Learning about Neurosurgery and Neurology

12/04/2026

🧠 Spinal Metastasis – Case #7: Rapid neurological decline at T6/7 despite ongoing oncologic treatment

72-year-old woman with newly diagnosed metastatic NSCLC, known thoracic spinal involvement at T6/7, presented via the ED with rapidly progressive left leg weakness. PET-CT in 01/2026 had already shown metastatic disease at this level. She had meanwhile received palliative radiotherapy to T6/7 and was on systemic oncologic treatment. According to the treating pulmonology team, expected survival was still meaningful. Relevant history: Clopidogrel.

A few days before admission, she had fallen. Since then, progressive paresis of the left leg, markedly worsening over 48 hours. On admission: severe monoparesis left leg, proximally 1–2/5, distally around 2/5, sensory level from about Th7, urinary catheter in place. Before this, she had still been mobile with a walker.

What I found notable: almost no relevant back pain. Main complaint was rib pain.

MRI showed a tumor-associated, high-grade, left-dominant epidural spinal cord compression at T6/7 with severe canal compromise.

This is exactly the kind of case where the discussion should not revolve primarily around mechanical scores. The dominant issue here was not instability, but metastatic epidural spinal cord compression with progressive neurological deficit.

Questions:
At this stage, would you still continue non-operative treatment because radiotherapy had already been initiated?

How do you weigh ongoing neurological deterioration against systemic disease burden and expected prognosis?

Would you proceed directly to decompression, or first escalate steroids and reassess?

-
-
-
-
-
-
-
-
-
-
-

What we did:
Because of the rapid neurological decline, the marked cord compression, and the still relevant oncologic perspective, we proceeded with urgent surgical decompression.

Postoperatively, the patient came to ICU intubated, was extubated during the night, and already showed a clear motor improvement, with strength improving to about 3+/4-/5.

My takeaway:
In metastatic spine disease, absence of pain can be misleading. The key decision point is not always spinal instability. Sometimes the central problem is epidural tumor causing cord compromise, and then timing of decompression becomes the decisive factor for function.

29/03/2026

🧠 Severe TBI – Case #9: Delayed Epidural Hematoma after Initially Negative CT

An unknown male patient was brought to the trauma bay after being found in a pool of blood in a public setting. Preclinically, he had massive vomiting, raising immediate concern for aspiration and airway compromise.

On arrival, the patient was severely injured with signs of major head trauma:

reduced consciousness
need for protective intubation
large occipital scalp laceration
blood from the right ear, suspicious for skull base injury
pupils slightly irregular bilaterally

He underwent initial polytrauma CT imaging.

📸 Image sequence shown here:

Left: initial cCT during trauma work-up
Right: follow-up cCT after ICP probe insertion and rising intracranial pressure

The first scan did not yet show a major surgically relevant intracranial hematoma, but given the severity of the traumatic brain injury and the clinical picture, an ICP probe was inserted for invasive monitoring.

Over the following course, ICP values increased significantly. Because of this deterioration, repeat cranial CT was performed.

The second cCT then revealed a new left occipital epidural hematoma, which had not been present in this extent on the initial scan.

❓ What would you do next?

1️⃣ How do you explain a delayed epidural hematoma after an initially non-surgical first CT?

2️⃣ In a case like this, how low is your threshold for repeat imaging after invasive neuromonitoring and/or rising ICP?

3️⃣ Once the follow-up scan shows a newly developed occipital EDH with ICP elevation:
→ immediate surgery, or would you attempt further conservative neurocritical care first?

---
--
-
-
-
-
-
-
✅ What happened next

Given the combination of:

severe TBI
rising ICP
new epidural hematoma on follow-up imaging

the patient underwent urgent surgical evacuation.

This case is a good reminder that in severe neurotrauma, the first CT is only the beginning of the story. Dynamic lesions evolve, and delayed epidural hematomas can become life-threatening within hours.

19/03/2026

🧠 Great resource for students interested in neuroscience & research

If you're a medical student or early-career researcher looking to get involved in neuroscience, this platform is definitely worth checking out:

👉 https://www.connectome-students.com/researchhub

The Connectome Research Hub connects students with ongoing research projects and opportunities in neuroscience – a great way to gain experience, build your CV, and get involved early in academic work.

💡 Especially relevant if you're interested in:

Neurosurgery

Neurooncology

Neurology

Translational research

Early exposure to research is key – not only for academic careers, but also for developing critical thinking and understanding evidence-based medicine.

💬 Have you already participated in student research projects?
Drop your experience below!

The Research Hub is our online platform which seeks to widen access and promote student participation by minimizing the current barriers through serving as a centralized database of research projects currently looking for studential support. Project leaders can send a short description of their proj...

