Alaa Nabil Turkistani

Background: Metal hypersensitivity to spinal implants is a rare complication documented predominantly in isolated case reports. While nickel, cobalt, and chromium are the most commonly implicated allergens, titanium alloys used in cervical fusion constructs may also elicit immune-mediated responses. Standalone cages, a common choice in anterior cervical discectomy and fusion (ACDF), are primarily composed of titanium alloy, making them a potential source of metal sensitization. Case Description: We present the case of a patient who underwent ACDF using a standalone titanium alloy cage for cervical spondylotic radiculopathy. Postoperatively, the patient experienced atypical, difficult-to-explain pain with a radiating quality that was inconsistent with the expected surgical recovery pattern. Further history revealed an antecedent self-reported sensitivity to certain jewelry metals. The patient was returned to the operating theatre, the standalone cage was removed, and reconstruction was performed using an iliac crest autograft. Postoperatively, the patient reported notable symptom improvement. As an exploratory observation, a titanium screw from the implant was placed in contact with the patient’s skin, and localized erythema developed within 24 h, providing suspicion of metal hypersensitivity. Conclusions: This case highlights the importance of eliciting a thorough preoperative allergy history, including reactions to jewelry and metal-containing items, before performing instrumented spinal fusion. When metal hypersensitivity is suspected postoperatively, implant removal and replacement with alternative materials might be considered. Skin contact testing may provide helpful adjunctive clues to guide the diagnostic process in suspected metal hypersensitivity.

Background/Objective: Intracranial arteriovenous malformations (AVMs) are high-flow cerebrovascular lesions associated with a significant risk of intracranial hemorrhage, neurological morbidity, and mortality. Current management strategies, including microsurgical resection, endovascular embolization, stereotactic radiosurgery, and conservative observation, remain limited by procedural risk and uncertain long-term outcomes. Beta-blockers, particularly propranolol, have recently attracted interest as potential adjunctive therapies because of their vasoconstrictive, antiangiogenic, and vascular remodeling properties. This review evaluates the mechanistic rationale and current evidence regarding beta-blocker use in intracranial AVMs. Methods: A comprehensive literature review was conducted using PubMed, Scopus, and Google Scholar databases through January 2026 using combinations of the terms “arteriovenous malformation,” “AVM,” “beta-blocker,” “propranolol,” “angiogenesis,” “hemorrhage,” and “cerebral cavernous malformation.” Eligible studies included experimental investigations, translational studies, observational cohorts, case reports, clinical trials, systematic reviews, and meta-analyses evaluating beta-blocker use in intracranial AVMs or related vascular malformations. Studies unrelated to cerebrovascular lesions, duplicate reports, and non-English publications were excluded. Given the heterogeneity and limited volume of available AVM-specific literature, findings were synthesized narratively rather than through formal systematic review methodology. Discussion: Preclinical studies suggest that beta-blockers modulate molecular pathways implicated in AVM pathophysiology, including VEGF, HIF-1α, SDF1α/CXCR4, MMP-9, and Notch-associated signaling. These mechanisms may reduce abnormal angiogenesis, endothelial instability, and pathological vascular remodeling. Clinical evidence, however, remains limited to retrospective studies, perioperative reports, and indirect evidence from cerebral cavernous malformations. Observational studies have reported associations between beta-blocker exposure and certain favorable AVM characteristics, including lower rates of hemorrhagic presentation and less complex angioarchitecture. However, these findings are highly susceptible to confounding, reverse causation, and selection bias and should not be interpreted as evidence of disease modification. Conclusions: Beta-blockers cannot currently be recommended as definitive therapy for intracranial AVMs. Their established role remains perioperative hemodynamic control, while potential disease-modifying effects require validation through prospective studies and randomized clinical trials.

Background: Aneurysmal bone cysts (ABCs) are reactive, proliferative, and highly vascular benign osseous lesions. They are very rare, and present significant diagnostic and treatment challenges. Case Description: For three months, an 18-year-old male developed progressive low back pain and mid-low back swelling. The computed tomography (CT) scan showed a mass invading the L1 vertebral body and right pedicle. The Magnetic resonance imaging (MRI) documented a complex cystic, osteolytic lesion measuring 7 cm × 7.7 cm × 5 cm that displaced the thecal sac to the left. After the biopsy confirmed an ABC, the patient underwent pre-operative embolization that reduced the vascularity by 80%; this was succeeded by en bloc total lesion resection with an instrumented fusion. Conclusion: ABCs rarely occur in the lumbar spine. The diagnosis should be established and confirmed utilizing both MR and CT studies. Biopsy should be followed by embolization (i.e., if appropriate), and gross total surgical resection with fusion if warranted.

