The occurrence of mesenchymal tumor, FET::CREB fusion-positive in the spinal compartment is exceptionally rare, with only a few previously documented cases. Here, we present a unique case of a 43-year-old man who developed a mesenchymal tumor, FET::CREB fusion-positive at the T1 spinal level. Clinically, the patient reported chronic posterior neck and shoulder pain accompanied by the intermittent paresthesia of the right arm. Magnetic resonance imaging demonstrated an intradural extramedullary mass, initially suggestive of a schwannoma. The patient underwent near-total surgical removal via a right C7-T1 hemilaminectomy. Histological examination revealed epithelioid and cord-like cellular arrangements within a mixed sclerotic and myxochondroid stroma. Immunohistochemistry revealed partial positivity for epithelial membrane antigen (EMA), smooth muscle actin (SMA), and CD99. Molecular analysis confirmed the presence of EWSR1::CREM fusion, establishing the diagnosis of a mesenchymal tumor, FET::CREB fusion-positive. To date, all reported spinal mesenchymal tumors within this molecular category have exclusively featured CREM as an FET gene family fusion partner, thereby highlighting a potential site-specific molecular signature. In this case report, we discuss the potential diagnostic challenges, characteristic pathological spectra, and clinical considerations associated with this rare entity of the spine.

Intramedullary ependymomas represent the most common histological subtype among intramedullary spinal cord tumors (IMSCTs). Early microsurgical resection remains the treatment of choice, as functional outcomes are strongly associated with preoperative neurological status and the presence of a favorable tumor-cord cleavage plane, often allowing gross total resection. Intramedullary tumor surgery is currently supported by several intraoperative adjuncts, including high-magnification microscopy, intraoperative ultrasound, and neurophysiological monitoring, all aimed at maximizing safe resection while preserving neurological function. Among emerging adjuncts, fluorescence-guided surgery using Sodium Fluorescein (SF) may provide additional intraoperative anatomical guidance during tumor resection. While SF has been extensively investigated in brain tumor surgery, its application in intramedullary spinal tumors remains limited. Fluorescence patterns generally correlate with areas of blood-spinal cord barrier disruption and contrast enhancement on preoperative MRI, potentially facilitating intraoperative visualization of the tumor-cord interface. Between December 2023 and October 2025, five consecutive patients with WHO grade 2 intramedullary spinal ependymomas underwent fluorescein-guided microsurgical resection. Fluorescence was detectable in all cases, gross total resection was achieved, and early neurological outcomes were favorable. This technical note describes the surgical workflow and technical nuances of Sodium Fluorescein-guided resection of intramedullary spinal ependymomas, illustrated by a representative case and operative video. Within a multimodal surgical strategy, SF may represent a useful adjunct to microsurgical dissection, although further experience and prospective studies are needed to better define its role in intramedullary tumor surgery.

Rhabdomyosarcoma with alveolar morphology is a diagnostically challenging tumor pattern, particularly in cases lacking canonical FOXO1-associated fusions. In the current WHO framework, molecular fusion status plays a central role in classification and risk stratification. However, a subset of tumors lacks canonical rearrangements and harbors alternative genetic events. We report a case of a 4-year-old girl with a massive parameningeal rhabdomyosarcoma presenting with cranial nerve dysfunction and airway compromise. Histological examination confirmed rhabdomyosarcoma with alveolar morphology. Fluorescence in situ hybridization revealed no rearrangements of FOXO1 or PAX3. Targeted RNA sequencing identified a novel NCOA1::ZNF143 fusion transcript. Despite intensive multimodal treatment including chemotherapy, radiotherapy, surgery, and metronomic therapy, the disease demonstrated multiple relapses with subsequent metastatic progression involving the spinal cord and central nervous system, ultimately leading to a fatal outcome.

