AIM:To characterise clinical, imaging, and angioarchitectural features of spinal epidural arteriovenous malformations (SEAVMs) and report endovascular outcomes from a single-centre series. MATERIALS & METHODS:We retrospectively reviewed spinal angiograms and clinical records from January 2010 to May 2025 and identified 24 patients with SEAVMs. Demographic, clinical, magnetic resonance imaging (MRI) and computed tomography (CT) findings, digital subtraction angiography characteristics, endovascular interventions, and Karnofsky Performance Status (KPS) before and after treatment were analysed. RESULTS:Twenty-four patients with a mean age of 25.8 years were included. Presenting complaints were motor weakness in 23/24 (95.8 %) cases, sensory symptoms in 17/24 (70.8 %) cases, radicular pain in 15/24 (62.5 %) cases and bladder or bowel dysfunction in 10/24 (41.7 %) cases. MRI detected an epidural venous sac in 20/24 (83.3 %) cases and cord signal change in 20/24 (83.3 %) cases; CT (n=18) showed vertebral osseous changes in 15/18 (83.3 %) cases. Angiography localised lesions predominantly to lower thoracic levels; five cases were metameric (SAMS) and intradural venous reflux was uncommon. Nineteen patients underwent endovascular embolizisation; N-butyl cyanoacrylateNBCA was used in 18/19 cases and venous sac penetration was achieved in 17/19 cases. There were no major periprocedural neurological complications. Angiographic degrees of obliteration among treated patients were complete/near- complete in 4 patients , substantial in 4 patients, moderate in 9 patients, and partial in 2 patients. Mean follow-up was 49.2 months; and mean KPS improved from 51.1 to 80.0 (mean increase: 28.9 points, P<0.001). CONCLUSION:SEAVMs occur in younger patients, frequently involve osseous structures, and are commonly associated with compressive epidural venous sacs. Targeted endovascular occlusion of the venous sac is safe and often yields substantial improvement with durable clinical benefit.

ABSTRACT:Aneurysmal bone cysts (ABC) are benign, vascular, osseous lesions accounting for 1% of all bony tumors. Giant cervicodorsal ABC are rare. Surgical excision is the treatment of choice. Incomplete excision has a high chance of recurrence. Giant lesions of the spinal column require staged surgeries and circumferential instrumentation to avoid instability. An 18-year-old male presenting with acute onset paraplegia and urinary incontinence with features of myelopathy. On evaluation, he was diagnosed with multi-level giant ABC of the cervico-dorsal spine. He underwent tumor excision and instrumentation via staged surgery. The postoperative course was uneventful. The patient was planned for adjuvant therapy but lost to follow up. He developed torrential bleeding from the tracheostomy site and expired. Management of giant ABC poses a challenge to the neurosurgeon. Multidisciplinary approach is mandatory for successful management of these patients. Surgical excision is the treatment of choice. Complete excision is achievable using staged excision.

Cervical kyphosis is a rare debilitating condition that leads to functional disability. Surgical correction of cervical kyphosis is challenging. Realistic goals and meticulous preoperative planning are crucial to achieving the desired outcomes. To analyse the safety and efficacy of various surgical approaches, and clinical and radiographic outcomes following cervical kyphosis correction. Retrospective study. Patient sample: 50 patients with cervical kyphosis who underwent deformity correction between 2008 and 2023 with 24-month follow-up. Outcome measures: Nurick’s grading, mJOA, C2–7 sagittal Cobb angle, C2 slope, and T1 slope. Baseline patient demographics, surgical characteristics, baseline and follow-up clinical (Nurick grading and mJOA), and radiographic outcome (C2–7 sagittal Cobb angle, C2 slope, and T1 slope) measures were collected from the database on admission and the latest follow-up. Radiographic parameters were studied on CT and cervical spine radiographs to assess stability, the degree of deformity correction, and fusion status at the latest follow-up. A total of 50 patients with a mean age of 25.2 years were included. The mean kyphotic segment was 3.6. All underwent surgical correction using various approaches. Combined anterior and posterior approach (44

Midnolin has emerged as a versatile protein involved in gene regulation, metabolism and disease. It controls Early Response Genes by promoting their ubiquitin-independent proteasomal degradation. It also affects glucose metabolism by interacting with glucokinase in pancreatic beta cells. Recent studies have highlighted the significant role of Midnolin in various human diseases, including non-alcoholic fatty liver disease, Parkinson's disease, and several malignancies such as liver cancer, breast cancer, gastric cancer, multiple myeloma and B-cell leukemias and lymphomas. Moreover, it has also been linked to lipid metabolism, mitochondrial function and tumor growth. However, its exact role is still not fully understood. This review summarizes current knowledge about Midnolin functions and highlights its potential target for future research in health and disease.

