Nischal Acharya

BACKGROUND: Collision tumors, defined as the coexistence of two distinct neoplasms with independent origins in the same anatomical location, are rare entities that pose diagnostic and therapeutic challenges. While pituitary adenomas and meningiomas are individually common intracranial tumors, their coexistence as collision tumors is exceptionally uncommon, with only a handful of cases reported in the literature. Even fewer involve growth hormone–secreting pituitary adenomas, and none have involved sphenoid wing meningiomas to date. OBSERVATIONS: The authors present the case of a 54-year-old female who presented with progressive expressive aphasia, right-sided weakness, gait imbalance, and memory decline. Initial MRI demonstrated a large dural-based mass involving the left sphenoid wing and sellar region; the tumor was resected in staged procedures and diagnosed as a meningothelial meningioma. Fourteen months later, follow-up imaging revealed a distinct sellar lesion. Endoscopic endonasal resection demonstrated a pituitary adenoma extensively involved by the meningioma, establishing the diagnosis of a collision tumor. LESSONS: The authors highlight the importance of recognizing the potential for dual pathology in complex intracranial tumors. This case describes the limitations of preoperative imaging in diagnosing collision tumors. Careful long-term surveillance and multidisciplinary management are essential for accurate diagnosis and optimal treatment of collision tumors. https://thejns.org/doi/10.3171/CASE25709

Study Design: A retrospective cohort study.Purpose: We present data assessing the differences in 30-day morbidity, mortality, and postoperative complications between the two surgical remedy options.Overview of Literature: The choice between decompression with fusion or decompression alone for the management of cervical spondylotic myelopathy (CSM) remains controversial.Methods: The American College of Surgeons National Quality Improvement Program database was queried for adults ≥18 years diagnosed with spondylosis with cervical myelopathy (10th revision of the International Classification of Diseases [ICD-10]: M47.12) or spinal stenosis of the cervical region (ICD-10: M48.02) who underwent laminectomy (Current Procedural Terminology [CPT] 63001, 63015, 63045) with or without fusion (CPT 22600) between 2015 and 2020. Patients were stratified into fusion and non-fusion cohorts for comparative review. Estimated 30-day mortality and morbidity, postoperative complications, and American Society of Anesthesiologists (ASA) classification were evaluated using chi-square and analysis of variance tests, and results were further stratified according to ASA classification.Results: Of the 6,412 patients, 3,355 (52%) received laminectomy without fusion, and 3,057 (48%) experienced laminectomy with fusion. Patients undergoing decompression with fusion had higher mean morbidity (estimated probability 0.073 vs. 0.064, p<0.001), unplanned reoperations (4.2% vs. 2.7%, p<0.002), unplanned readmissions (7.6% vs. 6.3%, p<0.014), mean length of stay (5.0±8.9 days vs. 3.4±7.2 days, p<0.001), deep wound infections (0.8% vs. 0.4%, p<0.022), and bleeding risk necessitating transfusion (3.8% vs. 1.6%, p<0.001). Stratification by ASA scores demonstrated an overall higher rate of 30-day postoperative complications with increasing ASA scores in both cohorts, However, the decompression with fusion cohort showed a greater relative increase in complications compared to the decompression-alone cohort with each ASA group.Conclusions: Decompression with fusion is correlated with higher estimated morbidity, unplanned reoperations and readmissions, and 30-day complications postoperatively. Decompression alone is an appealing procedure option for CSM, particularly for patients with higher ASA scores and those at greater risk.

Study Design: A retrospective cohort study.Purpose: To assess differences in 30-day morbidity and mortality and postoperative complications between two surgical treatment options.Overview of Literature: The choice of decompression with fusion or decompression alone for the management of degenerative spondylolisthesis (DS) is controversial.Methods: The American College of Surgeons National Quality Improvement Program database was queried for laminectomy or laminotomy with and without fusion from 2015 to 2020. The estimated 30-day mortality and morbidity, 30-day complications, and American Society of Anesthesiologist (ASA) classification were evaluated through chi-square and analysis of variance tests, with the results further stratified according to the ASA classification.Results: Of the 4,120 patients, 2,384 (58%) underwent a laminectomy or laminotomy without fusion and 1,736 (42%) underwent a laminectomy or laminotomy with fusion. Patients undergoing decompression with fusion had higher mean mortality (estimated probability 0.0034 vs. 0.0027, p<0.001), mean morbidity (estimated probability 0.053 vs. 0.048, p<0.001), mean length of stay (3.62±3.4 days vs. 3.15±4.3 days, p<0.001), and bleeding risk necessitating transfusion (9.5% vs. 7.6%, p =0.038). There was a higher rate of overall 30-day postoperative complications associated with an increasing ASA score for both cohorts.Conclusions: Decompression with fusion was associated with higher estimated mortality, morbidity, and 30-day complications. Decompression alone is an appealing treatment option for lumbar DS, particularly for patients with higher ASA scores and those at higher risk.

