BACKGROUND: Delayed pharyngoesophageal perforation (DPEP) after anterior cervical discectomy and fusion (ACDF) is rare but morbid, typically resulting from hardware erosion or migration. When extensive prior constructs limit complete removal, reconstruction that restores anterior column integrity while minimizing recurrent esophageal irritation is needed. OBSERVATIONS: A 24-year-old man with a prior C5–6 corpectomy and C4–7 anterior fusion plus C2–T1 posterior fusion presented 68 months post-ACDF with progressive neck swelling and odynophagia. Imaging and endoscopy confirmed a 4-cm full-thickness perforation with hardware exposed. Furthermore, the anterior plate and failed corpectomy cage were removed, and a fibular strut allograft was fashioned. Two short anterior cervical plates were sutured to the graft’s ends and then attached to C4 and C7 vertebral bodies to reconstitute anterior column stability. The esophageal defect was primarily closed with a pectoralis major muscle flap. At the 6-month follow-up, he reported no dysphagia; upright radiographs and CT scans demonstrated intact alignment and construct stability without complications. LESSONS: In DPEP associated with ACDF, fibular strut allograft and short anterior cervical plates can be used to restore anterior column stability and allow reliable esophageal healing. To the authors’ knowledge, this is the first detailed description of this salvage strategy in the setting of post-ACDF DPEP. https://thejns.org/doi/10.3171/CASE25856

Background: Temporalis muscle thickness (TMT) measured on routine neuroimaging has emerged as a radiological marker of sarcopenia, but its prognostic value in acute ischemic stroke is not well defined. This systematic review examined whether TMT is associated with functional status, swallowing outcomes, and mortality after acute ischemic stroke. Methods: A PRISMA-guided systematic review identified observational studies (2000–2025) reporting TMT and at least one clinical outcome in adults with acute ischemic stroke. PubMed, MEDLINE, Embase, Web of Science, and Scopus were searched. Two reviewers independently screened records and extracted data. Risk of bias was assessed using ROBINS-I and the Newcastle–Ottawa Scale, with justification relative to prognostic-factor tools. Due to heterogeneity in TMT definitions and outcome measures, findings were synthesized narratively. Results: Four cohorts, including 1361 patients, met the inclusion criteria. Mean age was 69.7 years, and 53.9% were male. Study-level mean TMT ranged from 5.2 to 6.35 mm; among the 704 patients in cohorts that reported TMT-defined sarcopenia status, prevalence was 51.8% (365/704). Across studies, lower TMT or TMT-defined sarcopenia was associated with poorer functional outcomes and higher mortality, independent of age and stroke severity. In one thrombectomy cohort, each 1-mm increase in TMT increased the odds of functional independence (adjusted OR 1.14, 95% CI 1.03–1.27). In contrast, each 1-mm increase reduced 90-day mortality (adjusted OR 0.71, 95% CI 0.54–0.93). Lower TMT also predicted prolonged nasogastric tube dependence. Conclusions: TMT is a simple CT- or MRI-based measure that is consistently associated with disability, dysphagia, and survival after acute ischemic stroke. Current evidence is observational and supports further prospective validation and measurement standardization rather than immediate routine decision-making use.

Chordomas are rare, locally aggressive spinal tumors. En bloc resection may improve local control but can cause substantial morbidity. Thermal ablation may provide a less invasive adjunct or alternative in selected cases. We systematically reviewed reports of radiofrequency ablation (RFA), cryoablation, laser interstitial thermal therapy, high-intensity focused ultrasound, and similar thermal techniques for spinal or sacral chordoma to characterize their clinical applications and reported clinical and radiographic outcomes across pre-resection, primary non-operative, and palliative settings. Eligible studies reported at least one ablation-related clinical or radiographic outcome. Data were descriptively synthesized, and risk of bias was assessed using the Joanna Briggs Institute criteria. Thirteen studies including 33 patients and 34 ablated sites were identified. Cryoablation was used in 21 patients, RFA in 11 patients, and laser interstitial thermal therapy in one patient. Ablation was used as a pre-resection adjunct, primary treatment for unresectable disease, or palliation for recurrent or metastatic lesions. Most reports described pain improvement, short-term local stability, and few major complications. We also report an L4 chordoma treated with CT-guided RFA and vertebroplasty before staged en bloc spondylectomy, without a new neurologic deficit or local recurrence at 18 months. Thermal ablation may be a technically feasible adjunct, primary non-operative option, or palliative strategy for carefully selected spinal and sacral chordomas. In the presented mobile-spine case, planned pre-spondylectomy RFA was feasible before staged en bloc resection; however, limited follow-up and sparse heterogeneous literature preclude conclusions regarding long-term local control, recurrence reduction, survival, or routine use. Ablation should not replace oncologically appropriate en bloc resection when that procedure can be safely achieved and should be considered selectively within multidisciplinary chordoma care.