Objective The transverse atlantes ligament (TAL) is a principal stabilizer of the atlantoaxial complex. The odontoid groove, a cortical imprint on the posterior surface of the dens formed by the TAL, may serve as an anatomical marker of its location on computed tomography (CT) imaging. This study evaluated the incidence of the odontoid groove and its concordance with commonly used C1 reference landmarks. Methods In this retrospective morphometric study, thin-slice cervical spine CT scans of adult trauma patients (18-60 years) without C1 to C2 injury or craniovertebral anomalies were analyzed. The groove center (point C) was assessed relative to the inferior margin of the anterior C1 arch (L1) and the combined inferior margins of the anterior and posterior arches (L2). Proportions were expressed with 95% confidence intervals (CI), and nonparametric tests were applied where appropriate. Results Fifty patients (median age: 30.5 years; interquartile range: 18; 74% male) were included. The odontoid groove was identified in 39 of 50 patients (78%; 95% CI: 63.7-88.9%). Groove presence was associated with higher age ( p = 0.018) but not with gender ( p = 0.14). L1 did not coincide with the groove in any case (0%; 95% CI: 0-9.0%), lying above in 64.1% and below in 35.9%. L2 coincided in 17.9% (95% CI: 7.5-33.5%), with substantial positional variability. Conclusion Although the odontoid groove is identifiable in most adults. The anatomical relationship of odontoid groove center and the anterior C1 landmarks was found to be nonconcordant. Atlas-based reference lines may not reliably represent the TAL footprint on CT, warranting cautious interpretation during odontoid fracture evaluation.
Hemangioblastomas are highly vascular tumors of the central nervous system and may occur sporadically or in association with von Hippel-Lindau (VHL) disease. Solid cerebellar hemangioblastomas represent a surgically challenging subset due to their marked vascularity and increased risk of intraoperative bleeding. We report a 52-year-old male with VHL disease who presented with progressive gait imbalance and headache and was found to have a vascular cerebellar lesion arising from the roof of the fourth ventricle with associated hydrocephalus. Systemic evaluation revealed additional spinal, renal, and pancreatic involvement. Preoperative digital subtraction angiography demonstrated dominant supply from branches of the posterior inferior cerebellar artery, allowing feeder-specific endovascular embolization. Subsequent microsurgical excision was performed via a midline suboccipital approach, achieving gross total resection with minimal blood loss. Histopathology confirmed hemangioblastoma (WHO Grade I). This case highlights the role of careful angiographic evaluation and selective embolization in facilitating safe surgical management of solid cerebellar hemangioblastomas in patients with VHL disease.
Background Prognostic indicators specific to non-missile low-velocity penetrating brain injuries remain less well characterized than firearm-related or blunt traumatic brain injury. This study evaluates clinical and radiological predictors of outcome in non-firearm, low-velocity penetrating brain injury (PBI) to inform treatment and prognosis. Materials and Methods This retrospective observational cohort study included 38 patients with non-missile, low-velocity PBIs treated at a tertiary center (January 2014-December 2024). Data included demographics, GCS, pupil reactivity, associated injuries, and radiological findings. Outcome was assessed using the Glasgow Outcome Scale-Extended. Logistic regression analysis identified predictors of poor outcome. Results Of 38 cases, 14 had poor outcomes. Patients with poor outcomes had lower GCS scores and more frequent pupillary and radiological abnormalities. In multivariate logistic regression, higher GCS at presentation independently reduced the odds of poor outcome (adjusted OR 0.42, 95% CI 0.21-0.86, p = 0.018). A composite major imaging finding (presence of infarct, intraventricular hemorrhage, or brainstem involvement on initial imaging) was strongly associated with poor outcome (adjusted OR 92.10, 95% CI 1.26-6730.15, p = 0.039). Age and pupillary reactivity were not independently significant. Conclusion Higher GCS at presentation independently reduces the risk of poor outcome in low-velocity PBIs, underscoring its importance in early neurological assessment and prognostication. Radiological injury burden was independently associated with poor outcome, although estimates were imprecise due to small event numbers.
