Piotr Paździora

Background and Clinical Significance: Meningeal melanocytoma is an exceptionally rare, typically benign melanocytic tumor of the central nervous system. Its clinical management becomes particularly challenging when located at the craniovertebral junction, where proximity to critical neurovascular structures limits the extent of safe surgical resection. Due to its rarity and complex anatomical location, each case contributes valuable insight into optimal diagnostic and therapeutic strategies. We report a case of circumscribed meningeal melanocytoma arising at the craniovertebral junction and provide a focused review of previously reported cases, with particular emphasis on clinical presentation, radiological characteristics, surgical challenges, treatment strategies, and outcomes; Case Presentation: A 65-year-old Caucasian woman presented with progressive binocular diplopia. Magnetic resonance imaging revealed two contrast-enhancing extra-axial lesions at the level of the foramen magnum, with one dominant mass. The patient underwent near-total microsurgical resection of the dominant lesion under intraoperative neurophysiological monitoring. Histopathological and immunohistochemical evaluation confirmed the diagnosis of meningeal melanocytoma. In the postoperative period, the patient developed transient lower cranial nerve dysfunction, which improved with conservative treatment. Follow-up imaging demonstrated a stable residual tumor. Given the subtotal nature of resection and the anatomically complex location, adjuvant proton beam radiotherapy was recommended; Conclusions: Meningeal melanocytoma of the craniovertebral junction poses distinctive diagnostic and surgical challenges because of its proximity to critical neurovascular structures. The available literature supports maximal safe resection as the primary treatment strategy, with adjuvant radiotherapy considered in selected patients with residual disease. Long-term radiological surveillance is warranted because late recurrence and malignant transformation have been reported.

Background and Clinical Significance: Meningeal melanocytoma is an exceptionally rare, typically benign melanocytic tumor of the central nervous system. Its clinical management becomes particularly challenging when located at the craniovertebral junction, where proximity to critical neurovascular structures limits the extent of safe surgical resection. Due to its rarity and complex anatomical location, each case contributes valuable insight into optimal diagnostic and therapeutic strategies. We report a case of meningeal melanocytoma arising at the foramen magnum and discuss the challenges associated with its management. Case presentation: A 65-year-old Caucasian woman presented with progressive binocular diplopia. Magnetic resonance imaging revealed two contrast-enhancing extra-axial lesions at the level of the foramen magnum, with one dominant mass. The patient underwent near-total microsurgical resection of the dominant lesion under intraoperative neurophysiological monitoring. Histopathological and immunohistochemical evaluation confirmed the diagnosis of meningeal melanocytoma. In the postoperative period, the patient developed transient lower cranial nerve dysfunction, which improved with conservative treatment. Follow-up imaging demonstrated stable residual tumor. Given the subtotal nature of resection and the anatomically complex location, adjuvant proton beam radiotherapy was recommended. Conclusions: This case underscores the importance of achieving maximal safe resection while preserving neurological function in surgically demanding locations such as the craniovertebral junction. It also supports consideration of adjuvant radiotherapy following subtotal resection to improve local disease control in patients with residual meningeal melanocytoma.

Wstęp: Guzy mózgu stanowią złożoną grupę nowotworów wywodzących się z różnych typów komórek ośrodkowego układu nerwowego. Ich klasyfikacja, oparta na cechach histopatologicznych i molekularnych, determinuje strategie terapeutyczne oraz rokowanie. Postępy w neuroobrazowaniu i technikach biopsji zwiększyły precyzję diagnostyczną, umożliwiając bardziej spersonalizowane i skuteczne metody leczenia. Biopsja mózgu (brain biopsy – BB) jest nieodzownym zabiegiem neurochirurgicznym, służącym do histologicznej diagnostyki nowotworowych zmian mózgu, odgrywającym kluczową rolę w postępowaniu z pacjentem. Celem badania jest ocena wyników histologicznych BB oraz identyfikacja grup wiekowych, rozkładu płci, topografii i różnych histologicznych typów guzów mózgu. Materiał i metody: Przeprowadzono retrospektywne badanie kohortowe w jednym z akademickich ośrodków medycznych, analizując 112 pacjentów poddanych BB w okresie od stycznia 2017 r. do sierpnia 2023 r. Badanie koncentrowało się na wynikach histologicznych oraz markerach molekularnych uzyskanych z biopsji stereotaktycznych i z użyciem neuronawigacji, oceniając skuteczność w uzyskiwaniu próbek diagnostycznych oraz zastosowanie systemu klasyfikacji nowotworów mózgu opracowanego przez Światową Organizację Zdrowia (World Health Organization – WHO). Analizowano również korelacje pomiędzy wynikami histologicznymi a powikłaniami. Wyniki: Badanie histologiczne potwierdziło wysoką skuteczność diagnostyczną BB, przy zbliżonej skuteczności metod stereotaktycznych i z zastosowaniem neuronawigacji. Do kategoryzacji zmian zastosowano klasyfikację nowotworów WHO, co również pozwoliło na zaplanowanie dalszego leczenia onkologicznego. Zaobserwowano niski odsetek powikłań, co potwierdza bezpieczeństwo procedury. Wnioski: Wyniki wskazują, że spektrum rozpoznań nowotworów mózgu u badanych pacjentów jest zbieżne z globalnymi trendami epidemiologicznymi. Zastosowanie klasyfikacji WHO umożliwiło zwiększenie precyzji diagnostycznej oraz ułatwiło standaryzację decyzji terapeutycznych.

