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The median [IQR; range] pressure gradient change after initiation of GA was -3 [-12, 0; -22, 9] mmHg (p = 0.014). After correction for increases in internal jugular vein (IJV) pressures associated with assumption of GA, the median [IQR; range] gradient change was -11 [-12.5, -5; -22, 0] mmHg (p less then 0.001). CONCLUSION The transition from CS to GA, results in clinically meaningful reductions in transverse sinus gradients in IIH. Correction for increases in the IJV pressures reveals even more dramatic reductions in transverse sinus gradients. BACKGROUND VerifyNow® directed personalized antiplatelet therapy for aneurysm embolization with a Pipeline embolization device (PED) remains controversial. OBJECTIVE Evaluate thrombotic complications between patients who received VerifyNow® directed personalized antiplatelet therapy versus those who did not following PED flow-diversion of complex cerebral aneurysms. METHODS Retrospective cohort of consecutive patients undergoing flow-diversion with PED at the Medical University of South Carolina (MUSC) between January 2012 to May 2018. Patients who received VerifyNow® directed personalized antiplatelet therapy were compared to those who received antiplatelet therapy without platelet function testing. Patients with a P2Y12 reaction unit (PRU) ≥ 194 were deemed to be clopidogrel hyporesponsive. The primary outcome is the rate of thrombotic complications and the secondary outcomes are the rate of hemorrhagic and thrombotic complications stratified by PRU and high-risk clinical and procedure-related candidate predictors. RESULTS Thrombotic complications were not different between patients managed with (n = 159) vs without (n = 110) VerifyNow® (6.9% vs 7.3%; p=0.911). Hemorrhagic complications were also no different (3.1% vs 4.5%; p=0.550). PRU stratification revealed no difference in thrombotic or hemorrhagic complications (p=0.488 and p=0.136, respectively). The only significant predictors for thrombotic complications were the presence of diabetes (OR 2.9; p=0.034), obesity (OR 5.1; p= less then 0.001), fusiform aneurysm (OR 3.3; p=0.023), posterior circulation implantation (OR 3.4; p=0.016), and more than one PED implanted (OR 2.4; p=0.046). CONCLUSION The role of VerifyNow® and personalized antiplatelet therapy in patients undergoing flow diversion with PED to treat complex aneurysms did not demonstrate a benefit in reducing thrombotic complications. OBJECTIVE The aim of this study was to evaluate the radiological outcomes and complication analysis of posterior vertebral column resection (PVCR) performed on previously operated severe kyphoscoliosis (SK) patients. METHODS Twelve patients (6 males, 6 females) with SK underwent PVCR. The mean age of the patients preoperatively was 16 years (range, 10-26). The mean follow-up period was 5.3 years (range, 2-7). Previous surgeries included posterior growth arrest in three patients, hemivertebrectomy in four patients and posterior fusion in five. The sagittal plane parameters and coronal parameters were measured in the preoperative, early postoperative and during the last follow-up stages. Complications were also noted. RESULTS The mean thoracic scoliosis Cobb angle was 76.8° (range, 35°-142°) preoperatively, 37.8° (range 5°-80°) early postoperatively and 41.5° (range, 11°-80°) during the last follow-up (p less then 0.0001). The mean thoracic kyphosis angle was 84.7° (range, 23°-132°) preoperatively, 50.3° (range, 25°-78°) early postoperatively and 48.5° (range, 25°-80°) during the last follow-up (p=0.0032). Complications occurred in five patients (41.7%); a hemothorax in one patient, rod fracture in three patients and permanent neurological deficit in one. Temporary loss of Neuromonitoring Motor Evoked Potential developed in two patients during deformity correction. CONCLUSION PVCR provides effective correction in SK patients. However, expected surgical correction of a deformity may not always be achieved due to intraoperative neuromonitoring changes. Furthermore, PVCR can lead to a large number of major complications in SK patients who have undergone previous spinal surgery. JW74 in vivo Sphenocavernous meningioma are technically challenging tumors that, in addition to cavernous sinus neurovascular involvement, frequently affect the optic nerve and carotid artery. The surgical goal generally consists of complete resection of the extracavernous portion of the tumor, while the cavernous sinus tumor can be treated with postoperative radiation if necessary. Traditional techniques include the pterional or orbitozygomatic approach that requires substantial soft tissue, scalp, and temporalis muscle mobilization along with temporal and frontal lobe manipulation. A keyhole craniotomy performed through a lateral orbitotomy provides a minimally invasive option with excellent tumor exposure that obviates the need for soft tissue trauma or brain manipulation. Use of an endoscope can provide further visualization for more expansive tumors. This video presentation demonstrates a case of an 84 year-old female with a growing sphenocavernous meningioma and abducens palsy who underwent a minimally invasive lateral orbital wall approach for resection of the extracavernous tumor. There were no intraoperative or perioperative complications and the patient was discharged home on postoperative day 1. This technique is a useful addition to the armamentarium of surgeons who treat these complex tumors. Proteus syndrome (PS) is a complex genetic disorder, characterized by the sporadic appearance of hamartomatous lesions that follow a mosaic pattern and have a progressive evolution. It affects most of the mesodermal origin tissues, including the bone. Scoliosis is a common manifestation, with great variability and specific peculiarities, but little has been published about it. PURPOSE Presentation of 2 clinical cases of patients with PS that underwent scoliosis surgery and literature review. METHODS Two 17-year-old's, a female (Patient 1) and a male (Patient 2), both diagnosed of PS, were being followed-up for scoliosis. Patient 1 had a right thoracic curve with a Cobb angle (CA) of 69,1º, while patient 2 had, as well, a right thoracic curve of 106,8º. In both patients a posterior fusion was performed, associating rib and ponte osteotomies at the level of the apex in patient 2. A minimum 2-year follow-up was done. RESULTS Both patients had a satisfactory evolution without neurological or other complications, with a high degree of correction of their curves (CA 29,2º and 55,6º respectively).
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