Journal of Neurosurgery Academy

Microsurgical excision of a giant cerebellopontine angle atypical teratoid/rhabdoid tumor in an 11-month-old infant: surgical video

Karthik Nandam — 2026-10-03

Atypical teratoid/rhabdoid tumor (ATRT) is an aggressive embryonal neoplasm of infancy that most often arises in the posterior fossa, where it may occupy the cerebellopontine angle and closely mimic more common pediatric tumors on imaging. Resection in this location is demanding because of the size of the lesion relative to the infant’s posterior fossa, its vascularity, and the intimacy of the tumor with the brainstem and the cranial nerves of the cerebellopontine angle. We present the operative video of an 11-month-old male infant with a 1-month history of projectile vomiting and 2 weeks of regression of acquired milestones, in whom imaging demonstrated a 4 _ 4 cm solid-cystic mass in the right cerebellopontine angle with brainstem and fourth ventricular compression and obstructive hydrocephalus. A ventriculoperitoneal shunt was placed through a left Frazier’s point burr hole in the emergency setting, and definitive tumor surgery was deferred by 1 week, during which hydration was corrected and a lower respiratory infection settled. The tumor was then approached through a hockey-stick incision and a suboccipital craniotomy extending 2 cm to the left and 4 cm to the right of the midline. At operation the lesion proved not to be purely extra-axial: it infiltrated the lower part of the right cerebellar hemisphere and the tonsil, filled the entire cerebellopontine angle, and distorted and rotated the brainstem. The tumor feeders were cauterized with preservation of the supply to the cerebellum and the brainstem, intratumoral decompression was carried out within a preserved arachnoid plane, and a cottonoid was placed in the fourth ventricle to prevent spillage of blood into the ventricular system. Near total excision was achieved, with a thin layer of tumor deliberately left on the brainstem and cranial nerves to avoid brainstem infarction and neurovascular injury. Histopathology established a Central Nervous System World Health Organization (CNS WHO) grade 4 ATRT. This video illustrates the operative sequence and the technical considerations relevant to the excision of a large cerebellopontine angle embryonal tumor in infancy.

Balloon kyphoplasty for traumatic thoracolumbar wedge compression fractures without neurological deficit: a case series of 12 patients

A. R. Baskar — 2026-09-18

Background: Balloon kyphoplasty (BKP) is well established for osteoporotic vertebral compression fractures. Its use in traumatic, non-osteoporotic thoracolumbar wedge compression fractures without neurological deficit is less understood, especially across a wide age range.

Case series: We reviewed 12 patients (9 male, 3 female; mean age 44.9 years, range 17–75) who underwent percutaneous BKP for acute traumatic thoracolumbar wedge compression fractures (D6–L2) without neurological deficit at a single center between July 2025 and January 2026. Seven patients underwent a unipedicular approach, and five had a bipedicular approach, depending on the surgeon's discretion. The mean pre-operative visual analogue scale (VAS) was 5.2 (range 4–6); all patients had a VAS of 1 and were able to walk unaided by post-operative Day 1. One patient (8.3%) had an asymptomatic cement leak that did not affect the nerves. The average length of stay was 2 days. At a mean follow-up of 9.5 months (range 6–12), all patients had a VAS of 0, could walk fully, and showed stable vertebral height on imaging.

Conclusion: BKP, performed with either a unipedicular or bipedicular approach, provided quick pain relief, early mobility, and a low rate of complications in this group of patients with traumatic thoracolumbar wedge fractures ranging from adolescence to old age.

Surgical video of corpectomy and fusion

Swarjith Nimmakayala — 2026-10-03

Degenerative cervical myelopathy (DCM), earlier referred to as cervical spondylotic myelopathy, involves spinal cord dysfunction from compression in the neck. The prevalence of DCM is expected to rise with age, making the optimization of treatment strategies crucial. Pharmacological treatments, including non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and corticosteroids, are commonly prescribed for symptomatic relief. The primary objective of surgery is to decompress the spinal cord, restore cervical alignment, and stabilize the spine. Corpectomy plays a pivotal role in cases of multilevel ventral compression, extensive ossification of the posterior longitudinal ligament, or when deformity correction is required. Corpectomy is technically demanding and associated with higher risks of graft subsidence. Corpectomy continues to be indispensable in the surgical management of cervical myelopathy. In the present video article, we present the case of a 32-year-old gentleman who presented with neck pain and progressive weakness in the extremities. His symptoms were resolved after cervical corpectomy and fusion.