Daniyar K. Zhamoldin

Background: Solitary spinal osteochondroma is an uncommon benign bone tumor, and symptomatic thoracic lesions causing compressive myelopathy are exceptionally rare. Owing to the indolent growth and nonspecific clinical presentation of these tumors, diagnosis is frequently delayed, increasing the risk of irreversible spinal cord injury. Case presentation: A 46-year-old man presented with progressive thoracic myelopathy characterized by gait disturbance, bilateral lower-extremity spasticity, and weakness that had evolved over approximately 20 years. Computed tomography (CT) demonstrated a large unilateral osseous lesion arising from the posterior vertebral arch at the Th1–Th2 level, producing severe dorsal spinal canal stenosis with an approximately 57% reduction in sagittal canal diameter. Magnetic resonance imaging (MRI) could not be performed because of retained metallic orthopedic hardware. Differential diagnosis included ossification of the ligamentum flavum, ossification of the posterior longitudinal ligament, diffuse idiopathic skeletal hyperostosis, congenital spinal canal stenosis, and primary osseous tumors. The patient underwent neuronavigation-assisted posterior decompression with Th1–Th2 laminectomy and en bloc microsurgical excision of the lesion. Histopathological examination demonstrated mature trabecular bone covered by a hyaline cartilage cap, confirming osteochondroma without evidence of malignant transformation. Postoperative CT confirmed complete decompression of the spinal canal. Neurological status remained unchanged in the early postoperative period, with persistent spastic paraparesis, likely reflecting irreversible spinal cord injury secondary to prolonged compression. Conclusion: Solitary thoracic osteochondroma should be considered in the differential diagnosis of chronic progressive thoracic myelopathy, even in the absence of hereditary skeletal disorders or prior trauma. CT plays a pivotal role in diagnosis when MRI is unavailable. Complete surgical excision provides definitive decompression and excellent local control; however, neurological recovery is strongly influenced by the duration of preoperative spinal cord compression, underscoring the importance of early recognition and timely surgical intervention.

Background: Solitary fibrous tumor/hemangiopericytoma (SFT) is a rare mesenchymal neoplasm of the central nervous system characterized by unpredictable biological behavior, including delayed recurrence and metastatic potential. Spinal localization is uncommon, while cervical intradural extramedullary involvement remains exceptionally rare. Long-term outcomes and optimal postoperative management strategies are not well established. Case presentation: A 39-year-old male presented with progressive cervical myelopathy caused by an intradural extramedullary tumor at the C4–C5 level. The patient underwent microsurgical gross total resection (GTR) with intraoperative neurophysiological monitoring. Histopathological and immunohistochemical evaluation demonstrated a CNS WHO grade 2 solitary fibrous tumor with diffuse CD34 and STAT6 positivity. Postoperative recovery was uneventful, and serial contrast-enhanced magnetic resonance imaging (MRI) demonstrated no evidence of recurrence during a 5-year surveillance period. Results: In 2026, the patient developed recurrent cervical pain and sensory disturbances. Follow-up MRI revealed a localized recurrent intradural extramedullary lesion at the previous surgical site. Systemic staging showed no evidence of metastatic disease. Repeat microsurgical gross total resection was performed. Histopathological examination of the recurrent lesion demonstrated increased mitotic activity (>5 mitoses per 10 high-power fields), tumor necrosis, and an elevated Ki-67 proliferative index (10–12%), consistent with progression to CNS WHO grade 3 solitary fibrous tumor. Postoperative MRI confirmed complete tumor removal. Following multidisciplinary evaluation, close radiological surveillance was recommended. Conclusion: This case highlights the potential for delayed recurrence and histological progression of spinal solitary fibrous tumors despite apparently curative gross total resection and prolonged disease-free survival. Long-term, potentially lifelong radiological follow-up should be considered even for initially low-grade lesions. Recurrent or higher-grade tumors may require multidisciplinary evaluation regarding adjuvant treatment strategies and systemic surveillance.