Cladophialophora bantiana is a rare neurotropic dematiaceous fungus that can cause fatal brain abscesses, particularly in immunosuppressed hosts such as renal transplant recipients. Early recognition is critical due to high mortality and diagnostic difficulties. A 25-year-old male renal transplant recipient presented 1 month posttransplant with generalized tonic-clonic seizures and altered sensorium. MRI revealed a thick-walled right frontoparietal abscess measuring 5.9 & times; 5.1 & times; 4.2 cm with mass effect. He underwent craniotomy with complete excision of the abscess. Gram stain, potassium hydroxide mount, and culture confirmed C. bantiana . Histopathology showed necrotizing granulomas with septate pigmented hyphae and acute-angle branching mimicking Aspergillus . The patient was treated with liposomal amphotericin B and intravenous voriconazole, and later transitioned to oral voriconazole. Despite initial neurological improvement, he developed sepsis and multiorgan failure, succumbing 19 days after surgery. This case highlights diagnostic pitfalls, including imaging resembling bacterial or tubercular abscess and histology mimicking Aspergillus , as well as therapeutic challenges of C. bantiana CNS infections in immunosuppressed hosts. Early diagnosis, surgical excision, prompt initiation of effective antifungal therapy, and careful management of immunosuppression are essential to improve outcomes.
Tension pneumoventricle is an uncommon but potentially life-threatening complication of ventriculoperitoneal (VP) shunt placement. It results from the accumulation of pressurized intraventricular air, producing mass effect and neurological deterioration. Its occurrence following VP shunt surgery is exceedingly rare. A 24-year-old man with obstructive hydrocephalus due to aqueductal stenosis underwent right-sided VP shunt placement with symptomatic improvement. Two weeks later, he developed cerebrospinal fluid rhinorrhea. Computed tomography revealed significant intraventricular air with ventricular distortion consistent with tension pneumoventricle. Magnetic resonance cisternography demonstrated a left frontal encephalocele with a fistulous tract extending from the frontal sinus into the frontal horn of the lateral ventricle. The patient underwent bifrontal craniotomy, excision of the encephalocele, frontal sinus cranialization, and multilayered dural repair using a vascularized pericranial graft. Postoperative recovery was uneventful, and follow-up imaging confirmed complete resolution. VP shunt-induced intracranial hypotension may unmask occult skull base defects, facilitating air entry through a pressure-gradient mechanism. Early diagnosis and definitive surgical repair are essential to prevent recurrence and infectious complications.
Glioblastoma (GBM) is a highly aggressive brain tumor with poor prognosis, marked by vascular endothelial growth factor -driven angiogenesis. Hemorrhagic stroke causes cerebral vessel rupture, hypoxia, and neuronal injury, and may trigger reactive gliosis-a process implicated in malignant transformation. We report a 54-year-old man who developed GBM in the same region previously affected by a venous hemorrhagic stroke, suggesting a potential link between cerebrovascular injury and GBM pathogenesis. A 54-year-old man with no oncogenic risk factors developed GBM in the right temporoparietal region previously affected by a spontaneous venous hemorrhagic stroke in May 2025. Initial conservative management was followed by MRI findings of a chronic post-hemorrhagic lesion; subsequent MR spectroscopy in September 2025 revealed metabolic changes suggestive of malignancy (up arrow choline, up arrow lactate, down arrow N-acetyl aspartate). Craniotomy and histopathology confirmed GBM, showing classic features including palisading necrosis, microvascular proliferation, and hemosiderin-laden macrophages. This case underscores the diagnostic difficulty in distinguishing post-stroke changes from tumor recurrence and suggests a possible association between cerebrovascular injury and GBM pathogenesis. While rare, GBM should be considered in patients with new neurological decline at a prior hemorrhagic stroke site, particularly when imaging reveals a progressive mass. This case highlights a potential association between cerebrovascular injury and gliomagenesis, though causality remains unproven. Early histopathological confirmation is essential to distinguish neoplastic processes from post-stroke sequelae.
