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Thenceforward, ICP monitoring technology underwent progressive improvements through the contributions of French scientists Guillaume and Janny, Swedish neurosurgeon Nils Lundberg, among others. Nowadays, ICP monitoring can be performed via direct and indirect methods using a potpourri of devices such as, but not limited to, subarachnoid bolts, microtransducer catheters and telemetric monitors. Nevertheless, despite advancements in ICP monitoring technology, the gold standard remains an extra-ventricular drain catheter connected to an external pressure transducer. BACKGROUND Surgical clipping of intracranial aneurysms is typically robust and durable. However, residual aneurysmal components may be seen after clipping. Furthermore, there may be occasional aneurysmal recurrence. These are both clinically relevant because subarachnoid hemorrhage after clipping is a rare but important event. The rationale for any treatment is to substantially lower the future risk of hemorrhage. Small series have demonstrated coiling as a re-treatment strategy after unsuccessful clipping, but none have explored the feasibility of Woven Endobridge (WEB) implantation. CASE DESCRIPTION We examined the feasibility of WEB implantation as second-line treatment for wide-necked residual aneurysms after unsuccessful clipping. We also recorded the safety and efficacy in this small series of 6 patients. To determine safety, we measured the modified Rankin Scale (mRS) before and after the procedure, and at two later time-points (mean follow-up 5 months and 15 months). To determine efficacy, we obtained radiographic aneurysm occlusion outcomes (including WEB Occlusion Scale) at these two time-points. Four middle cerebral artery and two anterior communicating artery complex aneurysms were treated with WEB implantation showing feasibility in 6/6 (100%) cases. Follow-up at 15 months demonstrated no change from pre-procedural mRS and there were no other complications. There was adequate occlusion in 5/6 (83%) cases. CONCLUSIONS WEB implantation provided a feasible option in this challenging re-treatment scenario. We emphasize that this is a small series and prospective data is required to make outcome inferences for this population. Nonetheless, we observed no complications and high adequate occlusion rates. BACKGROUND Hydrogen peroxide (H2O2) solution is commonly used to irrigate wounds because of its hemostatic and antiseptic properties. Previous studies suggest that H2O2 can result in toxicity to keratinocytes and fibroblasts, but complications after H2O2 application, including oxygen embolism, which is one of the most severe, have rarely been reported. CASE REPORT A 40-year-old woman was diagnosed with L4/5 lumbar spinal stenosis and subsequently underwent MIS-TLIF treatment at another hospital. Hypotension, hypoxia, and a decrease in PETCO2 occur immediately after H2O2 irrigation. After the operation, she was able to be extubated but remained comatose. Postoperative computed tomography revealed intracranial air trapping in the right frontal lobe and multiple cerebral infarction foci. CONCLUSION When using a knee-prone surgical position or in cases of dural laceration the application of undiluted H2O2 solution should be avoided, especially in a surgical wound within a closed cavity. When hypotension, hypoxia, and a decrease in PETCO2 occur immediately after H2O2 irrigation, oxygen embolism should be strongly suspected. OBJECTIVE To analyze the clinical data of patients with ipsilateral coexistence of hemifacial spasm (HFS) and trigeminal neuralgia (TN) and their treatment by microvascular decompression (MVD). METHODS We retrospectively analyzed the clinical data, imaging examination, offending vessels, surgical methods and efficacy in 40 patients with ipsilateral coexistence of HFS and TN from January 2009 to January 2018. The posterior cranial fossa (VPCF) was measured using ITK-SNAP 3.0 that counted the cerebrospinal fluid (CSF) volume, based on the region of interest (ROI). Preoperative and postoperative status based on visual analog scale (VAS) pain scores, and Cohen evaluation scale. RESULTS Preoperative visual analog scale (VAS) pain scores were 10 for 30 patients, 9 for eight patients and 8 for two patients. Preoperative Cohen scores were 4 and 3for 14 and 26 patients, respectively. A big looped vertebral basilar artery (VBA) was identified in the operative field in 18 patients (45%), which was regarded as the direct the responsible artery. In addition, patients with VBA involvement often develop HFS symptoms first and are more severe than those with non-vertebral artery involvement. Microvascular decompression is effective for patients with ipsilateral coexistence of HFS and TN. BACKGROUND Malignant peripheral nerve sheath tumors (MPNST) are rare nervous system tumors, that rarely appear on the scalp. About half of the scalp MPNSTs described in the literature have reached giant dimensions at the time of diagnosis. The surgical treatment is the gold standard for this type of tumors. Some authors suggest adjuvant radiotherapy for local tumor control, however there is uncertainty about its advantages and its use is not without risks. CASE DESCRIPTION We present the case of a 31-year-old male who presented with a large necrotic scalp tumor of the left fronto-parietal convexity. MRI showed a large extra-axial tumor, measuring 17 x 17 x 8 cm, centered on the soft tissues, with skull erosion and signs of dural invasion, although, with no intradural component. The tumor was surgically removed and the osteocutaneous defect was reconstructerd with a Latissimus Dorsi Muscle free flap. The anatomopathological diagnosis was MPNST. Then he underwent adjuvant radiotherapy. After seven months patient