Percutaneous vertebroplasty (PVP) has emerged as a key intervention for painful vertebral compression fractures in osteoporotic and metastatic disease, but its safety profile warrants comprehensive evaluation. We conducted a PRISMA-compliant systematic review of studies published between 2009 and 2024, identifying 15 clinical studies (n ≈ 8500 patients) that reported PVP-related complications in adults with osteoporotic or neoplastic fractures. Data extraction focused on complication incidence, presentation, imaging findings, risk factors, and management strategies. Cement leakage was the most frequently detected event (20–70% of levels, higher in neo-plastic lesions), yet symptomatic neural or vascular sequelae occurred in <1%. Pulmonary cement embolism appeared on imaging in 2–26% of cases but was clinically evident in ≤0.5%, with conservative management or brief anticoagulation sufficing for most patients. New vertebral fractures developed in 8–20% of osteoporotic and up to 30% of metastatic cohorts, paralleling underlying bone fragility rather than PVP itself. Postprocedural infection (0.2–0.5%) and neurologic injury (<0.5%) were uncommon but required prompt surgical and antibiotic interventions. Overall, PVP’s benefits—rapid pain relief and mechanical stabilization—outweigh its risks when performed with meticulous technique, vigilant imaging, and multidisciplinary follow-up, confirming its favorable safety profile in both osteoporosis and spinal malignancy.

Objective: Intramedullary melanocytomas are extremely rare spinal cord tumors with distinct histopathological and imaging characteristics. This report reviews the literature on this pathology and presents a representative case study, highlighting aspects of diagnosis and management. Methods: A scoping review of PubMed, Web of Science, and Embase databases was conducted to identify reports on intramedullary melanocytomas, focusing on clinical presentation, imaging features, histopathology, treatment, and outcomes. Case reports and case series were included due to the rarity of these tumors. Results: Twelve manuscripts met the inclusion criteria, including 15 patients. In the majority of patients, intramedullary melanocytomas present with progressive myelopathy and pain. Most common MRI findings include hyperintensity on T1-weighted images, iso- to hypointensity on T2-weighted images, and homogeneous contrast enhancement. Intralesional cysts and associated syrinx are common. Gross total resection (GTR) remains the primary treatment, but complete removal is often challenging due to tumor adherence to neural structures. Conclusions: Intramedullary melanocytomas require careful diagnosis and management due to their diagnostic overlap with malignant melanoma and potential for recurrence. While GTR is the mainstay of treatment, long-term surveillance is warranted due to high recurrence rates. Further research is needed to define the natural history of the disease and establish optimal therapeutic strategies.

To comprehensively review the diagnostic features, clinical management, and surgical outcomes of spinal idiopathic hypertrophic pachymeningitis (sIHP) through a systematic analysis of existing literature. A systematic review was conducted using PubMed, EMBASE, Web of Science, and Cochrane databases from inception to October 31, 2024. Studies reporting on adult patients with sIHP, including clinical, treatment, outcome, and follow-up data, were included. Data extraction covered patient demographics, clinical presentation, diagnostic workup, management strategies, and outcomes. The review included 29 studies, comprising 8 case series and 21 case reports, with a total of 43 patients. The median age at diagnosis was 54 years, with a slight female predominance (53.5%). Common presenting symptoms included lower extremity weakness (51.2%), sensory complaints (48.8%), and back pain (46.5%). Magnetic resonance imaging was the primary diagnostic tool (86% of cases). Histopathological findings typically showed inflammatory infiltrate (74.4%) and fibrosis (59%). Steroid therapy was the primary medical management, with surgical decompression often necessary. The recurrence rate was 27.6%, with a median time to recurrence of 5 months. sIHP presents unique diagnostic and management challenges compared to its cranial counterpart. While sharing similarities in demographic patterns and diagnostic approaches, sIHP often requires more aggressive initial management due to the risk of irreversible neurological damage from spinal cord compression. The findings underscore the need to consider sIHP in the differential for patients with progressive myelopathic symptoms without signs of neoplasm.

