Abstract Background and objectives Giant pituitary adenomas (GPAs) are challenging due to their size and proximity to vital neurovascular structures. While the endoscopic endonasal transsphenoidal approach (EETA) is increasingly used for pituitary adenoma resection, its effectiveness for giant adenomas remains underexplored. This study assesses EETA outcomes for GPA resection at a tertiary care center, focusing on resection extent, complications, and factors affecting surgical outcome. Methods This retrospective study reviewed the clinical data of 50 patients who underwent EETA for giant pituitary adenomas at our institution between 2018 and 2025. Demographic data, tumour characteristics, surgical outcomes, extent of resection, and postoperative complications were analysed. Factors such as tumour size, invasion of surrounding structures, and preoperative visual and endocrine status were evaluated to identify predictors of surgical outcome. Results The study included 50 patients with mean age of 40.92 years with a male preponderance in the cohort of 60%. The mean tumour dimensions were 41 mm(craniocaudal) × 43 mm(mediolateral) × 39(anteroposterior) mm The gross total resection (GTR) rate was achieved in 64% of cases, near total in 32% and subtotal resection in 4%. Postoperative complications were observed in 34% of the patients, with the most common being transient diabetes insipidus in 30%. Improvements in visual function was noted in 62% of patients postoperatively. Conclusion Endoscopic endonasal surgery is a safe and effective approach for GPAs, offering favourable visual and functional outcomes with manageable complication rates.

BACKGROUND:Meningiomas are the most common dural-based intracranial tumors, yet Indian literature is predominantly composed of limited single-center studies, restricting nationwide representation and data-driven decision making. With artificial intelligence (AI) becoming increasingly relevant in neuro-oncology for diagnosis, segmentation, and outcome prediction, the lack of a large, standardized national dataset poses a major barrier. The Medical Imaging Datasets for India (MIDAS) initiative, a collaborative national effort involving ICMR, IISc, and ARTPARK, aims to create high-quality, annotated medical imaging repositories that can support clinical research and AI model development. As a part of this initiative, we developed a multicenter national repository of dural-based lesions. METHODS:This ambispective study included patients with radiologically suspected and histopathologically confirmed dural-based lesions from seven neurosurgical centers across India (January 2022-July 2025). Standardized de-identified demographic, clinical, imaging, and pathological data were collected. Imaging was archived in DICOM format and annotated using ITK-SNAP, while histopathology followed WHO-2021 CNS tumor guidelines. Statistical analysis was performed using descriptive and comparative measures. RESULTS:Among 586 patients, women constituted two-thirds of the cohort, with a mean age of 47.2 years. Meningiomas accounted for 98.3 % of cases and were predominantly WHO Grade I, most commonly of transitional and meningothelial subtypes. Convexity, parasagittal, and falcine locations were most frequently involved. A small but important proportion of lesions were non-meningiomatous, including schwannomas, solitary fibrous tumors, granulomatous, and metastatic lesions. Simpson Grade II resection was the most common surgical outcome, and a subset of patients underwent postoperative adjuvant radiosurgery. CONCLUSION:This MIDAS-linked national repository represents the largest structured dataset of dural-based lesions from India, integrating standardized clinical, imaging, and pathological information across multiple centers. In addition to defining national disease patterns, the availability of curated imaging and volumetric segmentations provides a strong translational platform for future artificial intelligence-based research, including automated segmentation, diagnostic classification, and outcome prediction.

