Background: In the present study, we aim to develop simulation models based on computed tomography angiography images of intracranial aneurysms (IAs) and their parent vessels using three-dimensional (3D) printing technology. The study focuses on the value of these 3D models in presurgical planning and intraoperative navigation and ultimately their impact on patient outcomes. To the best of our knowledge, this is the first report of its kind from a war-torn country, like Iraq. Methods: This is a prospective study of a series of 11, consecutively enrolled, patients suffering from IAs for the period between February and September 2019. The study represents a collaboration between the two major neurosurgical centers in Baghdad/Iraq; Neurosciences Teaching Hospital and Neurosurgery Teaching Hospital. We analyzed the data of eleven patients with IAs treated by microsurgical clipping. These data include patient demographics, clinical, surgical, and outcomes along with the data of the 3D-printed replica used in these surgeries. All cases were operated on by one surgeon. Results: Our study included 11 patients, with a total of 11 aneurysms clipped. The mean age was 44 ± 8, with a median of 42.5 and a range of 35–61 years. About 60% of our patients were female with a female-to-male ratio of 1:5. About 60% of the aneurysms were located at the anterior communicating artery (Acom) while the remaining 40% were equally distributed between the posterior communicating and internal carotid arteries bifurcation. The standard pterional approach was followed in 50% of cases, whereas the other 50% of patients were treated through the lateral supraorbital approach. About 90% (n = 9) of the patients had a Glasgow Outcome Scale (GOS) of 5 and 10% had a GOS of 4. The 3D-printed models successfully replicated the aneurysm size, location, and relation to the parent vessel with 100% accuracy and were used for intraoperative guidance. The average production time was 24–48 h and the production cost was 10–20 US dollars. Conclusion: 3D printing is a promising technology that is rapidly penetrating the field of neurosurgery. In particular, the use of 3D-printed patient-matched, anatomically accurate replicas of the cerebral vascular tree is valuable adjunct to the microsurgical clipping of IAs, and our study conclusions support this concept. However, both the feasibility and clinical utility of 3D printing remain the subject of much, ongoing investigations.

Background: Occipitocervical fusion (OCF) has been performed for over 70 years to address craniocervical instability caused by trauma, tumors, or congenital anomalies. Despite technological advances, challenges persist due to the unique anatomy, high mobility, and complex pathological processes at the occipitocervical junction. This study aimed to evaluate clinical, radiographic, and surgical outcomes of OCF in patients with craniocervical instability. Methods: A 2-year cohort study was conducted at Dr. Saad Alwitry’s Neurosciences Hospital (April 2021– March 2023) involving 45 patients aged 17–53 (mean age 35.6). Inclusion criteria required radiologically confirmed instability, psychological fitness, and a normal coagulation profile. Patients with advanced rheumatoid arthritis or prior posterior fossa surgery were excluded. OCF procedures were performed using modern rigid instrumentation, including plates and rods, and outcomes were monitored using radiographic fusion assessments and clinical evaluations. Results: All patients achieved solid fusion (100%) within a mean of 7.06 months (range 5–9 months). Myelopathy and neurological deficits were present in all patients preoperatively, while neck pain affected 73.3%. Postoperatively, 73.3% of patients showed improvement in myelopathic symptoms, and all patients reported resolution of neck pain. Complications included one transient neurological deterioration, one wound infection, and one cerebrospinal fluid leak, all managed successfully. No operative mortalities or vascular injuries occurred. Conclusion: Rigid occipitocervical fixation stabilizes the craniocervical junction, achieving high fusion rates and symptom resolution with minimal complications. Thorough preoperative planning, precise surgical technique, and an understanding of craniocervical anatomy are crucial for optimal outcomes.

Background: Intracranial epidermoid cysts are infrequent, benign, and slow-growing lesions derived from ectodermal vestiges. Although extremely uncommon, these lesions represent a great challenge from a diagnostic and surgical point of view because they are located close to major neurovascular structures with great potential for complications. Our work aims to analyze demographic, clinical, radiological, and surgical features in patients with intracranial epidermoid cysts and to assess post-surgical outcomes to define better management strategies. Methods: We conducted a retrospective cohort study of patients diagnosed with histologically confirmed intracranial epidermoid cysts and treated surgically at Dr. Said Al-Witry’s Neuroscience Hospital from January 2020 to September 2024. Demographic data, clinical presentations, imaging findings, surgical approaches, and postoperative complications were analyzed using descriptive statistics and Chi-square tests. Statistical significance was set at P < 0.05. Results: Out of 40 patients, 75% were male, with headaches being the most common symptom (50%). Magnetic resonance imaging (MRI) findings demonstrated T1 hypo-intensity in 95% and T2 hyper-intensity in all cases. The retrosigmoid approach was the most frequently employed surgical method (60%), followed by frontotemporal (30%) and midline suboccipital (10%) approaches. Postoperative complications occurred in 35% of cases, including facial nerve palsy (15%), aseptic meningitis (10%), cerebrospinal fluid leaks (5%), and hydrocephalus (5%). Chi-square analysis showed significant associations between surgical approaches and postoperative complications (P = 0.048). Conclusion: Intracranial epidermoid cysts show a high incidence in males and present mostly with nonspecific symptoms such as headaches and seizures. MRI remains the key investigation modality. The retrosigmoid approach shows less complication rate when compared to other techniques. Even though surgery has evolved, complications such as meningitis and nerve palsy persist, so much attention to detail is required in preoperative planning and follow-up in the long run for optimum outcomes for the patients.

