Bareikis, Karolis

Introduction Craniopharyngiomas are rare benign epithelial tumors of the sellar and suprasellar region, accounting for 1.2-4% of intracranial tumors [1]. Cystic forms frequently cause visual impairment due to optic chiasm compression and show high recurrence rates despite treatment [2]. Management during pregnancy is particularly challenging because of limited diagnostic and therapeutic options. Case Presentation A 34-year-old woman, pregnant at 15 weeks of gestation, presented with rapidly progressive visual loss. MRI revealed a large intra- and suprasellar cystic mass compressing the optic chiasm, consistent with craniopharyngioma. Given the rapid visual deterioration, urgent transsphenoidal cyst decompression was performed during the second trimester, resulting in significant visual improvement. Postoperative cerebrospinal fluid leakage was successfully treated with lumbar drainage. Several months later, at 36 weeks of gestation, visual impairment recurred with MRI-confirmed cyst re-expansion. Due to worsening visual function, the pregnancy was completed by cesarean section. Postpartum stereotactic cyst aspiration led to transient visual recovery; however, further cyst recurrence occurred. Repeat transsphenoidal cyst aspiration was performed without complications. Given the high risk of radical surgery, fractionated stereotactic Gamma Knife radiosurgery was administered, leading to cyst reduction and gradual improvement of visual fields. Discussion Craniopharyngiomas demonstrate aggressive local behavior and frequent cystic recurrence [2]. Although pregnancy-related hormonal changes have been proposed as a contributing factor, clinical evidence remains limited and inconclusive, suggesting an association with cyst enlargement rather than true tumor growth [3,4]. Repeated cyst decompression provides rapid symptom relief but carries a high risk of recurrence [5]. Fractionated stereotactic radiosurgery offers effective tumor control while minimizing radiation-induced optic neuropathy in lesions near critical structures [6]. Conclusions This case highlights the complexity of managing recurrent cystic craniopharyngioma during pregnancy. A multidisciplinary, multimodal approach combining minimally invasive surgery and fractionated radiosurgery can achieve symptom control with acceptable morbidity.

Background and Objectives: Post-surgical central nervous system (CNS) infections are severe complications associated with high morbidity and mortality. Vancomycin is a key antibiotic used in their management. However, because of the restrictive properties of the blood–brain barrier (BBB), plasma concentrations may not accurately reflect drug exposure in the brain extracellular fluid (ECF), the presumed site of infection. Cerebral microdialysis enables direct measurement of unbound drug levels in brain ECF. This study aimed to assess vancomycin penetration into brain ECF in patients with suspected or confirmed post-surgical CNS infection. Materials and Methods: Five patients with suspected or confirmed post-surgical CNS infections were enrolled. Paired brain ECF microdialysate and plasma samples (and cerebrospinal fluid (CSF) samples, when available) were collected over two consecutive days at vancomycin steady state. Vancomycin concentrations were determined using a homogeneous enzyme immunoassay and corrected for probe recovery based on in vitro calibration. Pharmacokinetic parameters, including mean concentrations and 24-h area under the concentration–time curve (AUC24), were calculated for plasma and ECF, and ECF-to-plasma ratios were derived. Results: Two subgroups could be identified: patients with negligible ECF concentrations (“low penetrators”), and those with higher ECF levels (“high penetrators”). Mean (SD) ECF-to-plasma concentration ratios were 0.07 (0.04) in “low penetrators” and 0.44 (0.10) in “high penetrators”. The corresponding AUC24 ratios were 0.06 (0.03) and 0.40 (0.03), respectively. The presence of systemic inflammatory response syndrome (SIRS) was considered the most plausible factor differentiating these two subgroups. Conclusions: Vancomycin exposure in brain ECF demonstrated substantial interpatient variability in post-surgical CNS infections, with some patients showing minimal drug penetration.