Gliomas are the most common primary brain tumours with considerable heterogeneity and aggressive clinical behaviour. The recent WHO 2021 classification emphasises molecular markers, such as IDH1/2 mutations and 1p/19q codeletion, for refined diagnosis and prognosis. Among emerging regulatory mechanisms, RNA N6-methyladenosine (m6A) modifications and their interplay with SETD2 have attracted attention for their roles in tumour progression. A comprehensive analysis of SETD2 and seven m6A regulators (writers: METTL3, METTL14, WTAP; erasers: ALKBH5, FTO; readers: YTHDF1, YTHDF2) was conducted using quantitative real-time PCR (qRT-PCR) on glioma tissue samples. Global m6A levels were assessed using dot blot assays, and data from public databases (GlioVis, GENT2, TCGA) were employed to assess diagnostic, prognostic, and functional relevance. SETD2 and m6A regulators (METTL3, WTAP, ALKBH5, YTHDF1, and YTHDF2) displayed subtype-specific expression, with increased expression of in Astrocytoma IDH mutant grade 3 and 4. Dot blot assays revealed that IDH-mutant astrocytomas exhibit increased m6A levels as tumour grade increases. A strong correlation was observed between SETD2 and core m6A components (Pearson r: METTL3 = 0.75, WTAP = 0.98, ALKBH5 = 0.91, YTHDF1 = 0.63, and YTHDF2 = 0.9645, p < 0.05), suggesting co-transcriptional m6A deposition. GO analysis highlighted enrichment in RNA stability, methylation, and degradation pathways. This study provides preliminary evidence for a possible coordinated epigenetic–epitranscriptomic axis involving SETD2 and the m6A RNA methylation machinery in driving IDH-mutant glioma progression, highlighting SETD2 as both a key regulator of m6A dynamics and a diagnostic biomarker.

BACKGROUND:Neurocysticercosis (NCC), caused by the larval stage of Taenia solium, is the most prevalent parasitic infection of the central nervous system (CNS) and a leading cause of acquired epilepsy in endemic regions. Although neuroimaging has substantially improved the diagnosis of NCC, radiological appearances may vary according to the stage of the parasite and often overlap with neoplastic, inflammatory, and other infectious lesions. Consequently, histopathological examination remains the definitive diagnostic modality in surgically excised cases. METHODS:This retrospective clinicopathological study included 26 histopathologically diagnosed cases of surgically excised NCC over a 12-year period from January 2014 to December 2025 at a tertiary care center in Northern India. Demographic profile, clinical presentation, and radiological findings were retrieved from patient case files and the hospital information system. Operative notes were reviewed to document intraoperative findings and the provisional intraoperative diagnosis. Histological sections were reviewed to confirm the diagnosis, evaluate parasite morphology, and assess host inflammatory response and associated tissue changes. The diagnostic accuracy of radiological tests and intraoperative assessment was evaluated, with histopathological diagnosis as the gold standard. RESULTS:Twenty-six patients were identified, ranging in age from 11 to 68 years (mean, 32.0 years), with a male predominance (male: female ratio, 2.7:1). The majority of cases presented with signs and symptoms of raised intracranial pressure, including headache (22/26, 84.6%), followed by vomiting (16/26, 61.5%). Obstructive hydrocephalus was noted in 73.1% (19/26) of cases, all of which were localized in ventricles or cisterns. Depending on the location of the parasitic cyst, other presenting manifestations included focal or generalized seizures (6/26, 23.1%), visual disturbances (3/26, 11.5%), gait abnormalities (3/26, 11.5%), meningitis (3/26, 11.5%), and focal neurological deficits (2/26, 7.7%). The mean duration of symptoms was 8.2 months (range, 1-36 months). Lesion size ranged from 8 to 60 mm (mean, 21.3 mm). Preoperative radiological diagnosis correctly suggested NCC in 53.8% (14/26) of cases, whereas intraoperative diagnosis was accurate in 69.2% (18/26). Histopathological examination established the diagnosis in all cases and demonstrated variable stages of parasite degeneration, with an associated inflammatory reaction in 30.8% (8/26) of cases and calcification in 19.2% (5/26) of cases. The most common morphological stages of the parasite were the vesicular and colloidal stages, together accounting for 61.5% (16/26) of cases. CONCLUSIONS:CNS NCC exhibits diverse clinical and radiological manifestations that may pose significant diagnostic challenges. In surgically excised lesions, histopathological evaluation remains indispensable for definitive diagnosis and provides valuable insights into parasite viability, host inflammatory response, and disease evolution. Our findings underscore the limitations of imaging alone and highlight the complementary role of histopathology in achieving accurate diagnosis and guiding appropriate clinical management.

