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Vertical hemispherotomy is an effective treatment for many drug-resistant encephalopathies with unilateral involvement. One of the main factors influencing positive surgical results and long-term seizure freedom is the quality of disconnection. For this reason, perfect anatomical awareness is mandatory during each step of the procedure. Although previous groups attempted to reproduce the surgical anatomy through schematic representations, cadaveric dissections, and intraoperative photographs and videos, a comprehensive understanding of the approach may still be difficult, especially for less experienced neurosurgeons. In this work, we reported the application of advanced technology for three-dimensional (3D) modeling and visualization of the main neurova-scular structures during vertical hemispherotomy procedures. In the first part of the study, we built a detailed 3D model of the main structures and landmarks involved during each disconnection phase. In the second part, we discussed the adjunctive value of augmented reality systems for the management of the most challenging etiologies, such as hemimegalencephaly and post-ischemic encephalopathy. We demonstrated the contribution of advanced 3D modeling and visualization to enhance the quality of anatomical representation and interaction between the operator and model according to a surgical perspective, optimizing the quality of presurgical planning, intraoperative orientation, and educational training.

The outbreak of the Covid-19 pandemic has seriously affected our society. Governments have difficult situations by adopting strict and severe mitigation measures in order to contain the pandemic spreading. These decisions influenced significatively people's behavior changing their habits and routines. This study offers a statistical analysis of the incidence of the Maxillo-Facial traumas in Tuscany southern area, during the pandemic lockdown. The statistical analyzed has been obtained comparing the maxillo-facial trauma occurrence during the Italian lockdown between the 9th of March and the 18th of May 2020 in comparison with same period of the five previous years. KEY WORDS: Covid-19, Italian covid-19, Maxillofacial surgery, Maxillofacial trauma, Pandemic, Surgery management, Trauma incidence in Italy.

Meningiomas as anatomo-pathological entities were first described in the sixteenth century, but it was Harvey Cusching who in 1922 proposed to identify them with the term "meningioma". They are the most common intracranial tumors, occur between middle and late age and prefer female sex. The symptoms depend on their position with respect to the brain regions. These are mostly benign neoplasms, but there are atypical and even malignant forms. Plaque meningioma refers to a specific macroscopic aspect of the meningioma, due to diffuse dural involvement and usually with extracranial extension. We report here a case of plaque convex meningioma with typical grade I. Key Words: En plaque, Meningioma, WHO Meningioma.

Background: Gunshot injuries of the viscerocranium are rarely reported. Penetrating wounds to the cranio-maxillofacial region pose a significant challenge for surgeons as they often comprise serious soft tissue, bone and cerebral defects. We present a case report of a 42-year old female with a gunshot wound to the viscerocranium after suicidal attempt. Series of image of the disease course are available., Case Description: A 42-year-old female presented with gunshot wound to the viscerocranium after a suicidal attempt. At the arrival GCS was 8/15 and general examination showed the inlet wound in the submental region whereas the outlet one in the left temporal skull area. After first rescue procedures, ICP was monitored before proceeding surgically. Due to massive hemorrhage, embolization of ianternal maxillary artery was performed. Afterwards, tracheostomy, surgical reduction of multiple maxillo-facial fractures and ocular avulsion were performed. In a second time, ICP monitoring and CT scan revealed ICH signs due to intraparenchimal injures. The patient underwent to a second surgical procedure, consisting of bifrontal decompressive craniectomy. The patient was discharged on 20th post-op day to a rehabilitation center. She returned to our department after 4 months to perform a craniomaxillofacial recostruction. She presented 15 in GCS, left ptosis, left VII cranial nerve deficit, decannulated, KPS 100%., Conclusion: A step-to-step multidisciplinary approach both with Neurosurgeons and Maxillo-facial surgeons is mandatory in Cranial Gunshot Injuries where extensive damage is linked to a higher mortality., Key Words: Cranial gunshot inuuries, Cranial reconstruction, Maxillofacial reconstruction.

Background: Glomus tumors, or glomangiomas, are benign vascular tumors typically seen at distal extremities. These tumors differ from paragangliomas and classically present in the female population between the 4th and 5th decade. Intracranial localizations have not been described in literature in the adult population., Case Description: We present a case of a 32 year-old woman with a 3 months history of progressive left-sided visual loss and headache. A pre-operative MRI showed a homogeneously enhancing lesion extending from the left cavernous sinus to middle cranial fossa at first suspected to be a cavernous sinus meningioma. Eventually, histopathological analysis concluded for a glomangioma diagnosis. Post-operative RT was also performed., Conclusions: From our experience it is very important for clinical management considering glomangiomas in differential diagnosis of a homogeneously enhancing extra axial mass. Subtotal resection followed by radiation therapy determined no recurrence of the disease up to 7 years., Key Words: Glomangioma, Glomus tumor, Soft-tissue tumor.