Aurora Arben Muça

Subdural empyema is a neurosurgical emergency traditionally managed with craniotomy and prolonged intravenous antibiotic therapy. Minimally invasive approaches may represent an alternative in selected cases, particularly when combined with timely diagnosis and targeted antimicrobial treatment. We report two cases of subdural empyema treated with minimally invasive burr-hole evacuation. A 22-year-old man with developmental anomalies and postischemic stroke history presented with intermittent high fever for 2 weeks. Rapid neurological deterioration over 24 hours led to coma (Glasgow Coma Scale 5). Cranial computed tomography (CT) revealed a right-sided subdural empyema with significant mass effect. Emergency burr-hole evacuation was performed, followed by broad-spectrum antibiotics later tailored to Staphylococcus aureus. A 40-year-old man presented with hypertensive intracranial syndrome and febrile episodes for 1 week. CT and magnetic resonance imaging revealed a left hemispheric subdural collection suggestive of empyema, likely secondary to otitis media from suspected Streptococcus anginosus. Burr-hole evacuation and empiric triple antibiotic therapy were initiated. In both cases, postoperative imaging confirmed complete evacuation without residual collection. The first patient required prolonged intensive care with gradual neurological improvement over several weeks, whereas the second patient achieved immediate postoperative recovery. At 2-year radiological follow-up, no recurrence was observed in either patient. Minimally invasive burr-hole evacuation, combined with culture-guided antibiotic therapy, can be effective in selected cases of subdural empyema, yielding favorable clinical and radiological outcomes.

Background: From Dandy's earliest endoscopic cauterization of the choroid plexus in hydrocephalus to Fukushima's first successful endoscopic brain biopsy (EB) in 1973, neuroendoscopic indications have expanded substantially. Objective: To evaluate the effectiveness and diagnosis yield of endoscopic brain biopsy (EB) Design, Setting and Participants: Single center retrospective series by the senior author. Between November 2012 and June 2024, 27 patients underwent intraventricular endoscopic biopsy (VEB) and 7 underwent intraparenchymal endoscopic biopsy (PEB). Main Outcome(s) and Measure(s): Demographics, histopathology, operative times, adjunct procedures, hospital length of stay, and complications. Results: In the VEB group, age ranged 6-70 years (mean 28) with 2:1 female: male ratio. The most common diagnoses were pilocytic astrocytoma (26%) and metastasis and ependymoma (15% each). Pathology was inconclusive in 15%. Other diagnoses included glioblastoma (11%), germinoma (7%), and meningioma, pineoblastoma, and epidermoid cyst (each 4%). In the PEB group (age 25-70 years, mean 59), glioblastoma was most frequent (71%); 14% had diffuse astrocytoma grade II and 14% were non-diagnostic. Typical operative times were 1,5-3 hours for VEB (depending on concomitant procedures_ and up to 2 hours for PEB. Conclusions and Relevance: EB achieved an 85% diagnostic yield in this series, comparable to published yields for stereotactic biopsy (~86%). In appropriately selected intraventricular and deep lesions, EB offers tissue diagnosis with the potential to address hydrocephalus in the same session.

Osteoid osteoma (OO) is a rare primary (10% incidence) bone-producing benign neoplasm, most common during first two decades of life (87%) with male predominance. We present the sixth reported case in literature of thoracic OO. A 69-year-old male presented with chronic back pain, sphincter dysfunction, and lower-limb weakness, with nocturnal pain relieved by NSAIDs. MRI revealed a bilateral Th10 OO causing myelopathy. OO typically presents with nocturnal pain, stiffness, and muscular spasms solved with NSAIDs use; OO also presents with scoliosis and radiculopathy, spinal cord or nerve root compression. OO rarely exceed 10 mm, so it might easily be overlooked. OO is often self-limited over 2 to 6 years. When conservative treatment fails or adolescents develop structural scoliotic spinal curve, surgery is indicated.

Traumatic brain injury (TBI) remains one of the leading causes of mortality and long term disability among individuals under 45 years of age worldwide. Despite major advances in neurocritical and surgical care, the prevention of secondary brain injury continues to be the cornerstone of management. Early resuscitation with avoidance of hypotension and hypoxia remains vital for improved outcomes. Invasive intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring are widely recommended in severe TBI, though RCTs have not demonstrated clear superiority over clinical examination-based management. Landmark trials such as DECRA, RESCUEicp and RESCUE-ASDH have reshaped understanding of surgical intervention, showing that while it effectively reduces ICP, outcomes depend on timing and patient selection. Integration of quantitative pupillometry, biomarkers (GFAP, UCH-L1), and multimodal monitoring into tiered management frameworks represents a shift toward individualized, physiology-guided treatment. The aim of this review is to provide an updated synthesis of evidence-based management strategies for TBI, incorporating new insights from the 2024 American College of Surgeons (ACS) Best Practices Guidelines for the Management of Traumatic Brain Injury and recent clinical trials, with a focus on early recognition and the "time is brain" paradigm. The article reviews the current understanding of TBI pathophysiology, critical care monitoring strategies, and surgical management based on recent evidence and clinical trials.

Cubital tunnel syndrome (CuTS) is the second most common peripheral nerve disorder of the upper limb and results from compression at anatomically vulnerable points along the course of the ulnar nerve. A total of 26 consecutive patients with CuTS who underwent surgical treatment by a single surgeon between January 2017 and March 2022 were retrospectively reviewed. Demographic characteristics, history of prior elbow trauma, clinical presentation, electrophysiological findings, surgical findings, and postoperative outcomes were analyzed. Three patients had documented major prior elbow trauma and were described individually. In the posttraumatic cases, preoperative neurological deficits were heterogeneous, and intraoperative findings included perineural fibrosis, altered tissue consistency, and an anomalous anconeus muscle. One of the three patients with prior elbow trauma improved by one McGowan grade, while two remained in the same grade at 12 months. All three demonstrated improvement in sensory symptoms, while motor recovery was variable and more limited in the patients with persistent higher-grade deficits. Postoperative complaints were limited to operative-site pain and transient paresthesia in two patients. Given the small number of posttraumatic cases, these findings are descriptive and hypothesis-generating rather than suitable for inferential comparison.