The operating microscope has transformed neurosurgery more than any other innovation. In the early 20th century, modern neurosurgery pioneers such as Harvey Cushing and Dandy Walker carried out brain surgery with limited visualization, often facing high complication rates and restricted access to deeper structures. This changed dramatically in the late 1960s, when Mahmut Gazi Yasargil [1] introduced the surgical microscope which later changed the concept of surgical technique leading to a new term called microneurosurgery. For the first time, neurosurgeons could work with high magnification, bright illumination, and refined precision. This not only reduced damage to surrounding brain tissue but also opened the door to procedures that had previously been unimaginable, such as bypassing tiny cerebral arteries. The microscope also stimulated the development of an entirely new set of microsurgical instruments, specifically designed for delicate work in confined spaces. Modern microscopes now offer far more than magnification: they integrate real-time navigation and fluorescence tools such as indocyanine green (ICG) and sodium fluorescein, helping surgeons distinguish tumors, vessels, and functional pathways [2]. By reshaping both the technical and conceptual possibilities of brain surgery, the surgical microscope has become a cornerstone of modern neurosurgical practice.

A 41-year-old primigravida woman transferred from an outside hospital to our Lithuanian University of Health Sciences Hospital with acute-onset severe occipital headache, accompanied by nuchal rigidity, nausea, and vomiting at 35+5 weeks’ gestation. The patient was Hunt and Hess grade I or II with a GCS of 13 and was intubated under sedation and transferred to the NICU. Computed tomography revealed the presence of hemorrhage in the suprasellar, interpeduncular, left cerebellopontine angle, anterior segments of Sylvian cisterns and IV ventricle. Suspicion of a 1.5 mm saccular aneurysm in the distal part of the C7 segment of the left ACI on CTA was ruled out by DSA without evidence of vascular malformations or other structural sources of bleeding. The caesarean section was performed based on the predominant indications observed in the ultrasound assessment. Post-surgery extubated, fully conscious, no focal or generalized neurological deficits, predominantly painful and meningeal syndromes. The transcranial Doppler assessment of mean flow velocity (MFV) in the MCA indicated the presence of bilateral mild vasospasm (MFV of 120-149 cm/s), with no clinical symptoms expressed during the initial fourteen-day period in the NICU. A second diagnostic cerebral angiography, performed thirteen days later, did not reveal any cerebrovascular abnormalities. The choice of diagnostic approach should be tailored on a case-by-case basis, and it is not reasonable to delay or defer necessary emergency maternal diagnosis because of pregnancy in the presence of a suspicious and negative CTA, independently of the extent of hemorrhage.

Introduction Brain abscess is a focal intraparenchymal infection characterized by an encapsulated collection of purulent material, immune cells and other material following bacterial or fungal infection[1]. Brain abscess constitutes a critical neurosurgical condition with low numbers of positive cultures which makes additional challenges in management. Aim of the study The objective of this single-center study is to review our experience,to determine the predictors related to the outcome. Materials and methods The retrospective study recorded clinical and neuroradiological features of patients who were treated at the Lithuanian University of Health Sciences Hospital between 2018 and 2023. The patient cohort was stratified into positive (G+) and negative bacterial growth (G-) detected in pus culture. The functional status was assessed using the modified Rankin Score (mRS) at discharge. Statistical analysis was accomplished using the IBM SPSS Statistics 27.0 software package. Differences between the favourable (mRS of 0-3) and unfavourable (mRS of 4-5) outcome groups were tested. Results The study cohort comprised 65 patients (age mean ± SD, 52.83 ± 18.13; range 2 to 88; 42 (64.6%) male and 23 (35.4%) female). Postoperative infections with epidural or subdural empyemas (N 30, 46.2%) were excluded and only supratentorial intraparenchymal abscesses (N 35, 53.8%) were analyzed. Unfavorable outcomes were reported in 8 patients (23%), out of which 4 patients died, those patients were older (mean ± SD, 54 ± 23 vs. 74 ± 12, p<0.05). No culture growth was detected in 26 cases (74.3%) compared to 9 positive cases (25.7%). Within the G+ group, 5 patients (55.6%) manifested abscesses with multilobular involvement, while in the G- cohort, 10 patients (38.5%) exhibited frontal lobe abscesses (p=0.045). Of note, median duration of hospitalization was longer in the G+ cohort (37 ± 31 vs. 22.5 ± 19 days, p<0.05) also as more worse outcomes (p<0.001). Conclusions Structural factors such as deep-located abscess, extension of the infection into the ventricles with ventriculitis, obstructive hydrocephalus and multiple lesions leads to an unfavourable outcome. Of note, immunocompromised patients have an insufficient inflammatory response and therefore may not show a significant response of inflammatory markers in the poor outcome group. Aggressive treatment with surgery, if indicated, and careful management of the specimen for culture may more often improve to prescribe targeted antibiotic therapy into the pathogen to prevent irreversible outcomes.