Endoscopic minimally invasive skull base surgery using the transorbital neuroendoscopic technique for cavernous sinus epidermoid serves as a pivotal link to open transcranial surgeries. This method involves a minimally invasive transorbital approach, including lateral orbitotomy and drilling the greater sphenoid wing, followed by cutting the orbitomeningeal band, peeling the dura mater, and exposing the tumor. This approach is technically demanding and requires thorough knowledge of anatomy and familiarity with endoscopic instruments. The favorable clinical, cosmetic, and radiological outcomes underscore the effectiveness of this technique, highlighting the role of endoscopy in minimally invasive skull base paramedian pathologies. The video can be found here: https://stream.cadmore.media/r10.3171/2025.1.FOCVID24188.

Atypical teratoid rhabdoid tumor (AT/RT) of the central nervous system (CNS) is the rare, aggressive malignant neoplasm of infancy and early childhood and relatively rare in adults. Patients with ATRT typically follow a dismal course. Because of its rarity and rapid course and poor prognosis, there has been no consensus as to the optimal treatment of this tumor. We herein report a series of nine cases collected from the year 2015 to 2021 in a regional tertiary care center in North India. We retrospectively collected histologically diagnosed ATRT cases and obtained demographic and clinical data from the databases. We retrieved the archived slides and tissue blocks for analysis and found nine diagnosed cases of ATRT. The median age of presentation was 3 years (ranging from 0.9 to 13 years) and showed male preponderance (male to female ratio of 2:1). The mean duration of symptoms was 3.5 months with headache and vomiting being the commonest symptoms. The tumors showed heterogenous immunohistochemical expression. Patients with AT/RT underwent multimodal treatment comprising surgical resection, radiotherapy, and chemotherapy based on the patient’s age and tumor site and its resectability. The mean overall survival was 15.1 months (range, 1.5–30 months). ATRT is a rare neoplasm with a highly variable clinical course and poor prognosis. It portends poor outcomes in spite of a multimodal approach to treatment; hence, there is a dire need to help combat this enigmatic tumor.

CONTEXT:Central nervous system tumors are a major cause of morbidity and mortality worldwide. The most prevalent type of primary brain tumor is glioma. The exploration of significant genetic, epigenetic, and transcriptional abnormalities has not only improved our understanding of glioma pathogenesis but has also revealed that these molecular alterations can serve as useful diagnostic markers for more precise classification and are linked to better treatment response and prognosis. Hence, incorporating molecular markers into routine tumor classification is a major priority in modern glioma diagnostics. AIM:The aim is to assess the mutation status of isocitrate dehydrogenase (IDH)-1, alpha-thalassemia/mental retardation syndrome X-linked (ATRX), and tumor protein 53 in glioma, and look for their association with various clinicopathological features. METHODOLOGY:A single-center prospective cohort study, where all biopsies of glioma (January 2019 to July 2020) were evaluated, and immunohistochemistry was performed to assess the expression of IDH-1, ATRX, p53, and Ki-67 index. The data were analyzed using IBM SPSS-24 software. RESULTS:Immunohistochemistry was performed in 123 consecutive cases of glioma. IDH-1 mutation was noted in 54 (43.9%) cases and these patients frequently presented with "seizures" ( P = 0.006). The expression was maximum in World Health Organization (WHO) grade 2 tumors (65.4%) ( P < 0.001), with the highest frequency in oligodendrogliomas (100% in WHO grade 2 and 3). Furthermore, these tumors showed lower proliferative indices ( P = 0.001). ATRX mutation was noted in 59 (48%) and p53 overexpression was noted in 76 (61.8%) cases. These mutations were significantly associated with astrocytic phenotype ( P = 0.03). CONCLUSIONS:Molecular characterization of glioma is an important step in modern glioma diagnostics and immunohistochemistry can play an important role. IDH-1 mutation is commonly observed in adults, frontal lobe location, patients presenting with seizures, and WHO grade 2 tumors with the highest frequencies in oligodendrogliomas. ATRX and p53 can be used as surrogate markers for tumors of astrocytic lineage.

