Background: Cerebral sparganosis is a rare parasitic infection of the central nervous system caused by the plerocercoid larva of Spirometra species. A hallmark of the disease is the dynamic migratory behavior of the parasite within the brain, often resulting in progressive neurological symptoms and shifting radiologic features. While most cases are diagnosed within a few years of symptom onset, chronic cases spanning more than a decade are exceedingly rare. Understanding long-term imaging evolution, migratory patterns, and treatment strategies in these rare cases is crucial for optimal management. Case Description: We report a rare case of cerebral sparganosis with an exceptionally prolonged disease course of 19 years. The patient initially presented with seizures and underwent a stereotactic brain biopsy; however, a definitive diagnosis could not be established at that time. Serial magnetic resonance imaging revealed a unique and extensive intracerebral migratory pattern, including deep-seated and eloquent areas. Eventually, the parasite migrated to a surgically accessible cortical location, allowing for successful resection. Histopathology confirmed a degenerated Sparganum larva surrounded by chronic inflammation. A schematic diagram was created to illustrate the complex migratory pathway. A literature review of cases lasting ≥10 years was also conducted, highlighting the parasite’s exceptional longevity and treatment outcomes. Conclusion: This case highlights the remarkable ability of Sparganum larvae to survive within human brain tissue for nearly two decades, with evidence of active intracerebral migration. Surgical excision remains the most definitive and effective treatment approach. Due to the potential for delayed diagnosis and chronic progression, long-term imaging follow-up and continued clinical awareness are essential for early recognition and successful management, even in regions where sparganosis is not commonly encountered.

Background: Schizophrenia is a prevalent disease, affecting 1% of the global population. Its negative symptoms are a source of significant morbidity and socioeconomic disability and display high treatment refractoriness. Deep brain stimulation (DBS) is currently being investigated as a possible treatment for various treatment-resistant psychiatric disorders, including treatment-resistant schizophrenia (TRS). In this systematic review, we aim to assess whether DBS is efficacious in treating the negative symptoms of TRS. Methods: We developed a search string using DBS and TRS as two concepts to search for DBS studies in adult TRS patients on six databases: PubMed, Cochrane Library, Scopus, Web of Science, Cinahl Ultimate, and Embase. Duplicates were resolved. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to select relevant articles. Data regarding participant age, gender, stimulation site, pre- and lowest post-DBS positive and negative syndrome scale (PANSS) negative scores, and time taken to achieve that lowest score was extracted. Averages were found for all variables and a paired sample t-test was run to check whether the difference between pre- and lowest post-DBS PANSS negative score was statistically significant. Results: Nineteen patients with TRS from five studies were included in our analysis having an average age of 38.74 years and with 10 participants (52.6%) being female. The average pre-DBS negative score was 24.311 and the mean lowest post-DBS score was 16.95. The time taken post-DBS to achieve the best improvement ranged from 6 to 36 months, with a mean duration of 23.26 months. The difference between pre- and post-DBS scores was found to be statistically significant ( P < 0.001). Conclusion: Preliminary evidence suggests DBS might have efficacy in treating negative schizophrenia symptoms. Higher quality studies with larger sample sizes are needed to further back this claim. Researchers must look to maintain methodological consistency in their studies to allow easier comparability between them.

Background: The craniovertebral junction (CVJ) is surgically challenging due to its complex anatomy and proximity to vital neurovascular structures. This study aims to evaluate the use of 3D multiplanar reconstruction technique and its impact on surgical and radiological outcomes. Methods: Thirty patients with CVJ anomalies operated on between July 2022 and December 2024 were included. Of the thirty patients, 15 had basilar invagination, six had atlanto-axial dislocation, five had C2 fractures with instability, and four had Arnold–Chiari malformations with instability. Preoperative 3D-computed tomography (CT) and CT angiography reconstructions were performed to evaluate vertebral artery (VA) anatomy, C2 pedicle, C1 lateral mass, C1–C2 facet joint inclination, pseudo-joints, and craniocervical tilt. All patients underwent C1– C2 fixation or occipito-cervical fixation with joint manipulation using spacers. Pre and postoperative neurological recovery were assessed using Nurick and modified Japanese Orthopedic Association grading. Postoperative CT was done in all cases. Results: Twenty-six underwent C1–C2 fixation and four patients underwent occipito-cervical fixation. No VA injuries or screw-related complications occurred. One patient required revision due to implant failure. Neurological improvement occurred in 90% of cases. Radiological indices (Chamberlain line, McRae line, atlanto-dental interval, clivus canal angle) showed significant postoperative improvement. Conclusion: Preoperative 3D multiplanar CT reconstruction enables detailed analysis of CVJ anatomy and VA variations, improving safety and surgical outcomes in complex anomalies.

