Summary: Congenital dermal sinus tracts (DST) of the lumbosacral region are uncommon forms of occult spinal dysraphism. Failure of complete disjunction between the cutaneous and neural ectoderm leads to an epithelial-lined fistulous tract extending from the dorsal skin into the spinal canal. When infected, these tracts can introduce virulent pathogens directly into the subarachnoid space and intramedullary conus medullaris, precipitating conus epidermoid abscesses, chemical or bacterial meningitis, and irreversible paraparesis. This clinical study presents diagnostic protocols, operative microsurgical techniques, and neurological outcomes in pediatric patients managed successfully.

Summary: Clear cell meningioma (CCM) is an aggressive, histological variant categorized as WHO Grade II meningioma. While intracranial clear cell meningiomas are known for higher local recurrence rates, purely extradural nondural-based lumbosacral clear cell meningiomas are exceptionally rare and frequently misdiagnosed preoperatively as benign spinal nerve sheath tumors (schwannomas or neurofibromas). This article details the clinical presentation, radiological characteristics, total surgical excision, and histopathological diagnosis of a giant lumbosacral clear cell meningioma.

Summary: Diffuse neurofibromas of the scalp are uncommon benign tumors of peripheral nerve sheath origin that predominantly affect children and young adults. In rare instances, diffuse scalp neurofibromas can cause osteolytic erosion of the underlying cranial vault, creating significant calvarial bone defects. This paper illustrates total single-stage surgical resection, vascular control, and primary titanium mesh cranioplasty in a young woman without clinical neurofibromatosis Type 1 (NF-1).

Summary: Preoperative identification of occult axillary lymph node metastasis in clinically node-negative (cN0) breast cancer patients is essential for accurate surgical staging and treatment planning. This prospective study assesses the diagnostic sensitivity, specificity, and positive predictive value of high-frequency ultrasound and ultrasound-guided Fine Needle Aspiration Cytology (USG-FNAC) compared with definitive histopathological staging.

Summary: Spinal schwannomas are predominantly benign, slow-growing tumors that rarely undergo sudden massive intratumoral hemorrhage. When acute bleeding occurs within a long-segment cervical schwannoma, rapid expansile cord compression can result in sudden, life-threatening quadriparesis and respiratory compromise. This paper reviews the pathophysiology, emergency diagnostic imaging, and urgent microsurgical decompression of a multilevel cervical intradural schwannoma with massive hemorrhagic degeneration.

Summary: The nationwide lockdown enforced during the COVID-19 pandemic caused unprecedented shifts in population mobility, vehicular traffic, and industrial activity. This institutional neurosurgical study analyzes the volume, etiology, injury severity (Glasgow Coma Scale), emergency operative intervention rates, and mortality among traumatic brain injury (TBI) patients admitted to a tertiary referral trauma center during the lockdown compared with pre-lockdown baseline data.

Summary: Primary intraorbital meningiomas that arise entirely within the retrobulbar intraconal space without attachment to the optic nerve sheath or sphenoid bone margin are exceptionally rare ectopic lesions. Because of their non-specific clinical presentation with unilateral progressive proptosis and visual decline, they are frequently misdiagnosed as cavernous hemangiomas or optic nerve gliomas. This study presents the surgical orbitotomy approach and complete vision preservation in an ectopic intraconal meningioma.

Summary: Spinal angiolipomas are uncommon, benign, slow-growing tumors composed of mature adipose tissue intermixed with an extensive network of anomalous, proliferating blood vessels. They comprise approximately 0.14% to 1.2% of all spinal tumors and most commonly manifest in the posterior epidural space of the mid-thoracic or dorsolumbar spine. This article details clinical diagnosis, characteristic MRI findings, posterior decompression, and total tumor excision resulting in complete neurological recovery.

Summary: Split cord malformations (SCM) or diastematomyelia typically consist of a bifurcation of the spinal cord into two separate hemicords (diplomyelia) separated by an osseous or fibrous midline spur. This landmark report documents an unprecedented, novel congenital variant: triplomyelia, characterized by the division of the spinal cord into three discrete functional hemicords within the thecal sac. We describe the embryological hypothesis, radiological identification, and surgical untethering technique.

Summary: Deep-seated intracranial lesions involving the thalamus, basal ganglia, corpus callosum, and brainstem present formidable challenges for open surgical resection due to high morbidity risks. Frameless neuronavigation-guided stereotactic biopsy has emerged as a cornerstone for acquiring definitive tissue diagnosis with minimal surgical trauma. This prospective clinical trial analyzes the diagnostic yield, trajectory planning, safety profile, and complication rates of frameless neuronavigation biopsy in 45 consecutive patients with deep brain lesions.

Summary: Craniofacial fibrous dysplasia involving the orbital roof, sphenoid wing, and zygomatico-frontal suture frequently results in severe facial disfigurement, non-axial proptosis, and risk of compressive optic neuropathy. Reconstructing the complex 3D orbital architecture following radical neurosurgical decompression has traditionally been unpredictable. This interdisciplinary study presents a combined transcranial skull base approach using custom CAD/CAM 3D patient-specific titanium implants (PSI) for anatomical reconstruction.

Summary: Vestibular schwannomas (acoustic neuromas) are typically indolent cerebellopontine angle (CPA) neoplasms presenting with gradual unilateral sensorineural hearing loss, tinnitus, and subtle balance imbalance. Acute intratumoral hemorrhage causing neurological collapse, acute hydrocephalus, and brainstem compression is an exceedingly rare and catastrophic event. This critical review examines the clinical spectrum, vascular mechanisms, and urgent surgical strategies for giant hemorrhagic vestibular schwannomas.

Summary: Lumbar intervertebral disc herniation is the leading cause of sciatica and lower-back disability worldwide. While single-level microdiscectomy is an established standard, comparative functional outcomes, biomechanical stability, and recovery trajectories in patients undergoing simultaneous double-level discectomies remain actively debated. This prospective clinical trial evaluates 80 consecutive patients undergoing single vs. double-level fenestration microdiscectomy, analyzing Visual Analog Scale (VAS) pain score reductions, Oswestry Disability Index (ODI) scores, and return-to-work metrics.

Summary: Aneurysmal bone cysts (ABCs) are rare, benign, expansile osteolytic lesions containing blood-filled spaces separated by fibrous septa. Although non-malignant, they behave aggressively in the spine by destroying posterior vertebral elements and pedicles, leading to pathological collapse, spinal deformity, and severe spinal cord compression. This article discusses surgical posterior decompression, gross tumor curettage, pedicle screw fixation, and autologous bone grafting in dorsal spine ABC.

Summary: Thoracolumbar junction (T11-L2) burst fractures represent the most frequent vertebral injuries in spinal neurotrauma. Debate continues regarding the optimal posterior surgical fixation strategy: short-segment pedicle screw fixation (incorporating the fractured vertebra) versus conventional long-segment pedicle screw fixation (two levels above and below). This prospective comparative study analyzes 60 consecutive patients with unstable thoracolumbar burst fractures to evaluate correction of traumatic kyphosis, operative duration, blood loss, and long-term functional recovery.

Summary: Complex neural tube defects and congenital craniofacial anomalies require structured clinical guidelines to standardize timing of operative intervention, diagnostic neuroimaging protocols, intraoperative neurophysiological monitoring, and multidisciplinary rehabilitation. This synthesis provides evidence-based clinical guidelines formulated from extensive tertiary clinical experience in managing occult spinal dysraphism, lipomyelomeningocele, and complex craniofacial synostosis.