Learning about Neurosurgery and Neurology

03/01/2026

https://www.youtube.com/watch?v=hK7IWJ5fvlk
Check this webinar from the
AANS/CNS Section on Tumors - Intraoperative Fluorescence-Guided Surgery and Photodynamic Therapy

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03/01/2026

https://www.youtube.com/watch?v=f7XX5_LaE2E&list=PLB0383CAB43A0FC66&index=6

Retrosigmoid Craniectomy

The Columbia University Medical Center Department of Neurological Surgery faculty will lead you through a retrosigmoid craniectomy. Presented by Ricardo Komo...

02/01/2026

🧠 Suspected Leptomeningeal Disease – Case #4: Breast Cancer & Brain Involvement

A 36-year-old woman with known triple-negative breast cancer (diagnosed 2023, currently on pembrolizumab) was transferred for evaluation of new neurologic symptoms.

🧾 Clinical Summary:
• GCS 15; 4-week history of persistent headaches, neurologically intact, no seizures or visual deficits, no facial paresis
• Stable extracranial disease

🧠 MRI (T1 post-contrast): Dural-based, homogeneously enhancing lesion with diffuse leptomeningeal enhancement and mass effect in the left frontal region.

❓ What’s your diagnosis?

1️⃣ Would you recommend biopsy or proceed with treatment based on imaging?
2️⃣ How would you manage symptoms?
3️⃣ What systemic options would you explore?

📸 MRI image provided — see frontal leptomeningeal spread with surrounding edema.

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✅ Suggested Answers/Management Plan

Diagnosis:
→ Imaging strongly suggests leptomeningeal metastasis from triple-negative breast cancer.
→ Biopsy may not be necessary in this case due to clear radiological features.

Treatment:
→ Whole-brain radiotherapy (WBRT) as primary local treatment
→ Dexamethasone for symptom relief (headache, edema)
→ Systemic therapy discussion with oncology: continue pembrolizumab vs. switch to alternative based on systemic status

💬 Would you biopsy in this case? What's your approach to leptomeningeal disease in TNBC?

02/01/2026

https://www.youtube.com/watch?v=t7YNOrz3nos&list=PLB0383CAB43A0FC66

Infratentorial Supracerebellar Approach by Ricardo Komotar

The Columbia University Medical Center Department of Neurological Surgery faculty will lead you through the infratentorial supracerebellar approach. Presente...

02/01/2026

AANS/CNS Section on Tumors - Spine Oncology: Developing a Spine Oncology Program Pearls/Pitfalls

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01/01/2026

https://www.youtube.com/watch?v=gyr6MwfGODE

Intersting webinar on immunotherapy on glioblastoma from the AANS

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01/01/2026

🧠 Epidural Hematoma – Case #3: Trauma & Decision-Making

A male patient in his early 30s was brought in after a road traffic accident. Details of the mechanism remain unclear — it's suspected he jumped out of a moving vehicle. Intoxicated (alc

🧾 On arrival in the trauma bay: GCS: 12 (E(3) V(4) M(5)), no anisocoria, heavily intoxicated and severely agitated, on ECG bradycardia (HR down to 30 bpm), initial cCT: Large epidural hematoma (EDH); No other major traumatic findings in the CT scan and on examination. Protective intubation was performed after initial imaging

🧠 Emergency craniotomy with hematoma evacuation was promptly performed.
Post-op: Stable course so far, sedation ongoing, follow-up cCT scheduled 6h post-op.

❓ What would you do?

1️⃣ Would you place an ICP probe in this scenario?
2️⃣ What are your key clinical priorities post-op?
3️⃣ If deterioration occurs: re-image first or go directly to OR?

Share your thoughts below 👇
📸 CT images (pre-/post-op) attached.

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✅ Case Update: What we did

ICP probe?
→ No — opted for early follow-up imaging and sedation reduction for neuro evaluation.

Clinical focus post-op:
→ Neurological monitoring during wake-up
→ Early detection of rebleeding or new mass effect

Deterioration protocol:
→ Step 1: Immediate cCT
→ Step 2: Tailored intervention based on findings (e.g., re-evacuation)

💬 How would you have handled this case? Would you trust the neuro exam alone or prefer direct ICP data?

31/12/2025

🧠 Odontoid Fracture – Case #2: Quiz Edition

A 60-year-old patient was admitted after a fall while intoxicated. Imaging revealed a dislocated dens fracture (C2) with a right-sided pedicle fracture.
Neurologically intact. Cervical spine is immobilized with a Miami J collar.

📚 Odontoid fractures (OFs) are common in the elderly due to low-energy trauma and are often type II (Anderson & D’Alonzo). These fractures can be stable or unstable depending on displacement, angulation, and ligamentous integrity.

❓ Test your knowledge!

1️⃣ What is the most common type of odontoid fracture?
A. Type I (tip of dens)
B. Type II (base of dens)
C. Type III (body of C2)
👉 Answer below before scrolling!

2️⃣ Which of the following is considered a relative indication for surgery in a Type II odontoid fracture?
A. Age < 30
B. Neurological deficits
C. Fracture at the tip of the dens

3️⃣ True or False: Posterior C1–C2 fixation offers higher union rates than anterior odontoid screw fixation in elderly patients.

