Background: Diabetic retinopathy (DR) is one of the leading causes of blindness among diabetic patients, particularly in areas with an increase in diabetes epidemics, such as Saudi Arabia. Notwithstanding the significant public health implications, data on the prevalence and risk factors of DR in Saudi Arabia are few and scattered, limited to certain geographic areas. Our study objective is to conduct a systematic review of the literature and a meta-analysis of the prevalence and predictors for DR in Saudi Arabia, within both type 1 and type 2 diabetes. Methods: A systematic review and meta-analysis were constructed according to PRISMA guidelines. We searched PubMed, Embase, Web of Science, and Google Scholar electronic databases for studies published from 2000–2023. Any study related to the prevalence of diabetic retinopathy in T1DM or T2DM among adult patients aged ≥18 years that was conducted in Saudi Arabia was included. Pooling prevalence estimates were calculated using a random-effects model, and heterogeneity across the studies was tested by the I² statistic and Cochran’s Q test. Results: A total of 11 studies published between 2006 and 2019 met the inclusion criteria, with sample sizes ranging from 99 to over 50,000 participants. The overall pooled prevalence of DR was estimated to be 31% (95% CI: 24–39%), with substantial heterogeneity observed across studies (I² = 99%). Prevalence estimates ranged from 16.7% to 69.8% and were influenced by variables such as study design, duration of diabetes, and glycemic control. Among individuals with type 2 diabetes, the pooled prevalence was 24% (95% CI: 20–28%). Poor glycemic control and longer diabetes duration were consistently identified as significant predictors of DR, while other factors, such as obesity and hypertension, were also associated with an increased risk of DR. Conclusions: The high prevalence of DR in Saudi Arabia highlights the critical need for focused public health initiatives, especially among those with type 2 diabetes. To minimize the effects of DR, early intervention, routine DR screening programs, and optimal diabetes control are essential. The increasing prevalence of DR in Saudi Arabia requires careful consideration of healthcare policy and resource allocation, which is made possible by our results.

Background: Brucellosis is an endemic zoonotic infection in Saudi Arabia, with thousands of cases reported annually. Although musculoskeletal involvement is common, spinal complications – particularly cervical spondylodiscitis with epidural abscess – are rare and often difficult to diagnose due to nonspecific symptoms. Delayed recognition may lead to neurological compromise requiring urgent intervention. Case Description: A 55-year-old farmer with regular exposure to cattle and a history of brucellosis presented with progressive right-sided weakness and neck pain. Magnetic resonance imaging revealed cervical stenosis with cord compression. Serology on admission showed Brucella immunoglobulin G positive, immunoglobulin M negative. The patient underwent anterior cervical decompression, biopsy, and fixation. Intraoperative cultures confirmed Brucella infection; however, species-level identification was not performed. Targeted antibiotic therapy with ceftriaxone 2g intravenous daily, doxycycline 100 mg orally twice daily, and rifampicin 600 mg orally daily was initiated. The patient showed gradual neurological recovery with complete resolution at follow-up. Conclusion: Spinal brucellosis, though rare, should be considered in endemic regions. Early diagnosis and combined surgical and medical management can prevent permanent neurological sequelae. The absence of Brucella species identification represents a limitation of this report.

BACKGROUND: Ewing sarcoma (ES) is a rare malignancy primarily affecting children and adolescents, with cranial involvement representing less than 1% of cases. The sphenoid bone is an exceptionally uncommon site, presenting diagnostic and therapeutic challenges due to its proximity to neurovascular structures. OBSERVATIONS: We present the case of a 19-year-old male diagnosed at the age of 13 with ES in the sphenoid bone, extending into the anterior cranial fossa and orbit. The patient initially received chemotherapy and radiotherapy, resulting in partial regression; however, the patient experienced disease progression and underwent resection. Postoperative recovery was complicated by osteomyelitis, which was resolved with antibiotics and wound debridement. One year postoperatively, the patient was neurologically intact with stable imaging findings. A systematic review of the literature was conducted to identify similar cases of sphenoid ES and highlight their outcomes. LESSONS: ES of the sphenoid bone is a rare pathology that demands a high index of suspicion and a multidisciplinary treatment approach. Despite anatomical challenges, outcomes can be optimized through an aggressive multimodal therapy approach. Continued research is needed to establish standardized treatment protocols and improve long-term survival. https://thejns.org/doi/10.3171/CASE25427