Neurosurgical oncology is a rapidly advancing field, driven by interdisciplinary collaboration, technological innovation, and a growing understanding of tumor biology. As we celebrate the 40th anniversary of the AANS/CNS Section on Tumors, this editorial highlights the collaborative spirit that defines the Section and explores the many ways it intersects with other neurosurgical subspecialties and AANS/CNS Sections to optimize patient care. This special edition features a series of articles showcasing these intersections across functional, cerebrovascular, spine, trauma, pain, and pediatric neurosurgery. For example, insights into neuron-glioma interactions-enhanced by tools such as optogenetics and advanced brain mapping-are opening doors to more personalized treatment strategies. Innovations in preoperative embolization for skull base meningiomas are improving surgical precision and outcomes. Similarly, advances in managing vertebral metastatic disease with surgical techniques and stereotactic body radiation therapy (SBRT) are reshaping standards of care. Neuro-intensive care has evolved to support personalized postoperative recovery, with a focus on neurological function and cognitive rehabilitation. In pain management, neuromodulation, including intrathecal drug delivery and spinal cord stimulation, is offering new relief to tumor patients. Adolescents and young adults (AYA) with gliomas remain an underserved population, requiring age-specific treatment frameworks and better integration into clinical trials. This edition celebrates the diverse and collaborative workforce propelling neurosurgical oncology forward.

While spinal epidural abscess (SEA) is a well-recognized neurosurgical emergency, its diagnosis remains a formidable challenge when presenting with atypical symptoms such as dysphagia, particularly in patients under anti-tumor necrosis factor (TNF) therapy. This report describes a critical diagnostic trap: a fulminant cervical SEA in a 59-year-old male patient treated with infliximab for ankylosing spondylitis. Despite being afebrile and neurologically intact upon admission, laboratory investigations revealed a massive inflammatory syndrome (C-reactive protein: 282.9 mg/L). His condition rapidly progressed to sudden tetraplegia during diagnostic imaging. MRI confirmed C3-C4 spondylodiscitis with a massive prevertebral and spinal epidural abscess causing critical cord compression (5 mm residual canal). The patient underwent emergency C3-C4 anterior discectomy and abscess drainage. Despite the successful eradication of the methicillin-susceptible Staphylococcus aureus (MSSA) infection, the patient suffered permanent neurological deficits. This case highlights the potent masking effect of anti-TNF therapy on systemic inflammatory signs and the diagnostic challenge of SEA presenting as dysphagia. It underscores that in immunocompromised patients, the absence of fever must not rule out severe infection when neck pain and elevated inflammatory markers are present. Clinicians must maintain a low threshold for emergency MRI, as the therapeutic window for intervention is exceptionally narrow once fulminant neurological deficits manifest.

TFE3-rearranged renal cell carcinoma (TFE3-RCC) is a rare molecular subtype of renal cell carcinoma (RCC), characterized by Xp11.2 translocations involving the TFE3 gene. It is more common in pediatric populations and is often associated with aggressive clinical behavior and diagnostic challenges. Given the rarity of this entity in adults and limited therapeutic evidence, institutional case series remain valuable to enhance understanding of its clinicopathologic spectrum and outcomes. We conducted a retrospective case series of four adult female patients diagnosed with TFE3-rearranged RCC at a tertiary cancer center. Diagnosis was established based on morphology and strong nuclear TFE3 immunoreactivity, supported by additional immunohistochemical (IHC) markers including cluster of differentiation 10 (CD10), Melan-A, human melanoma black 45 (HMB45), vimentin, carbonic anhydrase IX (CAIX), and cytokeratins. Clinical presentation, radiologic findings, histopathologic features, immunohistochemical (IHC) profile, treatment modalities, and outcomes were reviewed. The median age was 32 years (range: 22-51). Two patients presented with localized stage III disease and underwent surgical resection (partial or radical nephrectomy), remaining disease-free at six months and one year of follow-up. Two patients presented with stage IV metastatic disease. One patient experienced late metastatic recurrence seven years after initial nephrectomy and is currently on cabozantinib with stable disease. The other had widespread metastases with spinal cord compression and showed disease progression despite targeted therapy and palliative radiotherapy, ultimately succumbing to the disease. Morphologically, tumors demonstrated heterogeneous features including clear cell, papillary, epithelioid, oncocytic, and melanotic differentiation. One case with coarse melanin pigmentation mimicked perivascular epithelioid cell tumor (PEComa), highlighting diagnostic complexity. TFE3-rearranged RCC in adults demonstrates heterogeneous morphology and variable clinical behavior, ranging from favorable outcomes in localized disease to aggressive progression in metastatic settings. Accurate diagnosis requires a high index of suspicion and comprehensive IHC evaluation, particularly in tumors with atypical morphology or melanotic differentiation. Advanced disease shows unpredictable response to targeted therapy, underscoring the need for further molecular characterization and prospective studies to optimize management strategies. Long-term surveillance remains essential due to the risk of late recurrence.