Upper cervical spine bony tumors pose a challenge to surgeons because of their extensiveness and proximity to vital structures. Reconstruction following resection is necessary to prevent instability. Our objective is to describe a technical note on the C1 anterior arch screw with mesh cage reconstruction for anchoring the upper end of the cervical plate after resection of the upper cervical tumor. A retrospective review of patients with primary bony tumors of the upper cervical spine after surgical resection between 2018 and 2022 was included in the study. Imaging workup included computed tomography, MRI, and computed tomography angiogram. A total of 4 patients with primary bony tumors of the upper cervical spine underwent C1 anterior screw fixation with mesh cage reconstruction. The mean age was 33.8 ± 14.3 years. Tumor extent was C2-C4 in 2 patients (50%) and C2 in 2 patients (50%). Three patients had a spinal instability neoplastic score of >12 and were deemed unstable preoperatively, mandating the stabilization procedure. All patients underwent surgical resection: gross total resection (1, 25%), near-total excision (1, 25%), and tumor decompression (2, 50%). Surgery was staged in 3 patients (75%) because of the extensiveness of the tumor and massive blood loss. There was no perioperative mortality. The mean postoperative Nurick grading score was 1.5 ± 1.3 (range 0-3). All patients were ambulatory and showed neurological improvement postoperatively with a mean follow-up of 37.5 ± 21.9 months and evidence of fusion on the latest imaging. Radical resection of tumors involving the upper cervical spine requiring C2 corpectomy is challenging. En bloc resection is not always feasible. Neurosurgeons can consider using the anterior arch as an anchor point. The use of neuronavigation facilitates the precise placement of the C1 arch screws.

Background:Internal carotid artery (ICA) injury is a feared complication of transnasal transsphenoidal surgery (TNTS), with an incidence of 1-9%. Endovascular coil embolization remains a mainstay for managing ICA pseudoaneurysms; however, delayed complications such as intranasal coil herniation are exceedingly rare but potentially serious. Case Description:We report a 44-year-old male with a pituitary macroadenoma who sustained a left ICA injury during TNTS at a peripheral center. He was stabilized with nasal packing and referred to our institution, where coil embolization of the ICA pseudoaneurysm was performed. The patient declined definitive surgery at that time. Four years later, he presented with progressive visual decline. Imaging revealed coil migration into the nasal cavity. Pre-operative imaging highlighted a short intercarotid distance. Definitive endoscopic surgery was performed with intraoperative identification of herniated coils protruding into the sphenoid sinus. The coils were carefully trimmed to prevent entanglement, and tumor resection was successfully completed with preservation of both ICAs. Post-operative recovery was uneventful. Conclusion:Literature review revealed variable timelines of coil extrusion, with most cases managed endoscopically. Rebleeding, though rare, was documented in a few. Intranasal coil herniation is a rare, delayed complication requiring careful planning, radiological evaluation, and multidisciplinary management to prevent fatal outcomes.

AIM:Massive epistaxis due to cavernous internal carotid artery (cICA) pathology is a life-threatening condition. The most common causes are craniofacial trauma and, rarely, spontaneous rupture of cICA aneurysms. While surgical management of cICA aneurysm is often challenging, endovascular methods offer a more straightforward and more reliable solutions. This article shares our institutional experience in the endovascular management of these grave pathologies and their long-term outcome. MATERIALS AND METHODS:We retrospectively identified 20 patients who presented with recurrent or massive epistaxis due to internal carotid artery pathologies (aneurysm/CCF). In our department, they were treated using endovascular methods. The outcome of the endovascular treatment was assessed based on the resolution of symptoms and the angiographic obliteration of ICA pathologies. RESULTS:Of the 20 patients in the study, 19 were male, and the mean age was 33.1 years (ranging from 19 to 72 years). The most common cause for epistaxis was craniofacial trauma due to road traffic accidents (RTA) (n = 14). Besides epistaxis, other clinical findings were ptosis (1), diplopia (1), tinnitus (7), proptosis (7), and carotid-cavernous fistula (CCF) (7). Treatment was instituted either as a reconstructive procedures (in 10 patients) or parent artery occlusion (PAO) (in 10 patients). CONCLUSION:Epistaxis, due to intracranial ICA pathologies is a life-threatening condition that needs urgent treatment. The plethora of causes underlying this aggressive condition can be safely mitigated using the endovascular route, which offers a more straightforward, reliable, and safer treatment compared with the surgical modality.