✅ Answers & Explanation:

1️⃣ B. Type II — It accounts for 60–80% of all odontoid fractures, especially in older adults.
2️⃣ B. Neurological deficits — These, along with displacement, instability, or poor bone quality, often push treatment toward surgical fixation.
3️⃣ True — Posterior fusion techniques (e.g. Goel–Harms) have shown better union and fewer reoperations, especially in patients >60.

👩‍⚕️ Stay tuned for more interactive neurotrauma content and real-world cases.
💬 Would you manage this patient operatively or conservatively? Let's discuss below.

30/12/2025

🧠 Clinical Case #1 | Intraventricular Tumor with Seizure Presentation

We recently admitted a 50-year-old woman who presented with a generalized tonic-clonic seizure. Postictally, she developed a transient right-sided Todd’s paresis and sensomotor aphasia, which have mostly resolved. On admission, she was fully oriented with no focal neurological deficits except for mild word-finding difficulties.

Her history includes breast cancer in 2020, treated with surgery, radiochemotherapy, and ongoing tamoxifen.

Imaging revealed a large intraventricular lesion in the left lateral ventricle, accompanied by perifocal edema. She was started on levetiracetam externally and dexamethasone was initiated in our department.

MRI with contrast is underway. Surgical resection is scheduled for Monday. The patient expressed a strong wish to return home for the New Year holiday after pre-op workup is completed.

Would you consider temporary discharge in such a case? What additional diagnostic information you would like to obtain?

27/12/2025

🧠 New Results: Glasdegib + Chemoradiotherapy in Newly Diagnosed Glioblastoma
🧪 Phase Ib/II GEINO 1602 trial published in Nature Communications
📅 Published: Dec 2025 | DOI: 10.1038/s41467-025-66747-z

The hedgehog signaling pathway may contribute to treatment resistance in glioblastoma (GBM). The GEINO 1602 study explored adding Glasdegib, a hedgehog pathway inhibitor, to standard therapy (Stupp regimen).

👥 79 patients received:
• Glasdegib + radiotherapy + concomitant and adjuvant temozolomide,
• Followed by Glasdegib monotherapy.

📊 Key Results:
▪️ 15-month overall survival (OS): 52.1% (did not surpass 60% futility threshold)
▪️ 2-year OS: 29.2%
▪️ Median progression-free survival (PFS): 7.1 months
▪️ Glasdegib was well tolerated at 75 mg/day

🔬 Takeaway:
Though the primary endpoint was not met, long-term survival in ~30% of patients warrants further investigation. Ongoing translational research will explore biomarkers of benefit.

📌 Funded by GEINO & Pfizer (IIR), this trial highlights the need to refine patient selection for hedgehog-targeted therapies in GB.

26/12/2025

New Study: Navtemadlin in Recurrent Glioblastoma – Insights from a Window-of-Opportunity Trial
📚 Science Translational Medicine, Feb 2025 | DOI: 10.1126/scitranslmed.adn6274

Researchers tested the MDM2 inhibitor Navtemadlin (KRT-232) in 21 patients with TP53-wildtype recurrent glioblastoma.
Patients received 2 doses before surgery and continued treatment post-op.

🔍 Key findings:
▪️ Navtemadlin showed pharmacodynamic activity (p53 pathway activation),
▪️ but progression-free survival (PFS) was only 3.1 months,
▪️ and overall survival (OS) did not significantly improve.

🔬 Mechanistic insights:
▪️ Tumors showed resistance without TP53 mutation.
▪️ Oligodendroglial features (e.g., OLIG2+ enrichment) emerged at relapse.
▪️ Combining Navtemadlin + Temozolomide increased tumor cell death in neurosphere models without harming normal bone marrow.

📌 Conclusion:
Targeting MDM2 alone may not be enough – combination strategies (e.g., with Temozolomide) could unlock better outcomes in future trials.

17/12/2025

🧠 New Study: Navtemadlin in Recurrent Glioblastoma – Insights from a Window-of-Opportunity Trial
📚 Science Translational Medicine, Feb 2025 | DOI: 10.1126/scitranslmed.adn6274

Researchers tested the MDM2 inhibitor Navtemadlin (KRT-232) in 21 patients with TP53-wildtype recurrent glioblastoma.
Patients received 2 doses before surgery and continued treatment post-op.

🔍 Key findings:
▪️ Navtemadlin showed pharmacodynamic activity (p53 pathway activation),
▪️ but progression-free survival (PFS) was only 3.1 months,
▪️ and overall survival (OS) did not significantly improve.

🔬 Mechanistic insights:
▪️ Tumors showed resistance without TP53 mutation.
▪️ Oligodendroglial features (e.g., OLIG2+ enrichment) emerged at relapse.
▪️ Combining Navtemadlin + Temozolomide increased tumor cell death in neurosphere models without harming normal bone marrow.

📌 Conclusion:
Targeting MDM2 alone may not be enough – combination strategies (e.g., with Temozolomide) could unlock better outcomes in future trials.