Introduction Neuronavigation systems have transformed cranial neurosurgery by improving surgeon's ability to assess and operate on brain tumors [1-3]. However, some studies suggest that neuronavigation may affect surgical duration [3- 4]. With increasing use of neuronavigation, it becomes crucial to evaluate its influence on intraoperative intervals to optimise surgical strategy, avoid complications and maximise the advantages of surgical tools [5]. Aim To examine how neuronavigation affects open cranial surgery duration, planning accuracy and intraoperative stages. Methods A retrospective study was conducted using data of 79 patients, who underwent open cranial surgery in 2022, at the Hospital of Lithuanian University of Health Sciences Kaunas clinics, Department of Neurosurgery, Kaunas, Lithuania. Data collected from the operating room management system included use of neuronavigation, surgery length, planned duration, discrepancy of surgery length (DOSL), compared to planned duration. The following intervals were calculated: Entrance into the Operating Room to Initiation of Anesthesia (EOR-IA), Initiation of Anesthesia to Incision (IA-I), Incision to Suturing (I-S), Suturing to the Conclusion of Anesthesia. (S-CA), Conclusion of Anesthesia to Departure from the Operating Room. (CA-DOR). IBM SPSS Statistics was used for statistical analysis, including Mann-Whitney U tests, Tukey's Hinges for interquartile range (IQR), and descriptive statistics. Results Neuronavigation has been associated with significantly longer actual and planned surgery duration. With navigation, median surgery length was 250 min. (IQR = 114 Range: 123 – 436), compared to 172 min. (IQR = 137; Range: 36 – 452; p = 0.0015) without. Median planned duration was 185 min. (IQR = 90; Range: 90 – 385), without navigation, the median was 145 min. (IQR = 120; Range: 35 – 265; p = 0.00068). However, no significant differences were observed in DOSL or any of the operative intervals between the groups with vs. without the use of navigation. Median DOSL was 46 min. (IQR = 70; Range: -69 – 212) when using navigation vs. 48.5 min. (IQR = 73; Range: - 125 – 195; p = 0.94) without. Median intervals (in minutes) with vs without navigation respectively: EOR-IA: 6 vs. 2 (IQR: 8 vs. 2.5; p = 0.36); IA-I: 60 vs. 55 (IQR: 28 vs. 32; p = 0.25); I-S: 150 vs. 126 (IQR: 94.5 vs. 133.5; p = 0.061); S-CA: 27.5 vs. 30 (IQR: 10.5 vs. 10; p = 0.61); CA-DOR: 13 vs. 13.5 (IQR: 15 vs. 18; p = 0.98). Conclusions Neuronavigation use in open cranial surgery was significantly linked to longer surgery and planned duration, but it did not significantly affect the discrepancy between the planned and actual surgery duration. Furthermore, no significant difference was noticed in intraoperative intervals with and without neuronavigation.

Background and Objectives: Head trauma is one of many conditions that trauma centres deal with daily. This study aimed to analyse the utilisation of head CT scans for patients with minor head trauma in two major hospitals in Lithuania and Poland. Materials and Methods: We conducted a retrospective, descriptive study of CT utilisation in minor head trauma patients presenting to the Level 1 trauma centre Hospital of the Lithuanian University of Health Sciences Kaunas Clinics (HLUHS KC) and Jan Biziel University Hospital in Bydgoszcz emergency departments (EDs), during the study period from 01 February to 30 April 2023. Results: During the study period, 1048 patients visited the HLUHS KC emergency department (ED) due to head trauma, and 388 patients visited the Jan Biziel University Hospital. Overall, 611 patients were included in the study. Most of the patients (92%) who suffered minimal trauma were younger than 65 years old. Eighty-two per cent of the patients older than 65 years old arrived at the ED after suffering a fall. Almost all the patients who were using antiplatelets (93%) or anticoagulants (91%) had CT scans. Non-emergency medicine (EM) physicians were more likely to order head CT scans than EM physicians (170 (83%) vs. 249 (62%), p < 0.001). There were 33 (5%) CT scans with traumatic features, and 8 (1%) of these were categorised as clinically significant. Patients who suffered clinically significant head trauma were more likely to be on anticoagulants and older than 65 when compared to normal/insignificant CT findings: 3 (38%) vs. 25 (6%), p <0.001; and 6 (75%) vs. 146 (36%), p < 0.021. Conclusions: A significant number of head CT scans performed were not necessary according to existing head CT guidelines and risk calculators. However, even in minor head traumas, clinically significant head injuries may occur.