Spinal mucormycosis is a rare entity commonly seen in immunosuppressed patients and is extremely rare in immunocompetent individuals. We present a case of a 54-year-old man with known chronic liver disease (Child-Pugh grade C) who presented with spondylodiscitis and progressive paraplegia. Magnetic resonance imaging of the spine was performed and was suggestive of lumbar vertebral osteomyelitis with abscess formation-likely Pott's spine. The patient was managed with a laminectomy of the L3 vertebra. Microscopic examination revealed aseptate ribbon-like fungal hyphae, suggestive of Mucorales species. The patient was then managed with multiagent antifungal regimen consisting of intravenous amphotericin B, micafungin, and oral posaconazole. Spinal mucormycosis is a rare entity with limited literature and can masquerade as Pott's/bacterial abscess. High vigilance and familiarity are necessary for accurate diagnosis and management. This case illustrates that, in profoundly immunocompromised patients, prognosis may remain dismal with progression to multiorgan failure despite urgent decompression and aggressive multiagent antifungal therapy.
Background Thalamic neoplasms contribute to approximately 1 to 5% of all brain tumors. These are more commonly found in the pediatric age group. The different aspects of thalamic gliomas (TG) have occasionally been reported.Objectives This article aims to assess the clinico-radiological profile, management, and postoperative follow-up; to compare differences between the adult and pediatric populations and between biopsy and resection groups; and to explore poor prognostic factors. Methods This retrospective analysis included 41 patients with TG over 5 years. Various study parameters were taken into consideration. Appropriate statistical tests were applied ( p < 0.05-significant). Results Our study included 10 patients in the pediatric age group and 31 adult patients. Out of these, 25(61%) were males and 16(31%) were females. Most patients (70.7%) presented with Karnofsky performance status <80. The most common symptom was headache (80.5%), followed by motor deficits. Only one tumor had bilateral involvement. Only 10 patients had tumors confined to the thalamus, while others had extensions to adjacent structures. Contrast enhancement was seen in most, with less than half showing cystic degeneration. Thirteen patients (31.7) had glioblastoma. More than half (22 patients) died due to TG, which included only two pediatric patients. The mean overall survival was 24.5 +/- 4.3 months, and the median was 8 +/- 3.1 months. Conclusion We found a higher occurrence of TG in adults and a male predilection in the pediatric group. Our study forms one of the largest studies on TG reported in contemporary times. The comparative analysis between pediatric and adult TG presented here is a valuable contribution to the literature.
Hydrocephalus in neurofibromatosis type 1 (NF1) is most commonly associated with tectal gliomas or aqueductal narrowing. Intraventricular hamartomatous lesions causing mechanical obstruction are rarely reported, particularly with histopathological confirmation. A 35-year-old female with genetically confirmed NF1 presented with progressive headache, vomiting, gait imbalance, seizures, and altered sensorium. Magnetic resonance imaging using high-resolution constructive interference in steady state (CISS) sequences demonstrated a well-defined cerebrospinal fluid (CSF)-intensity lesion measuring 2.6 & times; 2.4 & times; 1.6 cm in the posterior third ventricle extending into the aqueduct of Sylvius, resulting in obstructive hydrocephalus. Contrast-enhanced MRI could not be performed due to the patient's altered sensorium and lack of cooperation during imaging. The radiological impression favored an intraventricular arachnoid cyst. The patient underwent endoscopic third ventriculostomy with concurrent biopsy. Intraoperative findings confirmed aqueductal compression. Histopathological examination demonstrated a benign glial hamartoma with strong glial fibrillary acidic protein positivity and a low proliferative index. The patient showed significant clinical improvement following surgery and remained neurologically stable at 6-month follow-up. Third ventricular glial hamartoma should be considered in the differential diagnosis of obstructive hydrocephalus in patients with NF1. Imaging findings may mimic cystic or low-grade neoplastic lesions, and histological confirmation may be necessary in symptomatic cases. Endoscopic third ventriculostomy combined with biopsy provides effective CSF diversion and definitive diagnosis.
