Daniel Ilie Rotariu

Background: Pituitary carcinoma (PC) is a rare and aggressive pituitary neuroendocrine tumor (PitNET) defined by non-contiguous craniospinal or systemic metastatic spread. Evidence guiding treatment is limited to case reports and case series. This systematic review aimed to characterize the clinicopathological features, treatment patterns, and prognostic determinants of PC through pooled individual patient data (IPD) analysis. Methods: A systematic search of PubMed/MEDLINE and Embase (January 1990 to March 2026) was conducted in accordance with PRISMA 2020 guidelines (PROSPERO: CRD420261402665). Individual patient data were extracted for 56 pre-specified variables from the identified literature. Two additional institutional cases were analyzed separately as illustrative clinical examples and are not part of the pooled statistical cohort. Survival was estimated using the Kaplan–Meier method with log-rank tests. Univariate and multivariable Cox proportional hazards regression and binary logistic regression (outcome: long-survivor status, defined as OS > 24 months) were performed on the pooled literature cohort. Results: A total of 111 patients from 93 papers were included (51 males (45.9%); median age at PC diagnosis 54 years (IQR 40–61)), with corticotroph lineage predominating (47.7%). Median OS from PC diagnosis was 19 months (IQR 9.5–46); one-year OS was 67.7% and two-year OS 52.0%. Multimodal treatment was associated with significantly longer OS (median 45 vs. 12 months; log-rank p = 0.004). In multivariable Cox regression (n = 88; C-index 0.725), any objective treatment response (HR 0.245, 95% CI 0.101–0.593, p = 0.002), functional tumor status (HR 2.041, 95% CI 1.017–4.095, p = 0.045), and age at PC diagnosis (HR 1.018/year, p = 0.049) were independently associated with OS. Logistic regression identified multimodal treatment (OR 5.29, p = 0.009), any treatment response (OR 5.47, p = 0.006), and early metastasis (OR 0.18, p = 0.024) as independent predictors of long-survivor status. Ki-67 increased significantly from initial to PC-stage diagnosis (median 7% vs. 12%; Wilcoxon p < 0.001), which is, to our knowledge, the first demonstration of this longitudinal rise in a pooled pituitary carcinoma cohort. Conclusions: PC carries a poor prognosis, with a median OS of 19 months. Multimodal therapy and achievement of objective response are the strongest determinants of prolonged survival. Prospective registries with standardized molecular profiling are needed to advance precision management of this ultra-rare malignancy.

Spinal surgery involves highly complex procedures where the risk of severe complications, including postoperative infections, may compromise both surgical success and patient survival. In this study, functional coatings for spinal screws were developed to promote bone integration and simultaneously prevent infection. The coating design employed a multilayer architecture based on poly(ε-caprolactone) (PCL) as the main structural layer, covered with chitosan (CS), a biocompatible polymer that enhances surface interaction with both the metallic substrate and the active agents. To stimulate bone regeneration, calcium β-hydroxy-β-methylbutyrate (HMB) was incorporated, while antimicrobial efficacy was achieved by embedding PLGA-based polymeric microspheres encapsulating gentamicin sulfate, a broad-spectrum antibiotic. The obtained results confirmed the successful integration of all components, as evidenced by FTIR and Raman spectroscopy, along with homogeneous surface morphologies observed via SEM analysis. Biological assays demonstrated significant antimicrobial activity against Staphylococcus aureus and Escherichia coli. The developed coatings therefore exhibit strong potential as bioactive, dual-functional protective layers for spinal screws, providing both osteoconductive and antimicrobial properties.

Background: Autologous fat grafts are widely used for skull base reconstruction following endoscopic endonasal surgery. However, uncertainty regarding their postoperative volumetric evolution may complicate the distinction between expected postoperative changes and residual or recurrent disease on imaging. Methods: We performed a retrospective volumetric imaging analysis of patients undergoing endoscopic endonasal skull base surgery with reconstruction using autologous fat and the 3F technique between 2013 and 2023. Fat graft volumes were measured on postoperative day 1 CT scans and on 3-, 9-, and 15-month postoperative MRI using standardized volumetric segmentation analysis (method described in detail in the main text). It should be noted that baseline measurements were derived from CT, whereas follow-up assessments were performed using MRI. Resorption rates were correlated with demographic, pathological, surgical, and postoperative variables. Results: Thirty-four patients met inclusion criteria. Mean initial fat graft volume was 3.01 ± 2.65 cm³. Overall, fat graft volume demonstrated a consistent temporal decline, with mean reductions of 56.8% at 3 months, 75.3% at 9 months, and 81.8% at 15 months. In subgroup analysis, differences in resorption were observed according to surgical approach, with higher resorption following transsellar compared with transtuberculum approaches (87.4% vs. 74.8% at 15 months, p = 0.042). These findings were closely related to graft compartment, although compartment and surgical approach showed substantial overlap in this cohort. No significant associations were detected between resorption rate and age, sex, comorbidities, postoperative CSF leak, extent of resection, or adjuvant radiotherapy. Conclusions: Autologous fat grafts used for skull base reconstruction demonstrate substantial early postoperative resorption followed by slower progressive volume loss. Recipient anatomical compartment was associated with differences in observed resorption patterns, although this relationship should be interpreted in the context of overlap with surgical approach and limited sample size. These findings may assist in improving interpretation of postoperative imaging by clarifying the expected temporal pattern of fat graft evolution after endoscopic skull base reconstruction.