developed a progressive right hemiparesis and MRI showed results compatible with cerebral radiation necrosis. This motor deficit improved with corticotherapy. After nine months the patient went back to his home country and subsequently lost to follow-up. CONCLUSIONS Giant MPNSTs of the scalp are highly aggressive lesions that should primarily be treated in a surgical fashion. Although adjuvant radiotherapy has been used routinely for local tumor control there is uncertainty about its advantages. BACKGROUND Complications of ventriculoperitoneal (VP) shunts include migration into various anatomic compartments, and even extrusion through tissue layers. CASE REPORT A 31-year-old female patient with a VP shunt presented with distal shunt tubing extruding through the skin at the level of the inguinal ligament. Shunt hardware was removed, and cultures grew Dermacoccus. The patient was treated with broad-spectrum antibiotics and underwent placement of a lumboperitoneal shunt. CONCLUSIONS Dermacoccus is a gram-positive skin organism with very rare human pathogenicity and not previously known to cause shunt infections. BACKGROUND Surgical management of high-grade spondylolisthesis remains controversial. NSC 125973 Both reduction and in-situ fusion are available options, but it remains unclear which approach provides better outcomes. OBJECTIVE To conduct a systematic review and meta-analysis on studies reporting outcomes following reduction or in-situ fusion for adult high-grade spondylolisthesis. METHODS PubMed, Embase, Web of Science, and Cochrane databases were last searched on 06/24/2019. A total of 1236 studies were identified after excluding duplicates. After screening, 15 studies were included in the meta-analysis. Random-effects models were used to pool the effect estimates. RESULTS A total of 188 patients were analyzed. Compared to reduction, in-situ fusion had a higher mean estimated blood loss (584 mL vs 451 mL) and a clinically higher incidence of neurological (48% vs 15%), pseudarthrosis (13% vs 8%) and infectious (20% vs 10%) complications; however, these differences were statistically non-significant. Reduction, on the other hand, was associated with a clinically higher incidence of overall complications (32% vs 25%), dural tears (22% vs 7%); provided better pain relief (mean difference [MD] = 5.24 vs 4.77) and a greater change in pelvic tilt (MD = 5.33 vs 2.60); yet, these differences were not statistically significant; however, patients who underwent reduction had a significantly greater decline in ODI scores (MD = 55.7 vs 11.5; p-interaction less then 0.01) and greater change in slip angle (MD = 25.0 vs 11.4; p-interaction = 0.01) CONCLUSION In the management of adult high-grade spondylolisthesis, both approaches appear to be safe and effective. However, reduction appeared to offer better disability relief and spinopelvic parameter correction than in-situ fusion. BACKGROUND Artificial Intelligence (AI) may favorably support surgeons but may result in concern among patients and their relatives. OBJECTIVE To evaluate attitudes of patients and their relatives towards the use of AI in neurosurgery. METHODS In this two-stage cross-sectional survey, a qualitative survey was administered to a focus group of former patients to investigate their perception of AI and its role in neurosurgery. Five themes were identified and used to generate a case-based quantitative survey administered to inpatients and their relatives over a two-week period. Presented AI platforms were rated appropriate and acceptable using 5-point Likert scales. link2 Demographic data was collected. A Chi Square test was performed to determine whether demographics influenced participants' attitudes. RESULTS In the first stage, 20 participants responded. Five themes were identified interpretation of imaging (4/20; 20%), operative planning (5/20; 25%), real-time alert of potential complications (10/20; 50%), partially autonomous surgery (6/20; 30%), fully autonomous surgery (3/20; 15%). In the second stage, 107 participants responded. The majority felt appropriate and acceptable to use AI for imaging interpretation (76.7%; 66.3%), operative planning (76.7%; 75.8%), real-time alert of potential complications (82.2%; 72.9%), and partially autonomous surgery (58%; 47.7%). Conversely, most did not feel that fully autonomous surgery was appropriate (27.1%) or acceptable (17.7%). Demographics did not have a significant influence on perception. link3 CONCLUSIONS The majority of patients and their relatives believed that AI has a role in neurosurgery and found it acceptable. Notable exceptions remain fully autonomous systems, with most wanting the neurosurgeon ultimately to remain in control. BACKGROUND The Nigerian Academy of Neurological Surgeons in 2019 resolved to standardize the practice of Neurosurgery in Nigeria. It set up Committees to standardize the various aspects of neurosurgery viz. Neurotrauma, Paediatrics, Functional, Vascular, Skull Base, Brain Tumour and Spine. The Committee on Neurotrauma convened and resolved to study most of the available protocols and guidelines in use in different parts of the world. OBJECTIVE To formulate a standard protocol for the practice of neurotrauma care within the Nigerian locality. METHODS The Committee split its membership into three Sub-Committees to cover the various aspects of the Neurotrauma Guidelines viz. Neurotrauma Curriculum, Standard Neurotrauma Management Protocols and Neurotrauma Registry. Each Sub-Committee was to research on available models and formulate a draft for Nigerian Neurotrauma. RESULTS All the three sub-committees had their reports ready on schedule. Each concurred that neurotrauma is a major public health challenge in Nigeria.
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