Primary orbital Ewing sarcoma (POES) is an exceptionally rare and aggressive malignant tumor, particularly in the pediatric population. We report the case of a 14-year-old girl who presented with progressive right eye proptosis, visual disturbances (finger counting at 2 m), headache, and vomiting over a 4-month period. Imaging revealed a mass involving both intraorbital and extraorbital compartments with signs of optic neuropathy. The patient underwent right frontotemporal craniotomy with subtotal debulking of the tumor. Histopathology and immunohistochemistry confirmed a diagnosis within the Ewing sarcoma family (diffuse CD99 and NKX2.2 positivity). Molecular confirmation for EWSR1 rearrangement by fluorescence in situ hybridization (FISH) or reverse transcription polymerase chain reaction (RT-PCR) could not be performed due to resource limitations. She received VAC/IE-based adjuvant systemic chemotherapy. At 6 months, the patient remained clinically stable with improved proptosis and visual function (right eye: finger counting at 6 m; left eye: 6/6), without clinical evidence of progression. The orbit is an extremely uncommon site for Ewing sarcoma, posing diagnostic and therapeutic challenges. This case reinforces the importance of early recognition, surgical decompression when vision is threatened, and coordinated multidisciplinary management; however, a 6-month follow-up is early and does not permit claims of durable remission or long-term oncologic control. To the best of our knowledge, POES remains exceedingly rare in the Asian subcontinent, with only a limited number of cases reported.
Lateral medullary syndrome (LMS) typically spares motor pathways. Opalski syndrome is a rare variant characterized by ipsilateral hemiparesis due to caudal extension of infarction below the pyramidal decussation. We report a 55-year-old male presenting with vertigo, dysarthria, ataxia, ipsilateral hemiparesis, and contralateral sensory loss. MRI revealed infarction of the right posterolateral medulla with bilateral cerebellar involvement, while CT angiography demonstrated a hypoplastic and occluded right vertebral artery with non-visualization of the posterior inferior cerebellar artery. The patient developed bulbar dysfunction requiring ventilatory support and had a severe clinical course. This case highlights ipsilateral hemiparesis as a diagnostic pitfall and suggests that extensive vascular involvement and bilateral cerebellar infarction may be associated with poorer outcomes in Opalski syndrome.
Primary non-Hodgkin lymphoma (NHL) of the cranial vault is an exceedingly rare extranodal presentation of lymphoma, often posing significant diagnostic challenges due to its variable clinical and imaging characteristics that can mimic more common cranial masses. We present the case of a 72-year-old previously healthy and immunocompetent woman who developed a progressively enlarging, firm, nontender scalp swelling over the right parieto-occipital region since March 2024. Starting November 2024, she experienced new-onset associated symptoms including left-sided weakness, persistent dull aching headache, and mild drowsiness. Despite initial differential diagnoses that included mesenchymal tumors, plasmacytoma, metastatic carcinoma, and meningioma, surgical biopsy and subsequent detailed histopathological examination with immunohistochemistry confirmed a diagnosis of high-grade B-cell NHL. Whole-body positron emission tomography-computed tomography and/or bone marrow biopsy could not be performed due to resource constraints; therefore, the absence of systemic disease could not be definitively confirmed and this is acknowledged as a limitation when classifying the lesion as “primary” cranial vault lymphoma. This case highlights the unusual cranial vault presentation of this aggressive malignancy in an immunocompetent patient, the importance of a broad differential diagnosis for calvarial/cranial vault lesions, and the necessity of histopathological confirmation for accurate diagnosis and appropriate management. Given the high-grade histology and the relatively short available follow-up, longer-term surveillance is required to better characterize treatment response and prognosis.