Background: Acute subdural hematoma (ASDH) of the interhemispheric fissure is frequently experienced but is rarely indicated for surgery. We report a case of ASDH of the interhemispheric fissure that was treated with an endoscopic procedure. Case Description: A 73-year-old woman had undergone craniotomy for subarachnoid hemorrhage (SAH) due to a ruptured anterior communicating artery aneurysm and ventriculoperitoneal shunt for hydrocephalus after SAH. On X day, she fell and bruised the back of her head, resulting in weakness of the left upper and lower limbs, and she was brought to the emergency department on X + 1 day. When she came to our hospital, she was found to have left hemiplegia with lower limb dominance. Head computed tomography (CT) scan showed a 2.5 cm thick ASDH on the right side of the posterior half of the interhemispheric fissures. It was thought that paralysis was caused by this lesion, and we decided to perform surgery based on the belief that symptoms would improve if the mass effect could be alleviated. As for the surgical technique, craniotomy and ventriculoperitoneal shunt had been performed in the past; endoscopic evacuation of hematoma was performed with a small craniotomy. The day after surgery, a head CT scan confirmed that the hematoma had been successfully removed to a deep level and the pre-operative left hemiplegia had improved. Two months after surgery, the patient was discharged from the hospital with a modified Rankin Scale 2. Conclusion: We have experienced a case of interhemispheric fissure ASDH that was treated by endoscopic hematoma evacuation. Endoscopic procedure is non-invasive, and good results were achieved.

Background: Giant skull base meningiomas are rare and surgically demanding due to proximity to critical neurovascular structures, prolonged operative time, and reduced resection rates. Reports encompassing multiple skull base regions remain limited. This case-based series includes anterior, middle, and posterior fossa tumors, emphasizing anatomical diversity and surgical strategies. Case Description: Eleven patients with giant skull base meningiomas were retrospectively reviewed, including tumors ≥5 cm and surgically complex lesions. The mean age was 47.7 years (range 32–62), with a female predominance (8 females, 3 males). Presenting symptoms included visual loss, headache, anosmia, hemiparesis, and cranial nerve deficits. Approaches were tailored to tumor location, most commonly pterional and retrosigmoid, followed by bifrontal and combined skull base craniotomies. Gross total resection was achieved in 8 of 11 patients (72.7%). Near-total or subtotal resection (3/11) was performed when tumors encased critical neurovascular structures. Visual outcomes were favorable, with recovery or preservation in most anterior and middle fossa cases. Transient cranial nerve palsies occurred in two patients and resolved on follow-up. No postoperative mortality occurred. During follow-up ranging from 4 months to 5 years, no recurrences were observed, and residual disease remained stable. Conclusion: This series illustrates the anatomical spectrum and surgical complexity of giant skull base meningiomas. Favorable outcomes were achieved with individualized approaches and multidisciplinary planning. These cases contribute practical insights to the limited literature and reinforce the need for tailored management strategies.

Background: Plexiform schwannomas are rare lesions with different histopathological variants (i.e., multifocal, intraneural, and multinodular). They comprise ~5% of schwannomas and rarely occur in the spinal canal. Here, a 40-year-old male presented with an exceedingly rare plexiform schwannoma. Case Description: A 40-year-old male presented with low back pain, bilateral L3 radiculopathy, and mild L3-level hypoesthesias. The pre-operative lumbar magnetic resonance imaging (MRI) showed an intradural extramedullary, multinodular L3 mass, isointense on T1-weighted imaging, homogeneously hyperintense on T2-weighted imaging, and markedly enhancing with contrast. Gross total microsurgical resection was achieved through an L3 laminectomy. The histopathology revealed a plexiform schwannoma (World Health Organization Grade 1). The post-operative MRI confirmed complete tumor removal, and six months later, the patient remained asymptomatic. Conclusion: Microsurgical gross total resection is the mainstay treatment for rare symptomatic lumbar plexiform schwannomas.

