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Large thoracolumbar intradural cystic lesions are rare. The possible diagnosis would be a cystic nerve sheath tumour, dural ectasia or arachnoid cyst. We report the first case of a neglected giant thoracolumbar spinal cystic tumour that had resulted in progressive deleterious spinal column deformity due to bony erosion precluding any form of surgical remedy. In the same case, another fatal sequela of a neglected spinal cystic tumour is a spontaneous rupture resulting in an acute hydrocephalus and mortality. This case impresses the natural history of a spinal cystic lesion. The take home point would be these cases need early surgical intervention is indicated to prevent sequelae that has been described.

Objective The coronavirus disease 2019 pandemic poses major risks to health care workers in neurocritical care. Recommendations are in place to limit medical personnel attending to the neurosurgical patient as a protective measure and to conserve personal protective equipment. However, the complexity of the neurosurgical patient proves to be a challenge and an opportunity for innovation. The goal of our study was to determine if telemedicine delivered through smart glasses was feasible and effective in an alternative method of conducting ward round on neurocritical care patients during the pandemic. Methods A random pair of neurosurgery resident and specialist conducted consecutive virtual and physical ward rounds on neurocritical patients. A virtual ward round was first conducted remotely by a specialist who received real-time audiovisual information from a resident wearing smart glasses integrated with telemedicine. Subsequently, a physical ward round was performed together by the resident and specialist on the same patient. The management plans of both ward rounds were compared, and the intrarater reliability was measured. On study completion a qualitative survey was performed. Results Ten paired ward rounds were performed on 103 neurocritical care patients with excellent overall intrarater reliability. Nine out of 10 showed good to excellent internal consistency, and 1 showed acceptable internal consistency. Qualitative analysis indicated wide user acceptance and high satisfaction rate with the alternative method. Conclusions Virtual ward rounds using telemedicine via smart glasses on neurosurgical patients in critical care were feasible, effective, and widely accepted as an alternative to physical ward rounds during the coronavirus disease 2019 pandemic.

Rationale and Objectives Gliomatous tumors are known to affect neural fiber integrity, either by displacement or destruction. The aim of this study is to investigate the integrity and distribution of the white matter tracts within and around the glioma regions using probabilistic fiber tracking. Material and Methods Forty-two glioma patients were subjected to MRI using a standard tumor protocol with diffusion tensor imaging (DTI). The tumor and peritumor regions were delineated using snake model with reference to structural and diffusion MRI. A preprocessing pipeline of the structural MRI image, DTI data, and tumor regions was implemented. Tractography was performed to delineate the white matter (WM) tracts in the selected tumor regions via probabilistic fiber tracking. DTI indices were investigated through comparative mapping of WM tracts and tumor regions in low-grade gliomas (LGG) and high-grade gliomas (HGG). Results Significant differences were seen in the planar tensor (Cp) in peritumor regions; mean diffusivity, axial diffusivity and pure isotropic diffusion in solid-enhancing tumor regions; and fractional anisotropy, axial diffusivity, pure anisotropic diffusion (q), total magnitude of diffusion tensor (L), relative anisotropy, Cp and spherical tensor (Cs) in solid nonenhancing tumor regions for affected WM tracts. In most cases of HGG, the WM tracts were not completely destroyed, but found intact inside the tumor. Discussion Probabilistic fiber tracking revealed the existence and distribution of WM tracts inside tumor core for both LGG and HGG groups. There were more DTI indices in the solid nonenhancing tumor region, which showed significant differences between LGG and HGG.

3D printing is generating interest in many fields, for example, design, engineering, and medicine. The surgical fields in medicine have taken the lead in progress, especially in orthopedics, maxillofacial reconstruction, and neurosurgery (Eltorai et al. 2015; Yang et al. 2015; Mavili et al. 2007; Muller et al. 2003; McGurk et al. 1997). In particular, 3D printing has contributed greatly to the development of personalized medicine. 3D printing has emerged to play a unique role in the fabrication of personalized implants as well as in surgical planning and simulation, assisting in the consent process, and providing an educational tool for medical students and residents (Mavili et al. 2007; Muller et al. 2003; McGurk et al. 1997; Liew et al. 2015; Jones et al. 2016; Naftulin et al. 2015; Rengier et al. 2010; Webb 2000). This is based on the fact that reasonably complex 3D-printed models can be created in a short period of time with a good cost efficiency.

Cladophialophora bantiana is a dematiaceous fungus with a predilection for causing central nervous system (CNS) infection manifesting as brain abscess in both immunocompetent and immunocompromised patients. In this paper, we report comprehensive genomic analyses of C. bantiana isolated from the brain abscess of an immunocompetent man, the first reported case in Malaysia and Southeast Asia. The identity of the fungus was determined using combined morphological analysis and multilocus phylogeny. The draft genome sequence of a neurotrophic fungus, C. bantiana UM 956 was generated using Illumina sequencing technology to dissect its genetic fundamental and basic biology. The assembled 37.1 Mb genome encodes 12,155 putative coding genes, of which, 1.01% are predicted transposable elements. Its genomic features support its saprophytic lifestyle, renowned for its versatility in decomposing hemicellulose and pectin components. The C. bantiana UM 956 was also found to carry some important putative genes that engaged in pathogenicity, iron uptake and homeostasis as well as adaptation to various stresses to enable the organism to survive in hostile microenvironment. This wealth of resource will further catalyse more downstream functional studies to provide better understanding on how this fungus can be a successful and persistent pathogen in human.