Background: Three-dimensional (3D)-printed vertebral body replacement (VBR) and artificial vertebral body (AVB) implants are increasingly used for anterior column reconstruction after spinal tumor resection. However, the available evidence on complications remains limited, heterogeneous, and methodologically inconsistent. This systematic review aimed to synthesize reported complications, revision patterns, and mechanical outcomes of 3D-printed VBR/AVB implants in spinal oncology and to critically appraise the quality of the available clinical literature. Methods: This systematic review was conducted in accordance with PRISMA 2020. PubMed/MEDLINE, Embase, and the Cochrane Library were searched from 1 January 1980 to 26 February 2026. Eligible studies included clinical series and cohort studies reporting extractable complication and/or revision data in patients who underwent spinal tumor resection followed by reconstruction with a 3D-printed VBR/AVB implant. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Case Series. Due to substantial clinical and methodological heterogeneity, a structured narrative synthesis was performed. Results: Eleven studies comprising 217 analyzable 3D-printed reconstructions were included. Most were retrospective single-center series and showed marked heterogeneity in tumor histology, spinal level, implant strategy, follow-up duration, and complication definitions. Because adverse-event reporting was inconsistent across studies, no pooled overall complication rate was calculated. Reported perioperative non-mechanical complications included neurological deterioration, cerebrospinal fluid- or dural-related events, wound infection, pleural effusion, pneumonia, and vascular injury. Mechanical implant failure appeared relatively uncommon, although radiographic subsidence was variably defined and inconsistently reported. Implant mismatch and hardware-related problems were infrequent but clinically relevant, particularly with prefabricated or off-the-shelf devices. Revision procedures were most commonly associated with wound complications, clinically significant subsidence, hardware failure, or tumor recurrence. Overall study quality was limited by retrospective designs, small sample sizes, and non-standardized outcome reporting. Conclusions: Current evidence suggests that 3D-printed VBR/AVB implants are a feasible option with encouraging mechanical performance for spinal reconstruction after tumor resection. Most reported adverse events appear to reflect the complexity of oncologic spine surgery rather than device-specific failure alone. However, the available evidence remains low level and heterogeneous. Larger multicenter comparative studies with standardized outcome definitions and longer follow-up are needed to better define the clinical value and durability of 3D-printed vertebral reconstruction in spinal oncology.

Background: Primary central nervous system tumours in pregnancy are exceptionally rare, with posterior fossa lesions presenting particular diagnostic and management challenges due to their confined anatomical location and proximity to critical neurovascular structures. Pilocytic astrocytoma (PA), typically a paediatric tumour, is uncommon in adults and exceedingly rare in pregnant patients. The physiological changes in pregnancy can obscure tumour-related symptoms, contributing to diagnostic delay and increased maternal–fetal risk. Methods: We report the case of a 24-year-old pregnant woman at 23 weeks and 5 days’ gestation who presented with progressive neurological deterioration secondary to a cystic mass in the right cerebellar hemisphere. MRI revealed significant brainstem compression and triventricular hydrocephalus. Results: A multidisciplinary team performed an urgent retrosigmoid craniotomy with gross total tumour resection under general anaesthesia and continuous intraoperative fetal monitoring. Histopathology confirmed PA (CNS WHO Grade I). Postoperative recovery was uneventful, and both maternal and fetal outcomes were favourable. Conclusions: This case highlights the importance of early neuroimaging, multidisciplinary coordination, and timely surgical intervention in managing posterior fossa tumours during pregnancy. Although PAs are considered low-grade gliomas, their behaviour in pregnancy can be unpredictable. With careful perioperative planning, neurosurgical treatment can be safely undertaken during gestation, offering optimal outcomes for both mother and fetus.

Post-traumatic neuromas are a common complication of peripheral nerve injuries, often resulting in chronic pain, as well as sensory and motor dysfunction. The ulnar and median nerves are most frequently affected. The high incidence of neuroma formation and its significant impact on patients’ quality of life highlight the importance of effective surgical management. Intraoperative ultrasound is increasingly being utilized in neuroma surgery, offering real-time visualization of nerve pathology, although its routine use remains limited. This paper presents a clinical case of a 27-year-old patient with a recurrent post-traumatic neuroma of the left median nerve. The patient had undergone multiple previous surgeries, including primary neurorrhaphy and revision neurolysis. Due to persistent neuropathic symptoms, a revision surgery was performed with the use of intraoperative ultrasound, which enabled accurate identification of the neuroma, evaluation of lesion extent, and precise delineation of resection margins. Early postoperative outcomes demonstrated reduced pain, decreased swelling, stabilization of neurological function, and no recurrence on follow-up ultrasound. This case illustrates the potential of intraoperative ultrasound as a safe and effective tool that can improve surgical precision and reduce the risk of neuroma recurrence.

