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ABSTRACT Papillary glioneuronal tumors are rare neoplasm, accounting only <0.02% of all intracranial tumors. They are generally low grade usually occur in the temporal lobe near the third ventricle. We report an extremely rare case of intraventricular tumor with a high proliferation index. CD 117 expression found in our case is the first study to the best of our knowledge to be described in these tumors. The clinical and diagnostic significance of this finding is subject to further studies.

Abstract Background: Major vessel injury is among the most dreaded complications of any neurosurgical procedure. Once intraoperatively tamponaded, it can present in the form of pseudoaneurysm, dissecting aneurysm or complete occlusion of vessel. These injuries are often associated with very high morbidity and mortality. The literature available on this topic is limited and our understanding remains limited. Objective: In this article, we present our surgical experience with iatrogenic aneurysms and present a review of literature. Methods and Material: We conducted a retrospective analysis of all patients with major vessel injury during surgery from a prospectively maintained database from January 2012 to February 2020. Results: A total of 15 patients developed iatrogenic aneurysms following a major vessel injury during various neurosurgical procedures. The most common vessel injured was vertebral artery (n = 9) in craniovertebral junction (CVJ) anomalies and ossification of posterior longitudinal ligament (OPLL) followed by internal carotid artery injury (n = 5) in sellar and parasellar pathologies. One patient developed basilar artery injury during endoscopic third ventriculostomy (ETV). Eight patients had pseudoaneurysm and seven had dissecting aneurysm with or without complete thrombosis of the involved artery. A total of two patients died after vascular injury and remaining thirteen patients survived and discharged. Conclusions: The adage \"prevention is better than cure\" applies most aptly in such cases. Any major vessel injury should be followed by immediate angiography and subsequent early management. The endovascular management is more favorable as these aneurysms are difficult to clip due to the absence of a neck and fragile wall.

Papillary glioneuronal tumors are rare neoplasm, accounting only <0.02 of all intracranial tumors. They are generally low grade usually occur in the temporal lobe near the third ventricle. We report an extremely rare case of intraventricular tumor with a high proliferation index. CD 117 expression found in our case is the first study to the best of our knowledge to be described in these tumors. The clinical and diagnostic significance of this finding is subject to further studies.

Background and Introduction: A dermoid is an inclusion cyst. Its presence in the posterior third ventricle is highly infrequent. It usually compresses rather than infiltrates the posterior third ventricle's anatomical structures due to a well-defined capsule. Hence, the surgical anatomy in these tumors is less distorted. The approach to the posterior third ventricular tumors depends upon their relation to the galenic venous complex. Objective: This video abstract presents a case of the posterior third ventricular dermoid operated by gravity-assisted retraction less occipito transtentorial combined with the trans-splenial approach. Surgical Technique: A 36-year-old gentleman presented with a headache without any neurological deficits; the magnetic resonance imaging (MRI) revealed a well-defined heterogeneous lesion in the posterior third ventricular region. It was mainly toward the right side, just beneath the splenium, pushing the galenic venous system downward. This made the occipital transtentorial approach favorable as it required the least vessel handling. A right parieto-occipital craniotomy was performed. The patient was placed in a lateral semi-prone position with the head slightly rotated toward the right side with a slight neck extension. This allowed the right occipital lobe to fall away from the Falco-tentorial junction. With sharp dissection, an inter-Rosenthal corridor was made. But as the tumor was higher up in the posterior third ventricle, it was modified to another trans-splenial corridor. Near-total excision was achieved with a thin capsule left attached to the vein of Galen. The capsule was thick, filled with a cheesy white material, and a calcified sebaceous lump within. The postoperative scan showed no residual tumor. Results: The patient had improvement in the headache. There were no field cuts. The histopathology was suggestive of a dermoid cyst. Conclusions: Dermoid cysts of the posterior third ventricular region are rare, and judicious surgical decisions result in better outcomes.

Background and Introduction: Spinal dural arteriovenous fistula (SDAVF) is a rare but curable condition. Microsurgery is a highly effective and readily affordable treatment modality. Objective: We present a surgical video of SDAVF to demonstrate the operative nuances involved. Surgical Technique: A 53-year-old wheelchair-bound man with spastic paraparesis for 1.5 years was found to have a SDAVF at L1/2 level with a single fistula point. During surgery, a L1-L2 laminectomy and durotomy revealed a dilated vein accompanying the nerve root exiting L1/2 foramen that showed early filling on indocyanine green (ICG) video angiography. This vein was occluded, and a segment of this vein was removed during surgery, which led to resumption of normal spinal cord perfusion. Results: The patient showed gradual recovery of lower limb motor power and improved to assisted ambulation after 3 months. Conclusions: Surgery is a simple, effective, and cost-effective treatment option in SDAVF.

Background: Meningioma constitutes only 0.4%-4.1% of all the pediatric tumors. This article aims to find the impact of the pediatric meningioma surgery on the developmental and scholastic performance among these children over long-term follow-up. Materials and Methods: This study is a retrospective analysis of all the histopathological proven pediatric meningioma and a cross-sectional analysis to study the functional outcome, using Malin's Intelligence Scale for Indian children (MISIC); scholastic performance was assessed from behavioral checklist for screening the learning disabled (BCSLD) and subjective self-filled questionnaire to know parent satisfaction. Results: Twenty-eight patients (mean age 14.52 ± 0.722 years) (M:F = 16:12) were analyzed (6 [21.4%] were grade-schooler and 22 [78.5%] were teenage), with most common symptom being headache (n = 20, 71.4%) and mean duration of symptoms was 11.19 ± 16.25 days. The mean intelligent quotient (IQ) of grade-schooler was 83.4 ± 9.072 compared to 75.69 ± 9.903 among teenage group. The BCSLD analyses showed that the postoperative score was poorer. Similarly, an average change in BCSLD was observed among the patients with complications (10) compared to the patients without complication (8). Conclusion: The discontinuation in schooling or lack of alternative education may lead to poor MISIC scores, wrongly categorizing the children in poor IQ group. In pediatric benign disease such as meningioma, the holistic approach should be opted from the time of first visit to neurological care team.