Background: Traumatic cervical spondyloptosis (TCS) is a rare and the most severe form of cervical spine injury. Aims/Objective: The primary and secondary objectives were assessment of improvement in neurological status and rate of complications respectively. Methods: Sixteen patients of TCS operated between 2015 and 2019 were included. The pertinent details including demographics, neurological status, associated injuries, reduction method, surgical approach, complications, and outcomes at follow-up were recorded. Results: The mean age was 35.0 ± 12.1 (range 16–65). Fall from height (56%) and road traffic accidents (37.5%) were the common modes of injury. The most common level of injury was C6-C7 in eight patients, C5-C6 in five patients, and C7-T1 in two patients. The neurological status was ASIA A, D, and B in 12, 3, and 1 patients, respectively. Seven patients had one or more associated injuries. Surgical approaches included anterior (A), anterior and posterior (AP), and APA approach in 8, 6, and 2 patients, respectively. Cerebrospinal fluid leak was noticed in six cases. The median postoperative ICU stay was 17.5 days (2–80 days). Ten (62.5%) patients had one or more major postoperative complications. Four patients died during the hospital course. Of the 10/12 discharged patients who followed up, 6 patients (ASIA A) expired within 12 months from complications of recumbency. Three out of the remaining four patients, who survived, showed improvement. Conclusion: We report the largest case series of TCS to the best of our knowledge. These cases can be a surgical challenge, and complications and outcomes depend on the function of preoperative neurological status of the patient.

BACKGROUND:Non-contiguous Dual level spine injuries (NDSI) are not uncommon in cases of high energy trauma and can carry very high morbidity if not recognized and treated. There is lack of literature and proper guidelines on such injuries. AIM:In this study, we plan to understand the demographics, clinical characteristics, management, outcome and prognosis of NDSI in patients presenting to our tertiary care trauma centre from 2015 to 2024. MATERIALS AND METHODS:We retrospectively reviewed the online and offline database of AIIMS to search for cases of NDSI. Total of 38 patients were found whose data were studied. STATISTICAL ANALYSIS:SPSS version 23 was used to carry out statistical analysis. RESULTS:3.01% of total patients with spine injury had NDSI. 28 patients (73.7 %) were male while 10 patients (26.3 %) female. Mean age of patients was 37.86 years (range - 16 years - 60 years). Out of 38 patients, 22 patients (57.9 percent) had history of Fall from height and 16 patients (42 percent) had history of Road traffic accident (High velocity). Most common injury pattern was Cervicothoracic (15 patients, 39.5 %) followed by thoracolumbar (13 patients, 34.2 %), cervicocervical (4 patients, 10%), cervicolumbar (2 patient, 5.3 %). Associated injuries included head injury finding in 5 patients, chest injuries in 15, extremity injuries in 7 and abdominal injuries in 2. Out of 38, 30 patients had total of 2 noncontigous segment involvement, 6 had 3 and 2 had 4 non-contiguous segment involvement. Out of 38, 16 patients were managed with fixation aimed at 1 segment, whereas 21 patients required fixation of both the non-contiguous segments. Surgical management of unstable cervical, thoracic, and lumbar fractures involved stabilization through spinal fusion, decompression to relieve pressure on neural elements, and instrumentation with screws, rods, or plates. Procedures done included Anterior odontoid screw for odontoid fracture, ACDF (Anterior cervical discectomy and fusion), ACCF (Anterior cervical corpectomy and fusion), posterior LMSRF (Lateral mass screw rod fixation) for cervical fractures, and posterior decompression and pedicle screw fixation for unstable thoracic and lumbar fractures. Minor injuries and stable compression fractures were managed conservatively. The approach depends on fracture type, location, clinical neurology of patient, finally aiming to restore alignment, stabilize the spine, and prevent neurological deficits. At admission, 13 patients (34%) were ASIA A, 4 ASIA B(10.5%), 6 ASIA C(15.8%), 5 ASIA D (13.2%) and 10 ASIA E(26.3%). 10 patients required tracheostomy. 4 patients developed pneumonia during their hospital course. 36 patients were discharged, but 2 patients died due to associated sepsis, dyselectrolytemia, pneumonia. Out of 38 patients, 4 patients showed improvement in neurological deficit postoperatively. One patient improved from ASIA C to ASIA D and one from ASIA A to ASIA B, 2 patients improved from ASIA D to ASIA E. 2 patients deteriorated and died due to associated sepsis, dyselectrolytemia, pneumonia. CONCLUSIONS:Non-contiguous Dual spine injuries pose unique challenges, unstable segment need to be fixed before, while taking into account the neurology of the patient. Lengthy and complex procedures can be staged. Early fixation and mobilization is best for the patients with intact or partially intact neurology.