Background: Brainstem cavernous malformations (BSCMs) represent a surgical challenge due to their location deep within critical neural pathways. While histologically benign, BSCMs exhibit an aggressive clinical course, with a higher risk of bleeding and rebleeding than supratentorial cavernomas, often leading to significant neurological deficits. Management options include surveillance, radiosurgery, and microsurgical resection. Surgical treatment is especially complex, as it requires a delicate balance between the expected risk of rebleeding against the potential surgical morbidity. Favorable outcomes have been reported after microsurgical resection in multiple series. A precise understanding of brainstem safe-entry zones is essential to access these lesions and minimize parenchymal transgression. Case Description: We present the case of a young patient with bleeding from a pontine middle peduncular BSCM. Microsurgical resection was performed through a retrosigmoid transhorizontal fissure approach in a semi-sitting position, optimizing working angles while minimizing cerebellar retraction. This approach provides safe access through the middle cerebellar peduncle, allowing a more versatile dissection away from critical neural pathways compared to other safe-entry zones, minimizing brainstem manipulation. Key surgical nuances and relevant considerations in the decision-making process are demonstrated in this three-dimensional operative video. A complete resection was achieved, and the patient remained neurologically intact on long-term follow-up. The patient consented to the procedure and publication of this work. Conclusion: This case illustrates the surgical and anatomical complexity of pontine BSCMs and highlights the importance of tailoring the surgical approach to the lesion´s location, planned pial access, required exposure, dissection trajectory, and surgeon experience.

Background: Carotid cavernous fistula (CCF) is a rare vascular shunt between the carotid artery and the cavernous sinus, leading to venous hypertension and occasionally cortical venous reflux. It is primarily treated with endovascular therapy. However, transvenous or transarterial endovascular access may be difficult in some cases and may fail to obliterate the fistula. We describe the first case of utilizing the endoscopic transorbital approach (ETOA) to directly obliterating the CCF. Case Description: A 65-year-old man presented with the left eye blurring of vision for 2 months. He was diagnosed with the left Barrow type D indirect CCF with cortical venous reflux on digital subtraction angiogram. Primary transvenous embolization failed due to thrombosed venous access. Thus, we employed ETOA through a lid crease incision, lateral orbitotomy, and drilling of the sphenoid wing to access the cavernous sinus. Direct cannulation of the cavernous sinus was attempted. Ultimately, we injected hemostatic agents including Floseal to directly obliterate the CCF. Postoperative and follow-up digital subtraction angiogram showed complete obliteration. This is the first case of endoscopic-assisted transorbital approach to direct obliteration of a CCF. This approach allows for a smaller wound, less morbidity for complex cases with difficult venous access, with potential for complete obliteration. Conclusion: We illustrate the novel use of ETOA to direct obliteration of a complex CCF.

Background: Bobble-head doll syndrome (BHDS) is a rare movement disorder characterized by rhythmic head oscillations at a frequency of 2–3 Hz, typically in a yes–yes or no–no pattern. It is most commonly associated with suprasellar arachnoid cysts, causing pressure on midbrain structures, thalamus, and cerebrospinal fluid (CSF) pathways, resulting in movement abnormalities and hydrocephalus. While it usually presents in children aged 3–5 years, late adolescent or adult presentations are exceedingly uncommon. Case Description: We report a 23-year-old male with progressive involuntary side-to-side head movements since childhood, which had worsened over the preceding year and led to gait instability requiring support. He had a history of ventriculoperitoneal shunt placement in infancy for hydrocephalus, later removed due to infection. Magnetic resonance imaging revealed a large posterior fossa arachnoid cyst compressing the third ventricle, with intermittent CSF obstruction contributing to progressive neurological decline. The patient underwent endoscopic cyst fenestration, which restored CSF circulation and relieved mass effect. Head movements subsided almost completely within 48 h postoperatively, and gait improved significantly over 2 weeks. Six-month follow-up imaging confirmed resolution of ventricular compression and restoration of aqueductal flow. Conclusion: This case highlights a rare delayed presentation of BHDS in adulthood, underscoring the importance of timely surgical intervention. Endoscopic fenestration proved highly effective in restoring CSF dynamics, resolving abnormal movements, and improving functional outcomes, and may offer advantages over CSF diversion alone.