Inflammatory myofibroblastic tumor (IMT) is a rare, benign lesion of uncertain etiology, predominantly affecting soft tissues such as the lungs, with spinal involvement being exceedingly rare. We present the case of a 10-year-old male with a year-long history of low back pain, constipation, and difficulty in urination. MRI revealed an intradural extramedullary lesion at L5-S1, initially suspected to be a schwannoma or neurofibroma. The patient underwent L5 laminectomy and near-total excision of the tumor. Histopathological examination confirmed IMT, characterized by spindle cells and dense inflammatory infiltration. At 18 months follow-up, MRI showed no tumor progression with complete clinical improvement. This is the first reported case of IMT in pediatric age, affecting the lumbosacral spine. It highlights the importance of considering IMT in the differential diagnosis of spinal tumors, particularly when multiple nerve roots are involved, with intraoperative findings of an inflammatory lesion. Surgery remains the definitive treatment.

Glioblastoma is the most aggressive and commonest primary malignant brain tumour. Current standard of care includes surgery, radiation, and alkylating agent chemotherapy. Despite multimodal treatment, the survival of glioblastoma patients is dismal. Loss of O6-methylguanine-DNA-methyltransferase(MGMT) protein expression due to promoter methylation reduces glioma cell DNA repair activity and resistance to alkylating agents. Thus, in world health organization (WHO) grade 4 diffuse glioma patients treated with an alkylating agent, methylated MGMT promoter is currently being considered a clinically relevant prognostic as well as predictive biomarker. Our aim was to assess the frequency of MGMT promoter methylation in WHO grade 4 diffuse glioma patients and study their prognostic role and clinicopathological correlations. A two-year prospective cohort research was conducted on 89 WHO grade 4 diffuse glioma patients. The clinical and demographic data were retrieved from our hospital information system. MGMT methylation was assessed using methylation specific polymerase chain reaction. Data was analysed using SPSS-24 software. We studied 89 cases of WHO grade 4 diffuse glioma, of which 38.2% showed methylation of MGMT promoter. There was no significant difference in age, sex, location of tumor and clinical presentation between the methylated and unmethylated groups. A statistically significant association of methylated MGMT promoter was observed with isocitrate dehydrogenase-1 (IDH1) protein expression (p = 0.050) and alpha-thalassemia/mental retardation syndrome X-linked (ATRX) loss (p = 0.003). No significant association was noted with p53 overexpression (p = 0.492) and Ki-67 index (p = 0.698). The median overall survival in these patients receiving standard radiotherapy and concomitant temozolomide chemotherapy showed a trend towards better survival in group with methylated MGMT promoter (p < 0.001). Our study suggests that methylation of MGMT promoter is more frequent in the subset of grade 4 diffuse gliomas that significantly exhibit IDH1 immunopositivity and loss of ATRX expression. Also, patients who receive radiation therapy and simultaneous temozolomide chemotherapy have a considerably better prognosis and treatment outcome, if the promoter region of MGMT is methylated.

The differential diagnosis for an abdominal mass in a 2-year-old child is broad and includes lesions of renal, hepatic, gastrointestinal, adrenal, and lymphatic origins. Of these, Wilms' tumor and neuroblastoma are the most common tumors, where Wilms' tumor represents about 92% of renal masses in children. Non-Wilms' renal tumors, rhabdoid tumors, and clear cell sarcoma of the kidney (CCSK) are uncommon. CCSK constitutes approximately 3% of all malignant renal tumors in childhood. In this report, we present a child presenting with a huge renal mass consistent with Wilms' tumor on computed tomography and initial biopsy. However, the final pathologic diagnosis after resection revealed CCSK.

Papillary glioneuronal tumors are rare neoplasm, accounting only <0.02% of all intracranial tumors. They are generally low grade usually occur in the temporal lobe near the third ventricle. We report an extremely rare case of intraventricular tumor with a high proliferation index. CD 117 expression found in our case is the first study to the best of our knowledge to be described in these tumors. The clinical and diagnostic significance of this finding is subject to further studies.