INTRODUCTION Brain abscess is a focal intraparenchymal infection characterised by an encapsulated collection of purulent material, immune cells and other material following bacterial or fungal infection [1]. Brain abscess constitutes a critical neurosurgical condition with low numbers of positive cultures which makes additional challenges in management. AIM The objective of this single-center retrospective study is to review our experience, to determine the predictors related to the outcome. METHOD The retrospective study recorded clinical and neuroradiological features of patients who were treated with a diagnosis of intracranial abscess at the Lithuanian University of Health Sciences Hospital between 2018 and 2023. The patient cohort was stratified into positive (G+) and negative bacterial growth (G-) detected in pus culture. The functional status was assessed using the modified Rankin Score (mRS) at discharge. Statistical analysis was accomplished using the IBM SPSS Statistics 27.0 software package. Differences between the favorable (mRS of 0-3) and unfavorable (mRS of 4-5) outcome groups were tested with Mann-Whitney U and x2 tests. [...].

Background: The popularity during the last five years of electric scooters (e-scooters) due to climate neutrality and wide availability led also to accidents with significant injuries. Traumatic brain injuries require additional attention because of long-term consequences and disability with potential urge for prevention regulation decisions. This study was conducted to overview e-scooter related CT positive traumatic brain injuries, exploring circumstances, clinical course and outcomes. Methods: We retrospectively reviewed medical data of all patients treated in our center with e-scooter related brain injuries that had any traumatic feature in the CT scan during the period 2019, when e-scooters started being available via rental mobile applications, to 2023. Results: 45 patients were included in the review, 75.6% were males with median age of 40 years old. Numbers of injured patients consistently increase annually (4 in 2019, 14 in 2023), it did not differ between weekdays, working days versus weekends and time of the day. 80% of patients were injured because of fall off the scooter, the rest were hit by another vehicle while riding. Helmet usage was not reported in more than half of the cases, significant intoxication (>0,4‰) was found in 68,8% of cases. The most common intracranial changes were subarachnoid hemorrhage (55,6%), followed by brain contusions (48,9%), epidural (26,7%), subdural (26,7%) hemorrhages. Cranial fractures had a significant correlation with moderate intoxication (p=0,027), other bone fractures were more common in women (p=0,028). Men over 40 years old were more likely to undergo surgery (p=0,024), operated patients suffered more infections and more often ended with poor outcomes - mRS 4-6 (p<0,005). Conclusions: E-scooter related brain injuries increase annually, >40 years old males are prone to more severe injuries and worse outcomes.

The popularity of electric scooters (ES) during the last five years due to climate neutrality and public availability led to increased numbers in traffic accidents with significant injuries. This study was conducted to overview e-scooter related computed tomography (CT) positive traumatic brain injuries, exploring circumstances, clinical course, outcomes and possible relations to behavioral patterns. We retrospectively reviewed medical data of all patients treated in our center during the period 2019 to 2023, medical records were analysed and statistically processed. This review included 45 patients, 75.7% were males and median age was 40 years old. Patient numbers did not differ between weekdays, working days versus weekends and time of the day. Eighty percent of patients were injured from falling off the scooter, the rest were hit by another vehicle while riding. None of the patients were known using helmet, significant alcohol intoxication was found in 68.8% of cases. The most common traumatic intracranial features were subarachnoid hemorrhage (55.6%), followed by brain contusions (48.9%), epidural (26.7%), subdural (26.7%) hemorrhages. Age had a positive correlation with alcohol intoxication (r = 0.596, p = 0.007) and poor outcomes (r = 0.522, p = 0.004), also, men over 40 years old were more likely to undergo surgery (p = 0.024), meanwhile operated patients suffered more infections (p = 0.011) and more often ended with poor outcomes (p < 0.001).