Background Reliable pedicle screw placement is central to achieving stable fixation in thoracolumbar spine fracture surgery. Conventional C-arm fluoroscopy provides two-dimensional guidance and exposes operating room personnel to radiation, whereas O-arm-based navigation offers three-dimensional intraoperative imaging with potentially improved accuracy. This study compares functional outcomes, pedicle screw accuracy, fluoroscopy use for operating room personnel, and complications between C-arm fluoroscopy-guided and O-arm navigation-guided posterior fixation in thoracic and lumbar spine fractures. Methods This prospective comparative study included adult patients with traumatic thoracic or lumbar spine fractures undergoing posterior pedicle screw fixation. Patients were allocated to either C-arm fluoroscopy-guided surgery or O-arm navigation-guided surgery based on imaging availability. Functional outcomes were assessed using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Pedicle screw accuracy was evaluated on postoperative computed tomography using the Gertzbein-Robbins classification. Secondary outcomes included operative time, blood loss, fluoroscopy time as a surrogate for radiation exposure to operating room personnel, and postoperative complications. Statistical analysis was performed with a significance level of p < 0.05. Results A total of 338 patients (169 per group) were analyzed. Baseline demographic and injury characteristics were comparable. Both groups demonstrated significant postoperative improvement in VAS and ODI scores, with no significant intergroup difference at final follow-up. The O-arm group showed a significantly higher proportion of Grade A pedicle screws ( p < 0.05). Fluoroscopy time was significantly lower in the O-arm group, whereas operative time was longer. Although complication and revision rates were higher in the C-arm group, the difference was not statistically significant ( p > 0.05). Conclusion O-arm navigation significantly improves pedicle screw accuracy and reduces fluoroscopy use for operating room personnel without compromising functional outcomes. Despite longer operative time, O-arm navigation represents a valuable adjunct in the management of thoracolumbar spine fractures, particularly in complex trauma cases.
Endovascular treatment demonstrates high efficacy in managing direct carotid cavernous fistulas (CCFs). This report discusses a series of four cases of CCF to evaluate their ocular manifestations and effectiveness of endovascular treatment. The most common presenting symptoms were proptosis, chemosis, and redness of the affected eye. Endovascular approaches included coil embolization, balloon occlusion, and liquid embolic agent techniques. Complete angiographic occlusion was achieved, and symptomatic improvement was found in all the cases after the initial procedure. Patients were followed for at least 6 months, with evaluations at 1 week, 1 month, 3 months, and 6 months. Final outcomes were assessed angiographically at 6 months. Endovascular treatment offers a highly effective and safe approach for managing direct CCFs. Prompt diagnosis and individualized treatment strategies are critical for optimal clinical and radiological outcomes.
Objective The aim of the study is to evaluate the safety and effectiveness of primary first-line middle meningeal artery embolization (MMAE) for chronic subdural hematoma (CSDH) in a selective group of patients, with follow-up imaging and assessment of volumetric outcomes. Methods We performed a single-center, prospective interventional study involving 50 consecutive adults with CSDH who were initially treated with MMAE. Participants had symptomatic CSDH with minimal mass effect or ataxia/weakness, imaging showing chronic collections with neo-membranes, and medical issues that made open surgery risky. All patients underwent MMAE using polyvinyl alcohol particles through transfemoral microcatheterization of the MMA. We measured hematoma volume using Medtronics Stealth S6 and S7 system (in mL) on non-contrast head CT at baseline and at 1, 4, 8, 12, and 16 weeks. We classified outcomes at final follow-up as CR: virtually no residual hematoma) or near-total resolution (near-total resolution: minimal residual volume). Clinical neurological status was also recorded. Results Fifty patients (mean age 63.7 years, 66% male) were treated. The average presenting hematoma volume was approximately 70.4 mL (range 20 - 128 mL). Follow-up imaging showed a steady decrease in volume after embolization: mean volume dropped from 70.4 mL at baseline to 47.3 mL at 4 weeks and 30.4 mL at 8 weeks ( p < 0.001). At final follow-up (median 12 weeks), 28 of 50 treated hemispheres (56%) showed complete resolution, and 22 (44%) had near-total resolution. Follow-up CT images demonstrate progressive hematoma clearance over time. No patient required additional surgery, and there were no procedure-related complications. Functional outcomes were positive, with most patients asymptomatic or improved by 3 months. Embolization successfully ceased hematoma progression in all cases. Conclusion Primary MMA embolization is a safe, minimally invasive, and effective treatment for chronic subdural hematoma in selected patients. It achieved high rates of hematoma resolution without the need for further surgery in this prospective series. Larger controlled trials are needed to confirm these findings and to establish the optimal indications for MMAE as a primary therapy.