Pediatric pain is a public healthcare problem present in 78 % of hospitalized patients and it is frequently associated to needles. Fast and effective controls are needed, therefore, sensory stimulation and psychological strategies have been developed. The aim of this study was to describe the use of non-pharmacological strategies as adjuvants in needle associated children pain management. A review was made searching through original articles and other reviews. Pain mechanism involves C fibers and Aδ fibers, which respond to short term needle pain. Buzzy® device is among the physical strategies to relieve pain, which acts according to the pain threshold theory, diverting attention from pain to a pleasurable sensory stimulus (cold and vibration) decreasing its intensity when compared to topical anesthesia (p < 0,001). Meanwhile psychological strategies such as virtual reality divert the child’s attention to a pleasant visual and auditory stimulus. It creates a tridimensional environment with an electronic device, decreasing pain while distracting the child when compared to the control group (p < 0,05). The use of non-pharmacological strategies as adjuvants for needle pain management is effective decreasing children pain and reducing stress and anxiety in parents and healthcare workers.

Objective: The aim of this study was to systematically review the existing individual patient data in the literature on adult cerebellopontine angle (CPA) medulloblastoma (MB) and characterize the patient presentation, management strategies used, and oncological outcomes of this rare entity to guide future clinical practice. Methods: Following PRISMA guidelines, a systematic review was conducted by searching PubMed, EMBASE, Web of Science, and Cochrane databases from inception to 19 June 2024. Studies regarding adult patients with histologically confirmed MB radiographically confirmed to be located in the CPA were included. Clinical data were synthesized, and predictors of outcomes were evaluated. Results: Twenty-seven studies with 42 adult CPAMB patients were included. The median age was 32 years (range: 19–56). Headaches (81%), cranial neuropathy (90%), cerebellar dysfunction (79%), and nausea/vomiting (50%) were typical presenting features. The predominant histological subtype was the classic variant. Maximal safe surgical resection was performed, most commonly using a retrosigmoid approach, and 60% of cases received a gross total resection. Most patients received adjuvant treatment (93%), typically chemoradiotherapy. The recurrence rate was 11% after a median of 18 months of follow-up. Relatively high survival rates of 96%, 85%, and 85% were observed at 1, 3, and 5 years, respectively. Patients who received adjuvant therapy had significantly better recurrence and greater overall survival outcomes. Conclusions: These results support the consideration of MB in young adult patients presenting with CPA tumors with radiographical features suggestive of hypercellularity and the utilization of a management strategy of maximal safe resection plus post-operative craniospinal irradiation along with chemotherapy to optimally treat these rare patients.

Background: Spinal arteriovenous fistulas (SAVFs) are direct communication between arteries and veins without intervening abnormal vessel nidus, which often results in venous congestion and spinal cord dysfunction. Ventrally located SAVF can be challenging to treat through traditional open or endovascular approaches. Case Description: We describe a hybrid (open/endovascular) procedure in a 72-year-old male with a Takai Type IVb SAVF presenting with paraparesis and sphincter dysfunction. Imaging revealed a conus medullaris SAVF in which the main fistulous connection was located ventrally. The conventional endovascular approach was deemed risky, and open surgery failed in the first attempt. The SAVF was resolved using a hybrid approach: under direct visualization, an engorged dorsal vein was punctured with an Angiocath, and a fluoroscopy-guided microcatheter was advanced through it to reach and embolize the ventral perimedullary fistulous connection. After surgery, his progressive neurological decline stabilized, radiographic spinal cord edema improved, and follow-up angiography confirmed obliteration of the fistula. Neurological function remained at the preoperative baseline. Conclusion: This approach may be a treatment for selected cases of type IVb SAVF. Easily accessible feeding vessels are coagulated and cut; the inaccessible ones can be embolized endovascularly during the same procedure.