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Individuals with osteogenesis imperfecta develop pathologic bone due to genetic defects in collagen synthesis. These patients are prone to skull base abnormalities with resultant lower cranial nerve deficits, most common of which is trigeminal neuralgia. Typically, such patients are managed medically, and surgical options are not well explored for those patients, who become refractory to medication management. While microvascular decompression is often recommended for patients with classical trigeminal neuralgia, neurovascular compression by MRI, and normal skull base anatomy, ablative procedures have been described for patients with trigeminal neuralgia and osteogenesis imperfecta. MVD via a retrosigmoid approach has not been described in a patient with trigeminal neuralgia and skull base abnormalities secondary to osteogenesis imperfecta. A 23-year-old man with osteogenesis imperfecta was referred with right-sided classical trigeminal neuralgia. His trigeminal pain had become refractory to a number of medications. High-resolution MRI demonstrated compression of the trigeminal nerve by the superior cerebellar artery. Microvascular decompression of the trigeminal nerve via a retrosigmoid craniectomy was performed, and he remains pain-free 6 months after surgery. Microvascular decompression of the trigeminal nerve through a retrosigmoid approach can be an effective surgical treatment for young patients with trigeminal neuralgia secondary to osteogenesis imperfecta.

Background: The lateral supraorbital approach (LSO) provides an optimal access corridor for various skull bases lesions, including olfactory groove meningiomas (OGMs). The aim of this study is to describe the authors' experience with the management of large and giant OGMs utilizing the LSO approach and describe the technical nuances of the procedure., Methods: A retrospective review of seven patients with large and giant OGMs managed with the LSO approach between 2013 and 2019 was performed. Radiographic and clinical data were recorded and analyzed., Results: Seven patients with large and giant OGMs underwent surgical resection via the LSO approach. Six patients were female, with a median age of 56 years. Patients commonly presented with altered mentation, anosmia, and headaches. The average tumor volume was 120.6 ± 64.7 cm 3 with five cases of vascular encasement. Simpson grade II resection was achieved in four patients while Simpson grade IV resection was achieved in three patients. The median length of stay was 2.0 days. The median preoperative Karnofsky Performance Scale (KPS) score was 70, improving to 100 at last postoperative follow-up visit. Two complications were encountered in the form of postoperative cerebrospinal fluid leak in one patient and a transient diplopia in another patient. Tumor recurrence/progression was identified in two patients during a median follow-up time of 65.5 months. Both cases have been managed with adjuvant radiosurgery., Conclusion: The LSO approach is a safe and effective minimally invasive transcranial corridor for the management of OGMs that should be part of the armamentarium of skull base neurosurgeons.

We present the first report of a case of hemifacial spasm caused by an anomalous, enlarged branch of the ascending pharyngeal artery and treated with microvascular decompression. Clinicians must appreciate unusual causes of hemifacial spasm so that patients are not denied a curative operation due to atypical radiographic findings.

Background: Following retromastoid craniectomy for microvascular decompression of the fifth or seventh cranial nerve, the preferred method and value of cranioplasty remains disputed., Methods: In this study, we report the functional outcome of calcium phosphate cranioplasty following first-time microvascular decompression in 79 consecutive patients who underwent operations over a one-year period., Results: No patient experienced a deep infection, cerebrospinal fluid leak or undue incisional pain at long-term follow-up. Additionally, all patients stated that they were satisfied with the cosmetic outcome., Discussion: Although this technique is unlikely to affect the rates of infection and postoperative pain, we believe that the low rate of CSF leak provides a unique advantage over other currently used methods of closing retromastoid craniectomies.