Background Elevated intracranial pressure (ICP) is a neurological emergency requiring prompt intervention. While invasive ICP monitoring is the gold standard, it carries risks such as infection and hemorrhage. This study evaluated the correlation between transcranial color Doppler (TCCD) indices and directly measured ICP in patients undergoing cerebrospinal fluid (CSF) diversion procedures. Methods In this prospective observational study, 50 adult patients scheduled for CSF diversion were enrolled. TCCD measurements of middle cerebral artery flow velocities-peak systolic velocity (PSV), end-diastolic velocity (EDV), mean flow velocity (MFV), pulsatility index (PI), and resistivity index (RI)-were obtained. These were correlated with opening intraventricular ICP measured during the procedure. Receiver operating characteristic (ROC) analysis was used to determine optimal cut-off values of PI and RI for predicting elevated ICP at various thresholds. Results The mean opening ICP was 22.84 +/- 4.01 mm Hg. PSV showed a weak positive correlation ( r = 0.474, p = 0.001), EDV a strong negative correlation ( r = -0.641, p <0.0001), and MFV a weak negative correlation ( r = -0.119, p = 0.41). PI ( r = 0.814) and RI ( r = 0.817) showed strong positive correlations with ICP ( p <0.0001). ROC analysis showed PI significantly predicted ICP at 20 to 25 mm Hg, and RI at 15 to 25 mm Hg. At 25 mm Hg, both had 92.9% sensitivity; RI showed higher specificity (83.3 vs. 77.8%). Conclusion TCCD-derived PI and RI strongly correlate with ICP and may serve as reliable, non-invasive markers for detecting intracranial hypertension, particularly when invasive monitoring is contraindicated.
Long-segment intramedullary spinal cord lesions pose a unique diagnostic and therapeutic dilemma from a neurosurgical perspective. For the operating surgeon, the central challenge lies in distinguishing infiltrative intramedullary tumors from inflammatory demyelinating pathologies, as both may mimic each other clinically and radiologically. This distinction is critical: while early biopsy or decompressive surgery may be warranted for progressive neoplasms, unnecessary intervention in demyelinating disorders can result in avoidable morbidity in an already high-risk spinal cord environment. This report details two diagnostically challenging adult cases encountered in neurosurgical practice—one ultimately proven to be a astrocytoma, IDH-wildtype, CNS WHO grade 3 requiring definitive surgical management, and the other a neuromyelitis optica spectrum disorder (NMOSD) masquerading as a spinal cord tumor. By comparing their clinical progression, operative considerations, intraoperative neurophysiology, radiological subtleties, and final diagnoses, we highlight key decision points that influence whether to operate, observe, or pursue advanced immunologic testing. The aim is to provide neurosurgeons with a practical reference when faced with similar long-segment intramedullary lesions, underscoring the profound impact that early diagnostic accuracy has on surgical planning, neurological outcomes, and long-term patient quality of life.
Symptoms manifested by patients harboring brain tumors vary. Although depression, in the form of frontal lobe syndrome, may be present in patients with frontal lobe neoplasms, these tumors may be missed when there are circumstances relating to grief, especially in the absence of a focal neurological deficit. We present two cases of frontal lobe meningioma initially misdiagnosed as depressive illness. Both patients presented with psychiatric symptoms, including low mood and social withdrawal, which coincided with the loss of husband and separation from husband, respectively. These symptoms improved significantly after surgical excision of the tumors. These cases highlighted the importance of considering organic causes in patients presenting with psychiatric symptoms, particularly when treatment response is inadequate.