ABSTRACT:We report a rare case of spindle cell carcinoma, a histological subtype of metaplastic breast carcinoma, in a 40-year-old male who presented with an ulcero-proliferative lump in the right breast. Fine-needle aspiration cytology of the lesion showed poorly cohesive clusters of pleomorphic spindle-shaped cells, suggestive of malignant spindle cell tumor. Right mastectomy along with ipsilateral lymph node dissection was performed. Microscopic evaluation revealed a neoplasm comprising interlacing fascicles of oval to spindled pleomorphic cells with brisk mitosis and areas of necrosis. There was no nodal metastasis. Immunohistochemistry revealed a triple-negative phenotype along with diffuse positivity for CK5/6, vimentin, and smooth muscle actin. p63, beta-catenin, and CD34 were negative. The patient subsequently received adjuvant chemotherapy with 5-fluorouracil, adriamycin, and cyclophosphamide regimen and was disease-free at 1-year follow-up.

BACKGROUND:Seizures are commonly seen among meningioma patients and may cause impaired quality of life. These patients can be effectively treated with surgery. Still, many patients have persistent seizure episodes after surgery. The factors which are associated with worsening of seizure episodes remain critical in improving the quality of life for such patients. In this study, we aim to analyze the clinical and histopathological factors to predict the post excision seizure-outcome in meningioma and need of antiepileptic prophylaxis for these patients. METHODS:Adult patients who underwent primary resection of meningioma at our institute between 2007 and 2020 were included in the study. Eligibility criteria were as follows: (i) Surgery for newly-diagnosed biopsy proven meningioma, (ii) Presence of pre-operative seizure (iii) A follow-up period ≥ 12 months. RESULTS:Of the 1145 patients in this series, 333 patients were recruited in study. The major determinants of prophylactic anti-epileptic were tumour size (S), Oedema (O), location (L), inclusion body (I), antiepileptic drugs (D) and surgical complication (C). The factors independently associated with poor seizure control after surgical resection were presence of brain parenchyma invasion (p < 0.001), pre-operative use of > 2 antiepileptics (p = 0.016) and presence of intranuclear inclusion bodies (p = 0.001). CONCLUSIONS:The identification and consideration of factors associated with prolonged seizure control after surgery may help us to guide treatment strategies aimed at improving the quality of life for patients with meningiomas. Authors have proposed a SOLID-C guideline to avoid the blanket approach of prophylactic AED in patients undergoing for meningioma resection.

Involvement of the gastrointestinal (GI) system in corona virus disease-19 (COVID-19) in form of diarrhea, loss of taste, nausea, and anorexia is common and associated with poor prognosis. COVID-19 is also associated with a hypercoagulable state that mainly involves the pulmonary vasculature. However, GI complications involving thrombosis are observed infrequently. We report two COVID-19 patients who had two different causes of acute abdomen. The first patient was a 49-year-old male diagnosed with an aortic thrombus along with a splenic infarct. He was diagnosed early and successfully managed with anticoagulants. The second patient was a 30-year-old male who developed pain in the abdomen and was found to have features suggestive of peritonitis. A contrast-enhanced computerized tomography (CECT) scan of the abdomen revealed dilated bowel loops. Immediate exploratory laparotomy was performed; he was found to have jejunal perforation with gangrene. Histopathological examination of the resected specimen showed inflammatory cells with edema and thrombotic vessels. However, he succumbed to sepsis and multiorgan failure. Therefore, it is important to investigate cases of acute abdomen in COVID-19 thoroughly and whenever indicated CT angiogram should be obtained.