Over the past 50 years, various shunting procedures involving the peritoneum have been performed for the treatment of hydrocephalus. During placement of the peritoneal portion of the catheter, complications may arise secondary to a lack of direct visualization. We describe a reduced complication rate with laparoscopically-assisted placement of the peritoneal portion of the catheter. A retrospective chart review was performed of seventy-six (76) laparoscopically-assisted cases performed without consideration of prior abdominal surgery or obesity. Subjects ranged in age from 19 to 80 years. Mean operative time was 55.3 minutes. No visceral injuries occurred. To date, no infectious complications have occurred. In 3% of subjects, conversion to an open procedure was necessary after failure to establish pneumoperitoneum. Laparoscopic placement of peritoneal shunts is safe and efficacious. It provides visualization of the distal catheter target. Moreover, it reduces the risk of visceral complications, CSF pseudocysts, or extraperitoneal placement of the catheter. In the future, laparoscopic placement of the peritoneal portion of the catheter may become a standard treatment in those patients requiring placement of a peritoneal catheter.

The objective of the study was to determine if negative multidetector computed tomography (MDCT) and lateral radiography of the cervical spine effectively excludes patients with unstable cervical spine injuries. Over a period of 40 months, 6558 people were admitted to our trauma service with blunt injury and 447 (6.8%) were found to have cervical fractures. Fractures were identified by CT and/or lateral radiography. In order to rule out clinically significant instability in the absence of fracture, we identified nine patients who required any type of stabilization of the cervical spine including anterior fusion, posterior fusion and external orthosis. These patients also underwent MR of the cervical spine. Radiography, CT, and MR images and reports of these nine patients were reviewed. Nine patients without a fracture required cervical stabilization. These patients had the following abnormalities: disc herniation with canal stenosis in three, unilateral jumped facet in three, and various other soft tissue abnormalities in three, all of which were evident on CT or radiography. All nine patients had evidence for cervical spine injury or instability by MDCT. Normal MDCT and radiography appears adequate to 'clear' the cervical spine. We recommend that patients requiring cervical spine clearance undergo a complete MDCT and lateral radiograph of the cervical spine. If these studies are entirely normal, then the cervical spine may be cleared. If any abnormalities, including disc herniation, soft tissue swelling and bony malalignments are noted by radiography and/or MDCT, further studies, including MR, are indicated prior to clearance of the cervical spine.

Although tethering of the spinal cord in the lumbosacral region, particularly following repair of congenital anomalies, such as myelomeningocele, is a well-known phenomenon, only sporadic reports of tethering along the rest of the neuraxis, including the hindbrain, cervical and thoracic spinal cord have been documented. In this report, we describe a woman who developed symptoms related to tethering of the cervical spinal cord 5 years after suboccipital decompressive surgery of the posterior fossa for Chiari I malformation. The authors discuss the diagnosis, treatment, and postoperative course of this entity.

Ventriculostomy is a common practice in neurosurgery, but the annual trend of this procedure in the United States has not been reported in the literature. This study evaluates the annual trend during a recent 5-year period. Between 1997 and 2001, a retrospective review was undertaken concerning all patients in the Nationwide Inpatient Sample (NIS) who had undergone ventriculostomy. The population sample represented approximately a 20% stratified sample of nonfederal hospitals in the United States. The annual number of patients who underwent ventriculostomy during the study period ranged from 20,586 to 25,634. Most patients were male (53.4%), with a mean age of 44.8 years, were commercially insured (46.0%) and had a median annual income above $25,000 (84.4%). Most frequent ICD-9-CM diagnoses were subarachnoid haemorrhage, intracerebral haemorrhage and obstructive hydrocephalus, respectively. The majority of ventriculostomies were performed in large, private, not-for-profit, metropolitan, teaching institutions. Mean length of hospital stay was 19.2 days. Regarding discharge status for patients who had undergone ventriculostomy, approximately one-quarter died in the hospital, one-third were discharged home and one-third were transferred to another institution. No demographic variables changed during the study with the exception of location of ventriculostomy in a teaching hospital, which increased from 64.4% in 1997 to 77.4% in 2001. Patient and hospital demographic characteristics were consistent during the study period. By extrapolation of the data, the prevalence of ventriculostomy in the United States averaged 24,380 per year. This study is the first to comprehensively document data concerning the epidemiology of this common procedure.