Post-traumatic neuromas are a common complication of peripheral nerve injuries, often resulting in chronic pain, as well as sensory and motor dysfunction. The ulnar and median nerves are most frequently affected. The high incidence of neuroma formation and its significant impact on patients’ quality of life highlight the importance of effective surgical management. Intraoperative ultrasound is increasingly being utilized in neuroma surgery, offering real-time visualization of nerve pathology, although its routine use remains limited. This paper presents a clinical case of a 27-year-old patient with a recurrent post-traumatic neuroma of the left median nerve. The patient had undergone multiple previous surgeries, including primary neurorrhaphy and revision neurolysis. Due to persistent neuropathic symptoms, a revision surgery was performed with the use of intraoperative ultrasound, which enabled accurate identification of the neuroma, evaluation of lesion extent, and precise delineation of resection margins. Early postoperative outcomes demonstrated reduced pain, decreased swelling, stabilization of neurological function, and no recurrence on follow-up ultrasound. This case illustrates the potential of intraoperative ultrasound as a safe and effective tool that can improve surgical precision and reduce the risk of neuroma recurrence.

Background: Central nervous system (CNS) tumors during pregnancy are rare but present significant diagnostic, therapeutic, and ethical challenges. These include both primary and metastatic lesions, which share overlapping clinical features and management complexities. Their clinical course is influenced by gestational physiological changes, which can mask symptoms and delay diagnosis, thereby increasing maternal and fetal risks. Objective: This review aims to synthesize current evidence on the epidemiology, pathophysiology, clinical presentation, diagnostic strategies, treatment options, prognosis, and ethical considerations related to CNS tumors in pregnant patients. Methods: A comprehensive literature review was conducted, including retrospective and prospective studies, clinical guidelines, and systematic reviews focusing on brain and spinal tumors diagnosed during pregnancy. Particular attention was given to the impact of gestational age, tumor histology, and maternal condition on treatment outcomes. Results: Hormone-sensitive tumors such as meningiomas and prolactinomas may exhibit accelerated growth during pregnancy due to elevated progesterone and prolactin levels. Diagnosis is often delayed due to symptom overlap with normal gestational changes. MRI without contrast remains the imaging modality of choice. Glucocorticoids and selected chemotherapy agents can be cautiously used depending on gestational age. Surgical resection, particularly in the second trimester, has been shown to be safe and effective in appropriate clinical scenarios. Multidisciplinary coordination is essential. Prognosis varies based on tumor type and timing of intervention, with maternal survival prioritized in high-risk situations. Ethical management hinges on patient autonomy, informed consent, and proportionality of medical interventions. Conclusions: CNS tumors during pregnancy require early recognition, individualized treatment planning, and ethical vigilance. Multidisciplinary collaboration is vital to optimizing outcomes for both mother and fetus. Future efforts should focus on developing standardized protocols and expanding evidence through multicenter studies.

This prospective study evaluated the efficacy of 3D-printed personalized vertebral implants in restoring spinal stability following total en bloc spondylectomy (TES) for benign spinal tumors. Given the lack of specialized implants for post-resection reconstruction, this approach integrates customized 3D-printed implants to enhance the anatomical precision, biomechanical stability, and clinical outcomes. Four patients underwent TES using custom-designed 3D-printed vertebral implants. Key surgical parameters including operative time, intraoperative blood loss, pain reduction (VAS), and functional recovery (ODI) were assessed. Biomechanical testing was conducted to evaluate implant durability under high loads. Functional and neurological outcomes were monitored over a two-year follow-up period using clinical assessments and CT imaging. Personalized 3D-printed implants demonstrated high mechanical stability with no structural deformation under load-bearing conditions. Postoperative VAS and ODI scores significantly improved, indicating substantial pain reduction and enhanced functional recovery. Neurological evaluations revealed that 75% of patients regained full motor and sensory functions. CT imaging confirmed stable implant positioning, with no signs of subsidence, fixation failure, or implant-related complications. This study highlights the clinical feasibility and potential advantages of 3D-printed personalized vertebral implants for spinal reconstruction, including optimized surgical planning, reduced operative time, and minimal blood loss. Despite promising short-term outcomes, further large-scale, multicenter trials are required to establish long-term clinical efficacy and broader applicability in diverse patient populations.