Objective: Post-traumatic cervical kyphosis is a frequently observed clinical entity in developing countries, secondary to inadequate imaging, socio-economic factors, and associated polytrauma injury. The primary objective is to highlight the clinical presentation and surgical outcomes based on clinical and functional parameters. The secondary objective is to highlight the role of traction and surgical intervention on the quality of life of these neglected patients. Methods: Hospital records of 12 patients operated between 2008 and 2019 were retrospectively reviewed with a minimum follow-up of 24 months. Besides demographic information, radiological findings, and operative details, the outcome measures reported were neurological (ASIA score, MJOA), pain (VAS, NDI score), and operative complications. Results: The cohort included neglected upper cervical injury (5 cases-Hangmen [3], odontoid [2]) and sub-axial injury (7 cases-unilateral [3]/bilateral [2] facet dislocation, teardrop [2] fracture) with a mean delay of 59.5 ± 6.7 days. The mean age of the cohort was 28.5 years with males (10) and females (2) (11–31 years). The major etiology included missed diagnosis (6 [inadequate imaging], associated injury [head injury: 4], and socio-economic factors [2]). Closed reduction by traction was achieved in four patients. Upper cervical injury reduction was achieved by posterior release, joint drilling, and Goel–Harms stabilization, whereas sub-axial injuries were approached by posterior release, reduction facetectomy ± anterior stabilization. Significant kyphotic deformity correction was noted (pre vs. post: 28.8 vs. 6.2, P < 0.05) and consequently, clinical improvement was noted in VAS (pre vs. post: 6.8 vs. 1.0, P < 0.05), NDI score (pre vs. post: 49.5 vs. 23.7, P < 0.05), MJOA (pre vs. post: 9.1 vs. 13.6 P < 0.05) ASIA score (mean grade + 1 improvement in all). Early complications included blood loss (upper cervical vs. sub-axial–512 mL vs. 392 mL [mean]) and late complications included junctional kyphosis (2). Conclusions: A kyphotic deformity correction, if attempted in neglected traumatic cervical injuries, is also associated with significant clinical, functional, and radiographic improved outcomes.

Bobble-head doll syndrome (BHDS) is a rare movement disorder characterized by continuous or periodic head movements. The head nodding or bobbing occurs either forward and backward (yes-yes) or side-to-side movement (no–no) direction at a 2–3 Hz frequency. It is due to lesions in and around the third ventricle, causing pressure on periventricular neuronal structures (thalami). The most common lesions are suprasellar arachnoid cysts. We intend to analyze the clinical presentation, imaging findings, treatment options, and surgical outcome of BHDS in suprasellar arachnoid cysts. We retrospectively reviewed our database for BHDS in suprasellar arachnoid cysts surgically treated between 2016–2023. Patient records were reviewed with special attention to patient demographics, presentation, imaging findings, site and extent, surgery performed, complications, and outcomes. A total of 5 patients with a mean age of 6.7 years were included in the study. Abnormal head movements were the most common presenting complaint. The mean duration of symptoms was 2.9 ± 2 years. All patients underwent cyst fenestration (endoscopic or microscopic assisted). Approaches used: craniotomy and microscopic-assisted cyst fenestration in 1 patient (20