Background: The human calvaria harbors a variety of pathology and majority of them are incidentally noticed as painless swelling. The aim of the present study is to describe the histopathological subtypes of calvarial lesions, their management and factors affecting their surgical outcome at a tertiary care referral center. Material and Methods: All patients who underwent excision of the calvarial lesions over the last 15 years (from January 2005 to July 2019) were included in this study. Patients having calvarial pathology of infective origin and recurrent lesions were excluded. Any patient with multiple calvarial lesions who have been operated more than one time for same histopathological diagnosis was counted as one patient. We studied Karnofsky Performance Status (KPS) scores and radiological changes at 3-month follow up. Results: Total 65 patients were recruited in this retrospective observational study. The median age of patients in the study was 29 years (range: 8 years to 68 years). Fibrous dysplasia 20 (30.7%) was the commonest lesion while metastatic thyroid carcinoma 3 (4.6%) was the most common malignant pathology. Complete excision was performed in 51 (78.5%) of patients while in 14 (21.5%) cases, subtotal or near total decompression were achieved. After three months of surgery, there was significant improvement in the KPS score (P < 0.00001). Duration of follow up ranges from 6 months to 5 years with 4 mortality in the study. Conclusions: Most of the calvarial tumors were benign and surgically addressable. The malignant lesions were scattered with diverse underlying pathology and required individualized holistic approach.

Objective In contemporary neurosurgical practice, keyhole endoscopic approach has established its role in various neurosurgical pathologies. Intracranial epidermoid is an ideal pathology for endoscopic keyhole approach as epidermoid is well encapsulated, extra-axial, avascular, and easily suckable. The objective of this study is to share our experience of endoscopic keyhole approach for intracranial epidermoids at various locations as a new minimally invasive neurosurgical approach to deal with these lesions. Materials and Methods We conducted a retrospective study on 26 patients who underwent keyhole pure endoscopic excision of intracranial epidermoid between July 2015 and December 2019. Patient's demographics, clinical features, radiological imaging, and postoperative complications were noted. Follow-up outcome of preoperative symptoms and postoperative complications were also analyzed. Results The mean age of the study population was 30.5 years with a mean follow-up of 30 months. The common presenting features were headache, hearing loss, and trigeminal neuralgic pain. Gross total resection was achieved in 73.1% cases, while near total resection and subtotal resection were achieved in 19.2 and 7.7% cases, respectively. In the follow-up, maximal improvement was seen in trigeminal neuralgic pain (83%) and headache (66.7%). Major postoperative complications were facial nerve paresis, lower cranial nerve paresis, and transient facial hypoesthesia, most of which improved over time. None of the patients required resurgery till date. Statistical Analysis Patients' data were analyzed using SPSS software version 23 (Statistical Package for Social Sciences, IBM, Chicago, United States). Conclusion This study demonstrates that with careful patient selection, endoscopic keyhole excision of epidermoid is a good alternative to conventional microsurgical excision with comparable surgical and functional outcomes.

Angiomatous meningioma is a rare variant tumor classified as WHO grade 1 meningioma and accounts for about 2.1% of all meningioma. Their clinical presentation, surgical management, and prognosis are almost similar to the classical meningioma. Despite of benign nature and being comparatively small in size, they look aggressive on radiology images like massive peritumoral edema and intense contrast enhancement. Being a unique subtype of meningioma, the studies on angiomatous meningioma are very limited. In this cross sectional retrospective study, we described the clinical presentation, radiology, histopathological features and differential diagnosis of 30 cases of angiomatous meningioma from a single centre. The clinical parameters include demographic profile, symptoms and radiological findings including location, extent, pattern, histopathology with World Health Organization (WHO) grade-2016, extent of tumour excision, recurrence and surgical outcome. Incidence of angiomatous meningioma in our study was 2.46% with male predominance. The most common location in our study was convexity. 27 out of 30 had histopathology reports of angiomatous meningioma and 3 had lipoangiomatous meningioma. The high vascularity and disproportionate peri-tumoral edema makes it a surgical challenge for excision. The complications and surgical outcome were analysed. The radiological anticipation of tumour subtype, meticulous pre-operative planning and intraoperative precautions remains a key for success.

Intracardiac hydatid cyst is relatively uncommon and involvement of right ventricular outflow tract is extremely rare. We report a rare case of intracardiac hydatid cyst involving the right ventricular outflow tract and do a review of literature.