past decade, advances in microsurgical resection, stereotactic radiosurgery (SRS), and endovascular embolization have reshaped the management landscape, yet treatment remains highly individualized and controversial, especially in unruptured cases. This narrative review synthesizes findings from 20 eligible studies published between 2015 and 2025, examining outcomes across different modalities. Microsurgical resection demonstrated the highest immediate obliteration rates (>95%) in low-grade, accessible, ruptured lesions, but recurrence rates remain disproportionately higher in children (up to 29%). SRS achieved obliteration rates of 63–72% in Spetzler–Martin (SM) I–III lesions with low complication and recurrence rates, although outcomes were less favorable for higher-grade AVMs. Embolization alone provided limited curative potential but served as an important adjunct in multimodal therapy. Importantly, embolization prior to radiosurgery was associated with reduced obliteration rates and higher complication risks. Across modalities, hemorrhagic presentation often predicted better treatment response, while recurrence and long-term surveillance emerged as central challenges in pediatric care. These findings highlight the necessity of multidisciplinary, individualized management strategies and emphasize the importance of lifelong follow-up to mitigate recurrence risk and optimize outcomes.

Blunt cerebrovascular injury (BCVI) defines a relatively common finding in trauma-injured patients, seen in roughly 2.4% of trauma patients. Unrecognized and untreated complications of BCVI can include stroke and neurological deficits. Increased use of CT angiography has led to a greater incidence of BCVI in traumatic brain injury and polytrauma patients, prompting a greater understanding of treatment options to mitigate morbidity. Antiplatelet medications, including aspirin and P2Y12 inhibitors (e.g., clopidogrel), as well as warfarin, dual oral anticoagulants (DOAC, e.g., dabigatran, rivaroxaban, apixaban, and edoxaban) provide a wide variety of medical treatment options. This article serves as a review of current evidence from 2015 to 2025 regarding best practices involving antiplatelet and anticoagulation use in the treatment of BCVI.

Human glioblastoma (GBM) is a remarkable example of a highly aggressive and untreatable tumor. A formidable challenge in treating GBM is its extensive intratumor heterogeneity, which traditional bulk tissue analysis fails to capture. Fluorescence-guided multiple sampling, utilizing 5-aminolevulinic acid for tumor visualization, offers objective tumor tissue identification and enhanced spatial resolution. In this study, we present a perspective on a novel “spatial-in-spatial” approach that enables comprehensive analysis of tumor areas and their microenvironment—at macroscopic and microscopic levels—by combining fluorescence-guided multiple sampling with spatial-omics technologies. This perspective discusses how this integrated methodology has the potential to advance our understanding of GBM biology through the high-resolution, multidimensional characterization of tumor heterogeneity and identification of novel, area-specific therapeutic targets.

Introduction: Ectopic pregnancy (EP) is a significant cause of gynaecological morbidity and mortality. Salpingectomy is the preferred management modality in recurrent ectopic pregnancies; although they do not eliminate the risk of reoccurrence. The aetiology of recurrent ectopic pregnancies remains unknown but there are identifiable risk factors associated with increased likelihood of occurrence. Case Presentation: We present the case of a 30-year-old woman who attended the emergency unit with her second spontaneous ectopic pregnancy following a previous bilateral salpingectomy. She had prior multiple spontaneous ectopic pregnancies: laparoscopic salpingectomy for a left cornual EP in 2017 followed by laparotomic salpingectomy for a ruptured right EP after failed medical management in 2018. Lastly, she had laparoscopic removal of an EP sac in the scar of a previous left cornual EP in 2019. She presented with a history of missed periods, pelvic pain, and vaginal spotting. Her examination revealed left lower abdominal pain, soft, non-tender abdomen, and no cervical excitation. Pelvic ultrasound revealed a thin endometrium and no intrauterine pregnancy visualised. A suspicious complex mass near the left ovary with a ring-like structure was noted. Her β-HCG was (251 IU/L) which plateaued after 48 hrs (220 IU/L). She responded well to methotrexate with no need for surgical intervention this time. Conclusion: This case is unique as it highlights the importance of keeping an open mind when managing recurrent ectopic pregnancies, especially when preventative surgical measures have been performed previously.