Enlarged Virchow-Robin spaces are benign perivascular fluid-filled structures that may occasionally mimic pathological intracranial lesions on imaging. We report a 55-year-old male who presented with intermittent dizziness and was found to have extensive cystic lesions involving the left cerebral hemisphere on magnetic resonance imaging. The lesions demonstrated signal characteristics identical to cerebrospinal fluid across all sequences, with no diffusion restriction, contrast enhancement, edema, or mass effect, and followed the distribution of medullary arteries within the centrum semiovale. These features were consistent with type II enlarged Virchow-Robin spaces. The patient had previously been advised surgical intervention elsewhere; however, recognition of the characteristic imaging appearance allowed avoidance of unnecessary biopsy. Awareness of this entity and its typical radiological features is essential to differentiate it from cystic neoplasms, infections, or infarcts, thereby preventing unwarranted invasive procedures.
Objective There has been a tremendous focus on endoscopic spine surgery in the past two decades. The aims and objectives of this study are to evaluate the safety and effectiveness of full-endoscopic mono-portal excision of spinal tumors, that is, intradural extramedullary (IDEM). Methods We included five cases ( n = 5) from different age groups in this study. IDEM tumors were at different levels, including the D12-L1 junctional area. All underwent excision through the full-endoscopic mono-portal approach. Few instruments were customized (endo-dural knife, knot-pusher), and tumors were mobilized, separated, and excised. Endo-suturing was performed with Prolene 6-0 1/2 circle sutures. Results All the patients were observed for wound leak, motor or sensory deficit, and functional outcomes in the postoperative period. All had no/no added deficit postoperatively, and Visual Analog Scale (VAS)/American Spine Injury Association (ASIA) scores improved in the postoperative period. There was no cerebrospinal fluid (CSF) leak or pseudomeningocele formation during hospital stay or in follow-ups. Conclusion The full-endoscopic mono-portal excision of IDEM spine tumors appears to be a feasible technique, with the advantages of a small skin incision, less tissue damage, and early ambulation.
Background Meningiomas, accounting for the bulk of primary intracranial neoplasms and exhibiting a striking female bias, harbor potential hormonal dependencies. This investigation delineates estrogen receptor (ER) and progesterone receptor (PR) profiles via immunohistochemistry (IHC), correlating them with salient clinicopathological attributes. Materials and Methods This ambispective, observational analysis encompassed 100 histologically verified meningioma specimens accrued from September 2017 to August 2022. Specimens with depleted tissue or absent consent were excluded; IHC was executed on 50 cases using adequate FFPE tissue blocks as available. Results The peak incidence occurred in the 41 to 50-year age group (30%), with a female-to-male ratio of 1.85:1. Convexity emerged as the most prevalent site (50%), the transitional subtype was the most common (36%), and WHO Grade I was the most dominant. ER positivity manifested in 12%, principally among fifth-decade patients (33.3%), females (83.3%), transitional variants (66.7%), and solely Grade I lesions. PR positivity prevailed in 58% of cases, notably in the fifth decade (31%), females (62.1%), convexity tumors (41.4%), transitional histology (48.3%), and Grade I neoplasms (89.7%), with 28.6% brain invasion, 3.4% bone invasion, and 3.4% recurrence. Conclusion Meningiomas burgeon in middle-aged females, predominantly as WHO Grade I entities. PR is more frequently expressed in lower-grade tumors but no significant associations were found and prognostic significance could not be determined.
Background Multicentric glioblastoma (MCG) is a rare and aggressive form of brain parenchymal malignancy, with limited evidence guiding its optimal management. A trimodality treatment approach-comprising surgery, radiotherapy, and chemotherapy-appears to offer better clinical outcomes compared with partial treatment or supportive care alone. Objectives This study aimed to shed light on possible treatment strategies in patients with MCG and their clinical outcomes. Materials and Methods This is a retrospective case series of five patients diagnosed with MCG at our institution between January 2019 and December 2023. Patients were identified through a review of the institutional medical records department. Inclusion criteria were (1) histopathologically confirmed glioblastoma multiforme as per WHO classification, (2) radiological evidence of two or more spatially separate enhancing lesions in different brain regions with no connecting T2/FLAIR hyperintense signal, indicating absence of white matter tract dissemination or parenchymal continuity, consistent with MCG as per criteria, and (3) availability of complete clinical, radiological, and treatment data. All patients underwent pretreatment MRI with contrast, which was independently reviewed by two neuroradiologists. Surgical and oncological management decisions were made in multidisciplinary tumor board meetings. Molecular profiling, including methylguanine methyltransferase (MGMT) promoter methylation status and IDH1/IDH2 mutation status, was performed where available. Data collected included demographics, presenting symptoms, tumor locations, imaging findings, extent of surgical resection, adjuvant therapy, progression-free survival, and overall survival. Results Three patients underwent surgery, one underwent surgical biopsy, and one adult, being the exception-did not undergo any surgical intervention/biopsy. Three adults, except one adult and the pediatric patient, received radiation. All except one adult received temozolomide. The remaining adult patient who did not receive any treatment modality was a case of recurrent glioblastoma with multicentric disease, in a previously known case of solitary glioblastoma treated radically. This patient was kept on best supportive care. All the patients expired. Survival ranged from 3 to 14 months. The longest survivor (14 months) was an adult patient who underwent surgical resection followed by hypofractionated whole brain radiotherapy (30 Gy/10 fractions) and completed six cycles of adjuvant temozolomide. Patients receiving surgery followed by adjuvant therapy survived 11 to 14 months, whereas those receiving limited or no treatment had shorter survival (3-6 months). Conclusion Although outcomes remain poor, patients receiving multimodal therapy appeared to have longer survival, although interpretation is limited by small sample size. Larger studies are required to validate these findings.
Objective In India there are no clear-cut guidelines for giving medical fitness to resume driving following post-traumatic seizures (PTS). This leaves the medical professionals in jeopardy as such gray areas can have serious medico-legal implications. Against this background, we conducted a nationwide survey among neurologists and neurosurgeons to identify the norms and practices followed by them when issuing fitness certificates for this purpose. Materials and Methods A questionnaire consisting of 12 questions and an open-ended question for suggestions if any, was developed and set up using SurveyMonkey App (Table 1). A total of 2,400 neurologists and neurosurgeons in India were contacted between May 03, 2025and August 01, 2025 through email and WattsApp. Of these, 508 responses were considered valid. Results Most of our responders ( n = 385, 76%) agreed that, patients with PTS can resume driving after an adequate seizure-free interval (SFI). Regarding SFI most of the doctors ( n = 199, 39%) agreed on a SFI of 1 year. Majority of doctors ( n = 423, 83%) demanded that separate fitness criteria is required for PTS and other types of epilepsy. A total of 44 people (9%) pointed out that there are no definite criteria laid down for this purpose and most of them ( n = 487, 96%) agreed that medico legal aspects of certification of drivers must be included in the curriculum of neurosurgery and neurology residency programs. Conclusion Our survey throws light on the arbitrariness and inconsistencies of practices among doctors while giving fitness drive. The results of the survey underscore the importance of formulating clear and unambiguous guidelines for this purpose.