Background: 5-aminolevulinic acid (5-ALA)-induced fluorescence is well established in intracranial glioma surgery, aiding tumor visualization and extent of resection. This systematic review evaluates the utility of 5-ALA in spinal tumor surgery, focusing on fluorescence characteristics, resection outcomes, and perioperative safety. Methods: A systematic literature search was performed in Embase, Web of Science, PubMed, and MEDLINE databases; 13 studies met the inclusion criteria. Eligible studies involved human subjects undergoing spinal tumor surgery with intraoperative use of 5-ALA for tumor fluorescence. Primary outcomes assessed included fluorescence response and extent of resection; secondary outcomes included postoperative neurological status and adverse effects. Results: Thirteen studies involved 245 patients whose tumor diagnoses included ependymomas, meningiomas, astrocytomas, neurinomas, and metastatic lesions. Fluorescence rates varied by tumor type; uptake showed high positivity in ependymomas and meningiomas, but inconsistent findings for astrocytomas and metastases. Gross total resection was achieved more frequently in well-circumscribed benign tumors. Although patients experienced favorable postoperative outcomes, transient or persistent neurological deficits occurred in a subset of patients depending on tumor location and surgical complexity. Standard dosing (20 mg/kg preoperatively) was consistent across studies, and adverse effects were limited to expected photosensitivity. Conclusion: 5-ALA enhances intraoperative visualization and may facilitate more complete resection of selected spinal tumors, particularly ependymomas and meningiomas.

Background: This study provides a comprehensive overview of the management of postoperative vasospasm after skull base surgeries. This phenomenon is rare but can be of serious sequelae.Methods: Medline, Embase, and PubMed Central were searched, along with examining the references of the included studies. Only case reports and series that reported vasospasm following a skull base pathology were incorporated. Cases with pathologies other than skull base, subarachnoid hemorrhage, aneurysm, and reversible cerebral vasoconstriction syndrome were excluded from the study. Quantitative data were presented as mean (Standard Deviation) or median (range), accordingly, while qualitative data were presented as frequency (percentage). Chi- square test and one-way analysis of variance were used to assess for any association between the different factors and patient outcomes.Results: We had a total of 42 cases extracted from the literature. The mean age was 40.1 (±16.1) with approximately equal males and females (19 [45.2%] and 23 [54.8%], respectively). The time to develop vasospasm after the surgery was 7 days (±3.7). Most of the cases were diagnosed by either angiogram or magnetic resonance angiography. Seventeen of the 42 patients had pituitary adenoma as the pathology. Anterior circulation was nearly affected in all patients. For management, most patients received pharmacological with supportive management. Twenty-three patients had an incomplete recovery as a result of vasospasm.Conclusion: Vasospasm following skull base operations can affect males and females, and most patients in this review were middle-aged adults. The outcome of patients varies; however, most patients did not achieve a full recovery. There was no correlation between any factors and the outcome.

Introduction: In the recent era of technological evolution, electronic devices have become an essential part of our lives, not merely in professional work settings, but also in daily leisure activities. Although these devices have simplified our lives, they are associated with a wide variety of health complaints. Thus, the so-called computer vision syndrome (CVS) has become a growing public health problem and has gained significant attention as it plays an important role in the quality of life of each individual, which in turn has put an increased burden on the health care system. Eye symptoms are among the most reported, yet extraocular symptoms were frequently described as adding an extra load. Method: An electronic survey was distributed randomly through social media platforms among the general population in Saudi Arabia, between the period from July to December 2017, irrespective of their sociodemographic factors, aiming to determine the prevalence of CVS and to verify the most common associated risk factors. Results: In total, 690 participants were involved in our study, with a mean age of 33.8 years. Of these, 77.6% suffer from CVS, with eye-burning being the most common ocular symptoms (71%), as well as itching (67.5%), blurred vision (65%), tearing (62.3%), and other eye symptoms being reported. Neck/shoulder pain was found to be the most prevalent extra ocular symptom (85.2%); also back pain and headache are frequently expressed (78% and 70% respectively). A significant positive correlation was observed between CVS symptoms and time spent using the devices (P-value: 0.002). Conclusion: As technology advances, electronic devices have become a common tool that is used for different purposes on daily basis. We found in our study that the so-called computer vision syndrome is a growing public health problem. Thus, community education about the impact of such a lifestyle for proper handling of electronic devices must be addressed to avoid such health complaints.

Tumefactive multiple sclerosis masquerade as a central nervous system tumor: a case report