Giant colloid cysts are rare, benign lesions typically located in the third ventricle, accounting for approximately 2% of primary brain tumors and 15%-20% of intraventricular masses. Although small colloid cysts are relatively common, giant colloid cysts measuring over 3 cm are exceedingly rare and pose significant surgical challenges due to their size and critical anatomical location. This study retrospectively analyzes a series of 5 cases of giant colloid cysts from our local experience, in addition to a comprehensive literature review including 38 studies comprising 48 patients. Surgical approaches evaluated included transcallosal and transcortical craniotomy, endoscopic resection, and stereotactic aspiration. Complete cyst excision was achieved in 44 (83.0%) cases. Postoperative complications included seizures, hemiparesis, hydrocephalus, and cognitive dysfunction, though most patients demonstrated favorable recovery, particularly following complete excision. Our findings suggest that open craniotomy provides the highest rates of complete resection and remains preferable for very large, adherent, or anatomically complex giant colloid cysts, whereas endoscopic resection offers a minimally invasive alternative with acceptable outcomes in carefully selected cases with favorable ventricular anatomy. This study highlights the importance of timely diagnosis, individualized surgical approach selection, multidisciplinary care, and long-term follow-up to optimize patient outcomes and minimize complications.

Background: Pilocytic astrocytoma is a benign, slow-growing pediatric brain tumor, while Grisel’s syndrome refers to nontraumatic atlantoaxial subluxation classically associated with infection or head-and-neck surgery. Postoperative atlantoaxial rotatory subluxation following intracranial surgery is rare and poses significant diagnostic and management challenges. Case Description: We report a 7-year-old girl who presented with progressive headaches, imbalance, and signs of obstructive hydrocephalus. Imaging revealed a large cystic pilocytic astrocytoma involving the left frontotemporo-parietal region. The patient underwent left fronto-temporo-parietal craniotomy with excisional biopsy and placement of an Ommaya reservoir. Two weeks postoperatively, she developed painful neck spasm and mild torticollis. Cervical imaging confirmed C1–C2 rotatory subluxation (Fielding Type II), likely related to surgical positioning, with Grisel’s syndrome considered a possible inflammatory mechanism. Management included halo traction, closed reduction under general anesthesia, followed by halo vest immobilization and later application of a Miami-J cervical collar. The patient demonstrated good clinical and radiological recovery. Conclusion: This case highlights a rare postoperative complication of craniotomy with the development of atlantoaxial rotatory subluxation. Early recognition and multidisciplinary management are essential to prevent neurological sequelae. Surgical positioning may represent a contributing risk factor, and further research is required to establish preventive strategies.

Anterior lumbar interbody fusion (ALIF) is a widely utilized spinal procedure supported by an expanding body of literature. However, the structure, influence, and thematic evolution of the most impactful studies remain incompletely characterized. This study aimed to analyze the bibliometric profile of the 100 most-cited ALIF publications. A bibliometric analysis was performed using the Web of Science Core Collection. The 100 most-cited ALIF-related articles were identified from database inception through 2025. Extracted data included authorship, journals, institutions, countries, and citation metrics. Analyses used the Bibliometrix R package to evaluate productivity, collaboration, and keyword trends. Dataset included 463 authors across 28 journals, with a mean of 5.4 authors per article and international collaboration (9%). The literature demonstrated high impact, with a mean document age of 15.2 years and an average of 125.4 citations per article. Publication output was concentrated in Spine (19%) and The Spine Journal (17%), while the United States contributed the highest citation share. The most-cited studies reached 365 citations, whereas recent publications showed high citation velocity (up to 32.4 citations/year). Research focus evolved from fusion outcomes and biomechanics toward complications and minimally invasive approaches. Most studies were retrospective. Influential ALIF literature is highly concentrated and shaped by both historically cited studies and emerging high-impact work. The findings highlight a potential divergence between citation prominence and evidence hierarchy, emphasizing the need for critical appraisal and more robust prospective research. This analysis provides a structured framework to understand historical trends, current priorities, and future directions in ALIF research.