INTRODUCTION: Brachial plexus injuries are very much devastating and lead to significant socioeconomic and mental burden to the affected person and his family. In the early days of 20th century many authors were in favour of conservative management even the amputation of affected limb. But in later decades due to development in technological advancement of operating microscope, intraoperative electrophysiological monitoring, biological tissue glue etc. the results of surgical repair are beyond the imagination that could be done previously. METHODS: Our study is a Retrospective observational analytical study in which we included patients of Pan brachial plexus injury operated under the Department of Neurosurgery from April 2011 till February 2023 (excluding covid period from March 2020 to September 2021) at apex trauma center AIIMS Delhi, India. Demographic details, mode of injury, surgery performed and outcome were analyzed. Data was extracted from patient’s casualty, ICU and OT records and analyzed using SPSS version 29.0.0.0. Analysis of outcome was taken in terms of improvement in motor power and quality of life. RESULTS: There were 113 patients diagnosed to have Pan brachial plexus injury by clinical examination and supported with brachial plexus MRI, NCV and EMG of the affected limb. 24 (21.24%) cases underwent Neurolysis only, 17 (15.04%) cases underwent Supraclavicular neurotization only, 24 (21.24%) cases were operated by infraclavicular neurotization and 48 (42.48%) patients were operated by supraclavicular and infraclavicular neurotization both. Respectively 25%, 23.52%, 25% and 35.42% cases had motor and sensory improvement and were able to perform few of their daily activities with lesser support. CONCLUSIONS: In our study at least 25% Patients of Pan brachial plexus injury after surgery got benefited in their routine activity and quality of life thus lesser affected in socioeconomic and psychological front.

Pediatric cervical kyphosis is a distinct entity with diverse etiology (congenital, syndromic, traumatic, metabolic or neoplastic). Surgical correction in pediatric population is challenging due to their growing spine and low blood volume. To analyse their presentation, surgical techniques and outcome of pediatric cervical kyphosis and systematically review the pertinent literature. Retrospective study. 16 patients aged ≤ 18 years who underwent correction for cervical kyphosis between 2009 and 2021. Nurick’s grading, mJOA score and Global cobb’s angle. Clinical parameters (Nurick grading and mJOA score) were noted from database on admission and on follow-up at 6 months. Radiological parameters of assessment included Global Cobb’s angle. The C2–C7 Cobb angle was the angle of C2 vertebra lower end plate and C7 vertebra lower end plate. For C1–2 kyphosis, anterior border of C1 and anterior border of C2 angle was taken. Radiographic parameters were studied on CT and radiographs of cervical spine to assess for stability, the degree of deformity correction and fusion status at 6 months follow-up. 16 patients with mean age of 14.2 ± 3 years (9 syndromic, 4 post-traumatic, 2 metabolic and 1 post-laminectomy). All underwent surgical correction, 6 underwent Antero-posterior spinal fusion, 6 underwent Posterior spinal fusion and 4 underwent Anterior spinal fusion. There was significant clinical improvement postoperatively with—Nurick grade (pre vs. post: 2.8 vs. 1.8, p = 0.004), mJOA score (pre vs. post: 11.3 vs. 14, p = 0.003). There was significant deformity correction of Cobb’s angle from 40.7 ± 26.5° to 14.9 ± 10° (p = 0.001). Early complications included intraoperative hemodynamic instability (3) and wound complication (1). Mean follow-up was 76.9 ± 59.3 months. Pediatric cervical kyphosis is a debilitating condition which are managed surgically. Approach has to be individualized to the pathology and good results can be achieved. Patients should be screened for syndromic association and followed-up regularly.

Ewing’s sarcoma (EWS) is a malignant round-cell tumor arising from the bone and soft tissue. It is a disease of children and young adults. EWS affecting the central nervous system (cranial and spinal column) is relatively rare with an annual incidence of approximately one case per million in the Western population. Due to their rarity, very few studies are available in the literature. We present our experience of managing 21 such cases, highlighting their clinical, and radiological findings, treatment strategy, and surgical outcomes in patients with primary EWS affecting the central nervous system. We retrospectively collected hospital records of patients with primary EWS affecting the CNS (cranial and spinal column), who had been surgically treated in our Neuroscience Center between 2015 and 2023. Patients’ demographics, presentation, radiological findings, treatment strategy including surgery and biopsy followed by adjuvant therapy, and outcome at discharge, and the latest follow-up were analyzed from our database. There were sixteen male and five female patients with a mean age of 18.22 ± 12.73 years (ranging from 6 months to 59 years). The commonest presentation was headache and vomiting in cranial lesions (5/13 patients, 38.46

Background Primary intracranial Ewing's sarcoma (ES) is a type of primitive neuroectodermal tumour and is a rare malignant tumour in children and adolescents. The imaging features of ES overlap with other central nervous system embryonal tumours, making it difficult to pinpoint a specific diagnosis. We aim to explore the clinical, neuroimaging and differential diagnoses of this entity.Case presentation We describe a 6-month-old infant who presented with complaints of enlarging the head size and poor feeding. Imaging revealed a contrast-enhancing large solid-cystic mass lesion with internal calcification, focal bone erosion and haemorrhage in the posterior fossa. Histopathological examinations, immunohistochemistry, and molecular analysis confirmed ES.Conclusions The confirmative diagnosis of primary intracranial ES requires histological examination, immunohistochemical analysis, and genetic detection, along with radiological findings. Surgical excision followed by combined radiotherapy and chemotherapy is the treatment of choice.