Introduction and Purpose: Hydrocephalus is a neurological disorder caused by abnormal accumulation of cerebrospinal fluid (CSF) within the brain ventricles, leading to increased intracranial pressure and neurological impairment. Despite advances in neurosurgery and neuroimaging, optimal management remains a major challenge. This review aims to summarize current therapeutic strategies for hydrocephalus and highlight recent and emerging innovations to improve outcomes and patient quality of life. Materials and Methods: A comprehensive literature search was conducted using PubMed, BioMed Central, Scopus, and Google Scholar. Keywords included: hydrocephalus, NPH, VP shunting, LP shunting, and endoscopic third ventriculostomy (ETV). Reference lists of selected papers were also reviewed. Conclusion: Over the past century, hydrocephalus treatment has progressed from simple drainage to valve-regulated shunts and endoscopic procedures. However, no curative therapy exists, and CSF diversion remains the mainstay. Progress has been incremental due to heterogeneous etiologies, biological complexity, technical constraints, and lack of pharmacological options. Current approaches primarily include ventriculoperitoneal shunting and ETV, selected according to etiology and patient profile. Future directions involve hybrid surgical techniques (ETV with stenting), smart and biocompatible implants, molecular modulation of aquaporins and glial function, gene and stem-cell therapies, and prenatal neuroendoscopic repair demonstrated in experimental models. The next generation of therapy will likely unite mechanical precision with biological insight, shifting from simple drainage toward restoration of CSF physiology and brain health. Integrating surgical, molecular, and etiological perspectives is essential to move beyond symptomatic management.

Background and Objectives: As brain lesions present complex diagnostic challenges, accurate tissue sampling via biopsy is critical for effective treatment planning. Traditional frame-based stereotactic biopsy has been complemented by navigated biopsy techniques, leveraging advancements in imaging and navigation technology. This study aims to compare the navigated and frame-based stereotactic biopsy methods in a clinical setting, evaluating their efficacy, safety, and diagnostic outcomes to determine the optimal approach for precise brain lesion targeting. Materials and Methods: retrospective analysis was conducted on patients who underwent brain biopsies between January 2017 and August 2023 at an academic medical center. Data on patient demographics, clinical characteristics, biopsy technique (navigated vs. frame-based), and outcomes including accuracy, complications, and hospital stay duration were analyzed. Results: The cohort comprised 112 patients, with no significant age or gender differences between groups. Symptoms leading to biopsy were predominantly diminished muscle strength (42.0%), cognitive issues (28.6%), and aphasia (24.1%). Tumors were most common in the deep hemisphere (24.1%). The median hospital stay was 5 days, with a rehospitalization rate of 27.7%. Complications occurred in 4.47% of patients, showing no significant difference between biopsy methods. However, navigated biopsies resulted in fewer samples (p < 0.001) but with comparable diagnostic accuracy as frame-based biopsies. Conclusions: Navigated and frame-based stereotactic biopsies are both effective and safe, with comparable accuracy and complication rates. The choice of technique should consider lesion specifics, surgeon preference, and technological availability. The findings highlight the importance of advanced neurosurgical techniques in enhancing patient care and outcomes.