Gamma Knife radiosurgery is the principal alternative to microsurgical resection for acoustic neuromas (vestibular schwannomas). However; its increasing use worldwide and evolution of Gamma Knife device precision and safety had led to its acceptance as primary management for small- and medium-sized vestibular schwannomas. We tried to evaluate the tumor volume changes that occur with these tumors following Gamma Knife radiosurgery. Eighteen patients with stereotactic radiosurgery with Gamma Knife through the year 2016 completed 1-year MRI follow-up at the 3rd, 6th, and 12th month after the Gamma Knife treatment. All the patients had unilateral vestibular schwannomas; the mean dose of radiation to the tumors was 12 Gy (range 10–14 Gy). Post treatment imaging was done with a high-resolution 3 T MRI scanner. Tumor sizes are calculated by using Onis software. Four patterns of volumetric changes were noticed. Most of the tumors increased in size on the third month follow-up MRI (89%); 15 (83%) tumors on the sixth month returned to their initial pre-Gamma Knife radiosurgery (PGKR) sizes. On the last (12th month) follow-up MRI with tumor sizes compared to initial PGKR sizes, 8 (44%) tumors showed no change, 6 (33%) tumors became smaller, and 4 (22%) tumors increase in size. Tumor control rate was 78% for the first year after Gamma Knife radiosurgery. The third month follow-up MR images are practically not informative and might lead to unnecessary intervention; sixth month follow-up MR images are a crucial point and they may predict tumor behavior. Age, gender, and Koos stage whether stage II or III are not affecting tumor control. Gamma Knife radiosurgery is an effective intervention for Koos II and Koos III vestibular schwannomas.

Background: The surgical suction, irrigator, and retractor are vital instruments in all operative neurosurgical interventions. Several trials previously tried to combine these instruments to reduce the number of working hands in the surgical field and make them more controllable by the surgeon. An instrument combined the suction and irrigation used, and others added suction with the dissector, which was also invented but with many drawbacks. Methods: We designed a new surgical instrument that performs the function of three surgical instruments simultaneously. It works as a dissector, suction, and irrigator in the surgical field. Its innovative design unites three instruments, and every one of them has its holding method by the surgeon’s hand. They united into one maneuver. The surgeon’s work becomes easier by decreasing the number of hands in the surgical field; this will result in a reduction in time and better efficiency. Furthermore, its innovative design reduces the possibility of blockage of the suction tube, and the feasibility of reopening is much easier as compared with the available suction. Results: We use the 3D-printed design of the instrument by neurosurgeons. It was quite comfortable with better control by the surgeon and reduced the number of hands in the field, resulting in an increment of the operative field visible to the surgeon. Conclusion: This new instrument acts as three conventional instruments simultaneously to provide better control to the surgeon and increase the operative field visible to the surgeon.

Background: Primary dystonia is a disabling movement disorder often refractory to medical therapies. While bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) is established for motor symptom control, broader functional outcomes are less well characterized. To evaluate motor and real-world functional improvements following bilateral GPi DBS in patients with primary dystonia. Methods: A prospective observational study was conducted on 20 patients (mean age 34.7 years) with medically refractory primary dystonia. All underwent stereotactically guided bilateral GPi DBS. Functional outcomes assessed included skeletal deformity, facial twitching severity, wheelchair dependence, self-feeding ability, and bladder control. Evaluations were conducted at baseline and 6 months postoperatively. McNemar’s test and the Wilcoxon signed-rank test were used for statistical analysis. Results: Significant improvements were observed across all domains. Skeletal deformity rates decreased from 95% preoperatively to 10% postoperatively ( P < 0.001). Facial twitching improved significantly ( P = 0.005). Wheelchair dependence dropped from 50% to 5% ( P = 0.007). Self-feeding ability increased from 30% to 95% ( P < 0.001), and bladder control improved from 10% to 95% ( P < 0.001). No serious adverse events related to surgery or stimulation were reported. Conclusion: Bilateral GPi DBS in primary dystonia significantly improves motor symptoms and critical functional domains such as mobility, independence in self-care, and bladder control. These findings support the broader benefits of DBS, emphasizing its role in enhancing quality of life. Further studies with larger samples and longer follow-up are needed to confirm these outcomes.