Background Craniovertebral junction (CVJ) tumors are challenging due to their unique anatomical location. This study aimed to evaluate the complexities in dealing with such precarious CVJ extradural lesions over the decade. Methods Twenty-seven patients of extradural CVJ tumors operated between 2009 and 2018 were included. The demographic details, neurological status, surgical approach, extent of resection, type of fixation, complications, and outcome at final follow-up were recorded for each patient. Results The mean age of the patients was 39.5 ± 20 years. Most (17/27) of the patients had involvement of a single level. Clivus was the most common (9/17) involved region followed by atlas (7/17) vertebrae. Majority of the patients (13/27) were operated through the posterior-only approach. About 15 patients (55.5%) had instability or extensive lesions that necessitated posterior fixation. None of the patients underwent anterior fixation. Gross and near total excision were achieved in 10 patients (37%) and 3 patients (11%) respectively while 14 patients underwent subtotal excision of tumor. On histopathological analysis, clival chordoma (8/27) was found to be the most common pathology followed by giant cell tumor (6/27), plasmacytoma (4/27), and multiple myeloma (2/27). Most patients (13 out of 27) had the same neurological status after the surgery. Six patients (22%) improved post-operatively with decreased weakness and spasticity. Thirteen (48%) patients underwent adjuvant radiotherapy. Conclusions This retrospective study provides valuable insights into managing extradural CVJ tumors and highlights the importance of individualized approaches for optimal outcome.

Spinal deformities are common in Marfan syndrome (MFS). They usually involve the thoraco-lumbar spine but rarely involves the cervical spine. Kyphosis is the common spine deformity of the cervical spine and mandates surgical correction as they are at risk of neurological deterioration since they are refractory to conservative management. Few studies of surgical correction of spine deformity included cervical deformity. To analyze the challenges faced during surgery, clinical and radiological outcome, and complications following surgical correction for cervical kyphosis in Marfan syndrome. We identified that 5 patients with a diagnosis of MFS with cervical kyphosis who underwent fusion surgery between the years 2010 and 2022 were reviewed, retrospectively. We analyzed the demographic details, radiological parameters, operative variables (blood loss and nuances), perioperative complications, length of stay, clinical and radiological outcome, and complications following fusion surgery for cervical kyphosis in MFS. The mean age of patients was 16.6 ± 4.72 years (range, 12–23 years). The average kyphotic vertebra involved is 3 ± 0.7 bodies (range 2–4) with 2 patients with thoracic deformity. All patients underwent surgical deformity correction. All patients improved clinically with Nurick grade (pre vs. post: 3.4 vs. 2.2) and mJOA (pre vs. post: 8.2 vs. 12.6). There was significant deformity correction from 37.48° to 9.1°. Mean blood loss encountered was 900 ± 173.2 ml. Perioperative complications: wound complication with CSF leak (1). Late complications: ventilator dependence (1) and junctional kyphosis (1). Mean length of hospital stay was 103 ± 178.9 days. All patients were doing symptomatically better after mean follow-up of 58 ± 28.32 months. One patient is bedridden and hospitalized. Cervical kyphosis is a rare spine deformity in patients with MFS, and they usually present with neurological deterioration mandating surgical correction. Multidisciplinary approach (pediatrics, genetics and cardiology) is required for systematic evaluation of these patients. They should be evaluated with necessary imaging to rule out associated spinal deformity (atlanto-axial subluxation, scoliosis, and intraspinal pathology like ductal ectasia). Our results suggest better surgical outcome in terms of low operative complications with neurologic improvement in MFS patients. These patients require regular follow-up to identify late complications (instrument failure, non-union, and pseudarthrosis).

Bony tumors of CCJ and upper cervical spine are rare. Surgery is the gold standard, but they pose challenge to the surgeons in terms of extent of resection, compromising stability of the CCJ requiring stabilization procedures. We intend to analyze the indication, operative variables, need for stabilization procedures and outcomes in patients with tumors of the CCJ and upper cervical spine undergoing resection.