Oncologic emergencies are potentially life-threatening complications that require timely identification and intervention. Although these events are relatively uncommon, they pose significant risks for morbidity and mortality in children with cancer. This review focuses on five of the most critical oncologic emergencies encountered in pediatric practice: febrile neutropenia, hyperleukocytosis, spinal cord compression, tumor lysis syndrome, and superior mediastinal/superior vena cava syndrome. Each presents with a variable constellation of signs and symptoms that may mimic more benign illnesses, underscoring the importance of maintaining a high index of suspicion. Delays in recognition and treatment can result in rapid clinical deterioration, but with prompt supportive care and disease-directed therapy, outcomes can be significantly improved. This article provides a concise, practical overview of the pathophysiology, diagnostic approach, and initial treatment of each condition, with the goal of equipping general pediatricians and frontline providers with the tools necessary to identify these emergencies early and initiate appropriate care.

Cancer and its associated pain pose a serious threat to human health. Cancer therapy and pain management are two distinct medical disciplines and recently proposed cancer neuroscience offers a possibility to simultaneous cancer therapy and pain control. Ropivacaine (Rop), a representative local anesthetic possessing both analgesic and anti-tumor properties, emerges as an ideal agent to achieve this dual objective; however, its therapeutic potency is limited under conventional administration. Herein, a lipid nanoparticles (LNPs)-based Rop delivery system is developed to enhance its in vivo performance. Results show that obtained Rop-loaded LNPs (LNPs/Rop) are of a high drug loading efficiency (86.2 ± 5.5%), leading to a high loading capacity (17.7 ± 0.9%). The hydrodynamic diameter of LNPs/Rop is 171.1 ± 8.3 nm with negatively charged surface (-26.6 ± 2.7 mV). In vitro release assay reveals that LNPs/Rop have a high structural stability, sustainedly releasing 36.7 ± 1.7% of payload within 24 h. Cell experiments indicate that the anti-tumor potency of Rop can be significantly augmented under the co-cultured condition of neuron and tumor cells. In vivo results demonstrate that LNPs/Rop facilitate drug accumulation to target sites-dorsal root ganglion (DRG), spinal cord, and tumor. The accumulated LNPs/Rop in the nervous system effectively relieve cancer pain by blocking pain signal transduction and significantly extends the duration of action to at least 36 h, while it is less than 6 h for free Rop. Meanwhile, LNPs/Rop at a safe dose (3 mg/kg) show comparable anti-tumor potency to an equivalent dose of doxorubicin-loaded LNPs by blocking the nerve-tumor crosstalk. This work highlights a promising strategy to overcome the disconnect between cancer therapy and pain control.

A 10.5-year-old male castrated Standard Poodle was referred for the evaluation of chronic C6-T2 myelopathy. MRI revealed a severe asymmetric enlargement of the ventral internal vertebral venous plexus, intervertebral/vertebral veins, and possibly the C6 basivertebral vein, with secondary mild spinal cord compression. Intravascular neoplasm, particularly lymphoma, with probable concurrent thrombus formation, was prioritized. Due to the poor prognosis and subsequent development of severe anemia and melena, the patient was euthanized. Necropsy and histopathology diagnosed cervical intravascular osteosarcoma within the ventral internal vertebral venous plexus. This case represents the first description of magnetic resonance imaging features of intravascular osteosarcoma in a canine patient.