23/02/2026

https://www.annalsofoncology.org/article/S0923-7534(25)04931-2/fulltext

Interesting multinational study on LMD

Leptomeningeal metastatic disease (LMD) represents a devastating complication of non-small-cell lung cancer (NSCLC) with a poor prognosis. Our understanding of LMD is limited in the era of molecular testing and emerging therapeutic options for lung cancer.

21/02/2026

https://pubmed.ncbi.nlm.nih.gov/38871881/



Abstract
The leptomeninges, the cerebrospinal-fluid-filled tissues surrounding the central nervous system, play host to various pathologies including infection, neuroinflammation and malignancy. Spread of systemic cancer into this space, termed leptomeningeal metastasis, occurs in 5–10% of patients with solid tumours and portends a bleak clinical prognosis. Previous, predominantly descriptive, clinical studies have provided few insights. Recent development of preclinical leptomeningeal metastasis models, alongside genomic, transcriptomic and proteomic sequencing efforts, has provided groundwork for mechanistic understanding and identification of long-needed therapeutic targets. Although previously understood as an anatomically isolated compartment, the leptomeninges are increasingly appreciated as a major conduit of communication between the systemic circulation and the central nervous system. Despite the unique nature of the leptomeningeal microenvironment, the general principles of metastasis hold true: cells metastasizing to the leptomeninges must gain access to the new environment, survive within the space and evade the immune system. The study of leptomeningeal metastasis has the potential to uncover novel site-specific metastatic principles and illuminate the physiology of the leptomeningeal space. In this Review, we provide a biology-focused overview of how metastatic cells reach the leptomeninges, thrive in this nutritionally sparse environment and evade the detection of the omnipresent immune system.

The leptomeninges, the cerebrospinal-fluid-filled tissues surrounding the central nervous system, play host to various pathologies including infection, neuroinflammation and malignancy. Spread of systemic cancer into this space, termed leptomeningeal metastasis, occurs in 5-10% of patients with soli...

20/02/2026

https://www.youtube.com/watch?v=VphTSgkNpg0

AANS/CNS Tumor Section Webinar: Innovations in Glioma Therapy

Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube.

05/02/2026

https://pubmed.ncbi.nlm.nih.gov/41355353/

Brain metastases (BrMs) may present with intralesional or intracranial hemorrhage (ICH), yet risk factors and outcomes remain unclear. This monocentric cohort study at Germany's largest neurosurgical clinic included 973 adults undergoing BrM resection (2010-2024), with histopathologically confirmed....

05/02/2026

31/01/2026

🧠 Hydrocephalus in leptomeningeal disease – Case #8: serial LPs → VP shunt

Middle-aged patient with advanced metastatic carcinoma and known CNS involvement, now presenting with a classic hydrocephalus symptom triad in evolution: headache + nausea + recurrent vomiting. No focal deficit, fully awake.

🧾 Key facts

MRI (baseline): new ependymal / intraventricular lesion along the lateral ventricle → concern for impaired CSF dynamics

CSF: malignant cells → leptomeningeal disease confirmed

CT (follow-up): ventriculomegaly consistent with hydrocephalus

Clinically: pressure symptoms progressing despite supportive measures

🖼️ Serial imaging (right → middle → left)

Right: initial MRI

Middle: interval CT with hydrocephalus

Left: postop CT control with ventricular catheter in typical position after diversion

🧠 What we did (and why)
We used lumbar drainage pragmatically as a test and as a bridge:

Two therapeutic LPs

After the first, the patient had credible, but short-lived improvement

Symptoms recurred quickly, and ventricles remained enlarged on repeat CT

Larger-volume drainage again gave only temporary relief

At that point the trajectory was clear: this wasn’t going to be managed with repeated punctures. We moved to definitive CSF diversion.

✅ Plan / Outcome

VP shunt placed (postop control shown)

Parallel discussion with oncology: whether there’s a real, actionable plan for intrathecal therapy (and therefore whether an Ommaya makes sense upfront) vs keeping it simple with shunt alone.

❓ Questions for the group

Do you use serial LP response as a “shunt test” in suspected LMD-hydrocephalus, or do you go straight to diversion once CT confirms ventriculomegaly + symptoms?

In your practice, when do you add an Ommaya upfront (vs later, if intrathecal treatment becomes realistic)?

Any pearls on managing shunts in LMD patients (valve choice, overdrainage avoidance, infection risk mitigation)?

31/01/2026

https://www.usz.ch/veranstaltung/european-central-nervous-system-metastasis-conference-12-02-13-02-26/

We invite abstract submissions for the European CNS metastasis Conference taking place in Zurich on February 12-13, 2026.

31/01/2026

https://www.youtube.com/watch?v=cv21rU2g5vI

The panelist and authors discuss the recently published Journal of Neuro-Oncology article: Laser interstitial thermal therapy (LITT) vs. bevacizumab for radi...

30/01/2026

https://www.youtube.com/watch?v=4vUMRRbqfnw

Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube.