Manish Beniwal

Study design: Retrospective cohort study. Objective: Cervical ossification of the posterior longitudinal ligament (OPLL) is a well-established cause of degenerative myelopathy. The objective of this study was to compare the clinical outcomes of patients with cervical OPLL who underwent surgery, with and without a history of trauma. Summary of Background Data: Literature on the impact of OPLL on neurological recovery following cervical spine injury is conflicting. While some suggest an association between the presence of OPLL and neurological deterioration following trivial trauma, others have argued that OPLL does not affect neurological outcomes initially or at discharge. The correlation of clinical outcomes with preoperative radiologic features is also unclear. Methods: A retrospective analysis was performed of 61 patients who underwent posterior cervical approach and decompressive cervical laminectomy (without fusion) for cervical OPLL between January 2015 and December 2018 in a tertiary neurosurgical referral center. Seventeen patients had a history of antecedent trauma, while 44 did not. Patient demographics, clinical outcomes [modified Japanese Orthopedic Association score (mJOA) and Nurick grade], radiologic features, and parameters associated with recovery were analyzed and compared among the groups. Results: Male patients were predominant in both groups, and the mean age of presentation was slightly lower in the trauma group. The trauma group had lower pre- and postoperative mJOA scores. The length of high signal intensity (HIS) observed in T2-weighted sagittal MRI was longer in the trauma group. Significant recovery (defined as a recovery rate >50%) was significantly more frequent in the nontrauma group (35 patients, 79.5%) compared with the trauma group (2 patients, 11.76%) ( P =0.007). Conclusion: Patients with OPLL with a history of trauma more frequently harbor radiologic changes associated with myelopathy, with lower preoperative mJOA scores, and have a lower rate of significant recovery following surgery than those without a history of trauma.

Objectives: Hypervascular vestibular schwannoma is an entity characterized by excessive bleeding during surgical excision. This study aims to determine if the vestibular schwannoma has increased vascularity by identifying areas of increased vascularity on preoperative imaging and studying the expression of immunohistochemical (IHC) markers in post-operative biopsy specimen. Materials and Methods: A cross-sectional study of 31 patients with vestibular schwannoma meeting the inclusion criteria was undertaken. 31 patients underwent pre-operative imaging with arterial spin labelled (ASL) imaging, and relative tumor blood flow (rTBF) was determined using the ratio of TBF to regional cerebral blood flow (CBF) of gray matter (rTBF = TBF/CBF). Following surgical excision, the biopsy specimen was evaluated for expression of vascular endothelial growth factor (VEGF), Factor VIII, and CD31. Results: The mean rTBF was 1.56. The Spearman correlation coefficient between rTBF and VEGF, Factor VIII, and CD31 was 0.2 ( P = 0.2), 0.3 ( P = 0.106), and 0.3 ( P = 0.146). Conclusion: A statistically significant positive correlation is obtained between IHC markers, i.e., CD31 and VEGF and between CD31 and Factor VIII. A positive correlation, although not statistically significant, is observed between increased vascularity on ASL and increased expression of IHC.

Idiopathic foramen of Monro stenosis (IFOMS) is a rare clinical entity with varied presentations. We present a series of patients treated for IFOMS at our institute from 2000 to 2024. We conducted a retrospective study of all patients operated at our institute. A total of 11 patients with IFOMS were identified from the hospital records. Patients with a history of meningitis or intraventricular hemorrhage were excluded. Most patients presented in the third to fifth decade of life (81%). Most of the patients presented with headaches and one of them presented with features of normal pressure hydrocephalus. Nine patients underwent endoscopic foraminoplasty with septostomy, while two underwent septostomy with ventriculoperitoneal shunt placement. All patients were symptom-free after surgery. Foramen of Monro stenosis is a rare entity but has good outcomes with treatment. Unilateral asymmetric and bilateral lateral ventriculomegaly should raise suspicion of the foramen of Monro stenosis. Endoscopic foraminoplasty with septostomy is an effective treatment for this condition.