Spinal metastasis remains a significant clinical issue, frequently resulting in substantial pain and disability among cancer patients. Conventional management strategies have historically included chemotherapy, radiotherapy, and open surgical intervention. However, advancements in minimally invasive spinal surgery (MISS) have notably shifted the therapeutic landscape. This review examines recent evidence surrounding MISS, directly comparing it to traditional open procedures. Current literature demonstrates that MISS typically results in reduced intraoperative blood loss, shorter hospitalization durations, decreased infection rates, and functional outcomes that are at least equivalent—if not superior—to those of open surgery. Additionally, the emergence of hybrid therapeutic approaches—specifically, the utilization of separation surgery followed by stereotactic radiosurgery—has shown promise in achieving local tumor control, particularly in select malignancies. This narrative review also evaluates contemporary clinical decision-making frameworks such as NOMS, LMNOP, and NESMS. Further, it advocates for the integration of advanced prognostic tools and tumor genomics to enable more personalized treatment strategies for individuals with spinal metastasis.

Background: Midline cysts of the brain are comprised of the following entities, septum pellucidum cysts, cavum vergae cysts and velum interpositum cysts. These lesions are uncommon and often asymptomatic; nonetheless, certain clinical manifestations may be linked to midline cysts, including headaches, signs of elevated intracranial pressure, neurological deficits, or alterations in mental status. Controversy persists in the therapy of symptomatic cases, mostly due to the challenge of establishing a correlation between the symptomatology and the presence of the cyst. Case description: We present the case of a 64-year-old female known with type—1 neurofibromatosis that associated a midline cyst. The cyst was treated endoscopically, in the initial stage (single wall perforation) showed no clinical or imagistic improvement. The incriminated symptoms in these cases are caused not only by compression or obstruction of the CSF flow but also to a complex alteration of CSF dynamics, in this case the stoma was found permeable at the second surgery but there was no obvious communication on the preoperative evaluation by ventriculocisternostomy. A second surgery was performed, with bilateral perforation and subsequent improvement of symptomatology and decrease of cyst dimensions. A literature review is presented concerning clinical presentation, therapeutic options, and possible outcomes. Conclusions: Endoscopic fenestration is an efficacious method for treating midline cysts, with bilateral wall fenestration representing the standard practice. Understanding the anatomical and developmental specifics of the septal region, together with cerebrospinal fluid dynamics, is essential for effective treatment of this condition.

Pineal-region tumors are a histologically heterogeneous group of tumors and represent a rare occurrence, accounting for less than 1% of all adult intracranial tumors. Among these, primary pineal malignant melanomas (PPM) represent an even rarer entity, with only twenty-five cases being reported in the literature to date. We present the case of a 65-year-old patient who presented in our department for progressive headache, gait disturbance and memory impairment. Magnetic resonance imaging (MRI) of the brain revealed a solid mass in pineal region, measuring 2.2 × 1.2 × 2.0 cm and causing obstructive hydrocephalus. He underwent a third ventriculostomy, but we failed to obtain a sample for diagnostic purposes. The intraoperative surprise was the presence, at the level of the third ventricle, of multiple melanin deposits, which were not picked up by the MRI. Although the biopsy could not be performed and had to be obtained by stereotactic biopsy in a second intervention, the endoscopy findings allowed for the correct staging of the intracranial disease and appropriate treatment management.

The immobility of patients confined to continuous bed rest continues to raise a couple of very serious challenges for modern medicine. In particular, the overlooking of sudden onset immobility (as in acute stroke) and the delay in addressing the underlying conditions are of utmost importance for the patient and, in the long term, for the medical and social systems. This paper describes the design principles and concrete implementation of a new smart textile material that can form the substrate of intensive care bedding, that acts as a mobility/immobility sensor in itself. The textile sheet acts as a multi-point pressure-sensitive surface that sends continuous capacitance readings through a connector box to a computer running a dedicated software. The design of the capacitance circuit ensures enough individual points to provide an accurate description of the overlying shape and weight. We describe the textile composition and circuit design as well as the preliminary data collected during testing to demonstrate the validity of the complete solution. These results suggest that the smart textile sheet is a very sensitive pressure sensor and can provide continuous discriminatory information to allow for the very sensitive, real-time detection of immobility.

Indications and treatment techniques in brain AVM very much change last years. Basically microsurgery, embolization, radiosurgery and observation, alone or combined are the actual methods reported in literature and also that we use in ours patients. We review the case we treated since all this methods becomes available for our cases. Indication was established according with Spetzler-Martin scale together with some additional factors: vascular high risk factors in AVM architecture: associated aneurysms or varix; compact unique nidus versus multiple, diffuse or associated proliferative angiopathy; rupture/unrupture AVM; patient status: GCS, age, comorbidities, personal wiling. Statistical studies (ARUBA) influenced patient decision. A lot of time is spend to explain to patient the actual knowledge about his/him disease. Clinical finding, images, pre and posttreatment, surgical records, complications and results are analyzed and compared with literature data. In our opinion microsurgical resection is the gold standard for low grade AWM if not general contraindications exist. There are still very difficult cases where we just observe the patient but results are usually bad. For ruptures difficult AVM we prefer to use first embolization and immediately after surgery if embolization was not complete. If the remaining part of the nidus are in deep seated vital areas embolization is completed by radiosurgery.