BACKGROUND AND OBJECTIVES: Spondylodiscitis (SD) is an infection of the intervertebral disk. In the nonseptic, MRI-positive patient without focal deficits, current guidelines recommend computed tomography–guided biopsy (CTGB) for pathogen identification. Yet, pathogen positivity from CTGB is low (37%). Percutaneous endoscopic debridement and drainage (PEDD) may improve pathogen identification and reduce pain. We aimed to evaluate the utility of PEDD as the first-line intervention for the diagnosis and management of SD. METHODS: Demographic characteristics, perioperative outcomes, intraoperative data, and microbiological data were collected through retrospective chart review from 9 consecutive adult patients with suspected SD managed with PEDD between 2021 and 2024. Patients were followed postoperatively until no longer seen in clinic. Paired t -tests were used to compare Visual Analog Pain Scale and morphine milligram equivalents change after intervention. RESULTS: The mean age was 56.4 years (SD: 10.0) with 7 male patients (77.8%). The mean follow-up was 7.1 months (SD: 9.6). On presentation, back pain was reported in 100% and lower extremity weakness and paresthesia in 33.3%; 77.8% of patients were treated with antibiotics preoperatively. The mean operative duration was 87.7 minutes (SD: 21.2). The mean estimated blood loss was 16.9 mL (SD: 20.7). The mean length of stay was 9.6 days (SD: 9.9). There were no intraoperative or postoperative complications associated with PEDD. Successful pathogen identification was achieved in 88.9%. The mean time to pathogen identification was 5.5 days (SD: 5.2). All patients had postoperative pain relief. There was a significant reduction in Visual Analog Pain Score postoperatively from 9.2 to 3.2 ( P < .001). This pain reduction was also associated with a significant reduction in morphine milligram equivalents from 32.7 to 29.5 ( P < .001). CONCLUSION: We demonstrate that PEDD is a safe and effective procedure for the management of SD. PEDD may improve pathogen identification compared with CTGB while simultaneously reducing pain and opioid requirements. These data suggest that PEDD may be considered as a first-line intervention for SD. Further prospective studies are required to inform guidelines.

» Identification of malnourished and at-risk patients should be a standardized part of the preoperative evaluation process for every patient. » Malnourishment is defined as a disorder of energy, protein, and nutrients based on the presence of insufficient energy intake, weight loss, muscle atrophy, loss of subcutaneous fat, localized or generalized fluid accumulation, or diminished functional status. » Malnutrition has been associated with worse outcomes postoperatively across a variety of orthopaedic procedures because malnourished patients do not have a robust metabolic reserve available for recovery after surgery. » Screening assessment and basic laboratory studies may indicate patients' nutritional risk; however, laboratory values are often not specific for malnutrition, necessitating the use of prognostic screening tools. » Nutrition consultation and perioperative supplementation with amino acids and micronutrients are 2 readily available interventions that orthopaedic surgeons can select for malnourished patients.

PRMT5 is an arginine methyltransferase and a therapeutic target in MTAP null cancers. PRMT5 utilizes adaptor proteins for substrate recruitment through a previously undefined mechanism. Here, we identify an evolutionarily conserved peptide sequence shared among the three known substrate adaptors (pICln/CLNS1A, RIOK1 and COPR5) and show it is necessary and sufficient for interaction with PRMT5. We structurally resolve the interface with PRMT5 and show via genetic perturbation that it is required for methylation of adaptor-recruited substrates including the spliceosome, histones, and ribosome assembly complexes. Genetic disruption of the PRMT5-substrate adaptor interface leads to a hypomorphic decrease in growth of MTAP null tumor cells and is thus a novel site for development of therapeutic inhibitors of PRMT5.