Background Intracranial aneurysms are increasingly recognized as inflammatory vascular disorders rather than purely structural lesions. Metabolic factors such as hyperhomocysteinemia and systemic inflammatory markers may contribute to endothelial dysfunction and aneurysm instability, but their relationship with clinical severity and rupture status remains incompletely understood.Objective To evaluate serum homocysteine and high-sensitivity C-reactive protein (hs-CRP) levels in patients with intracranial aneurysms and examine their association with aneurysm location, rupture status, and established clinical grading systems. Materials and Methods In this cross-sectional observational study, patients aged > 18 years undergoing surgical treatment for intracranial aneurysms were included. Preoperative serum homocysteine and hs-CRP levels were measured. Clinical severity was assessed using Hunt and Hess, World Federation of Neurosurgical Societies (WFNS), and modified Fisher's grading systems. Statistical analyses included analysis of variance, Kruskal-Wallis' testing, effect size estimation (eta(2)), Spearman's correlation, rupture subgroup analysis using Cohen's d , ordinal logistic regression, and multivariate linear regression. Results The study included 79 patients with complete biochemical and radiological data. The mean serum homocysteine level was 11.37 +/- 5.61 & micro;mol/L, and the mean hs-CRP level was 57.90 +/- 47.18 mg/L. No statistically significant differences in biomarker levels were observed across aneurysm locations ( p > 0.05). Effect size analysis demonstrated small-to-moderate associations for homocysteine (eta(2) = 0.058) and moderate associations for hs-CRP (eta(2) = 0.102). No statistically significant differences in biomarker levels were observed between ruptured and unruptured aneurysms. Ordinal logistic regression demonstrated a statistically significant inverse association between hs-CRP levels and WFNS grade (beta = -0.078, odds ratio = 0.92), indicating that higher hs-CRP levels were associated with lower WFNS grades. However, the strength of association was modest. Conclusion Although hs-CRP demonstrated a modest inverse association with WFNS grade, neither homocysteine nor hs-CRP levels were significantly elevated compared with matched controls. These findings suggest limited discriminatory value of circulating biomarkers in aneurysm pathology.
Objectives To assess the prevalence of seizures in neurosurgery outpatient department (OPD) patients at All India Institute of Medical Sciences (AIIMS) Jammu, with emphasis on those presenting with brain tumors. We evaluated pathological correlations, anatomical risk factors, and comprehensive management strategies, including long-term functional outcomes. Materials and Methods This was a cross-sectional observational study conducted at the neurosurgery OPD of AIIMS Jammu over 12 months (August 2024-July 2025). Inclusion criteria comprised adult and pediatric patients presenting with new-onset seizures and/or intracranial tumor diagnosis. Statistical analysis included prevalence calculation with 95% confidence intervals (CIs), chi-square or Fisher's exact tests for categorical variables, multivariate logistic regression for seizure predictors, and functional outcome assessment using modified Rankin scale (mRS) and Quality of Life in Epilepsy-31 (QOLIE-31) scores. Results Of 2,800 neurosurgical outpatients screened, 212 (7.6%; 95% CI 6.6-8.6%) presented with seizures. Sixty-five patients (30.7% of seizure cohort) had confirmed intracranial tumors, with 29 of 65 (45%; 95% CI 33.4-56.7%) presenting with seizures as initial manifestation. Mean age for the overall cohort was 42.3 +/- 15.7 years, with a pediatric (<18 years) subgroup comprising 8.5% of all patients (238/2,800) and 12.3% of tumor-seizure patients (8/65). Focal seizures were more common than generalized seizures (53 vs. 47%). Tumor pathology significantly influenced seizure occurrence: gliomas 55.3% (36/65), meningiomas 18.5% (12/65), dysembryoplastic neuroepithelial tumors and gangliogliomas 10.7% (7/65), metastases 9.2% (6/65), and pituitary adenomas 6.2% (4/65). Anatomically, temporal lobe tumors (36.9%, n = 24) and frontal lobe tumors (27.7%, n = 18) carried the highest seizure risk. Of temporal lesions ( n = 24), 16 (66.7%) were in cortically eloquent regions involving superficial cortex; 10 demonstrated peritumoral edema. Laterality analysis showed right-sided lesions in 54.2% (13/24) and left-sided in 45.8% (11/24) of temporal cases. Multilobar involvement occurred in 8 of 65 patients (12.3%), predominantly in high-grade gliomas. Multivariate analysis identified tumor location (temporal/frontal), low-grade histology, and peritumoral edema as significant predictors ( p < 0.05); the 95% CI for odds ratios of low-grade tumors was 2.1-9.3. Follow-up at 12 months demonstrated seizure freedom in 127 of 212 patients (60%) with functional improvement: mRS improved or remained stable in 168 of 180 patients (93.3%), and QOLIE-31 scores improved from median 58 (IQR 42-72) at baseline to 71 (IQR 61-80) in seizure-free cohort ( p < 0.001). Conclusion Seizures represent a common and significant complication in brain tumor patients, particularly those with low-grade gliomas and temporal or frontal lobe location. Pathology-specific and anatomically informed management strategies, combined with comprehensive functional assessment, improve seizure outcomes and quality of life in this population.
