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.
