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Background: Spontaneous spinal subdural-epidural hematoma during pregnancy is rare. Case Description: A 29-year-old gravida II patient experienced the onset of vomiting, headache, and progressive paraparesis. The initial non-contrast brain computed tomography and coagulation profiles were negative. The next day, the spine magnetic resonance imaging (MRI) revealed a C7-T4 epidural hematoma; contrast studies revealed no accompanying vascular lesions. On day 3, she underwent a cesarean delivery followed by a C3-T1 laminectomy. Her sensory and sphincteric function returned on postoperative day 2, but at 6 postoperative months, she continued to exhibit a 3/5 paraparesis. Conclusion: Pregnant patients with acute paraparesis should undergo STAT MRI screening of the spine to look for epidural/subdural hematomas. [ABSTRACT FROM AUTHOR]

Background: Giant cavernous carotid artery aneurysms (>25 mm) are rare (3-5%), with some prone to spontaneous thrombosis (10-20% complete). We present a unique case of one of the largest aneurysms spontaneously thrombosing and calcifying. Case Description: A 57-year-old with persistent right-sided headaches had a substantial hyperdense mass in the right middle cranial fossa, eroding petrous bone. Magnetic resonance imaging and digital subtraction angiography revealed a giant cavernous segment fusiform aneurysm of the right internal carotid artery (ICA) with spontaneous thrombosis and distal ICA occlusion. Collateral circulation maintains the cerebral blood supply. Despite anatomical challenges, conservative management was chosen due to the patient's stability. Conclusion: This case highlights the complex interplay between thrombosed giant aneurysms and affected vessels, with unique features such as cross-flow, calcification, and bone erosion. We advocate conservative management for stable cases, supported by literature, emphasizing vigilant follow-up. This expands the spectrum of aneurysm presentations and encourages further research into their dynamics. [ABSTRACT FROM AUTHOR]

Aim: To identify subgroups of cases with ventriculomegaly who will benefit from the cerebrospinal fluid (CSF) diversion procedures, n patients with post-traumatic hydrocephalus (PTH), and to identify the risk factors for its development to minimize its occurrence., Material and Methods: We analyzed 500 head injury cases who were admitted over a one and a half year period in our institute with PTH, to assess them for treatment benefit by CSF diversion procedures and associated risk factors for its development. The patients were assigned to one of three groups: Group 1 had ventriculomegaly with periventricular lucency (PVL), and raised intracranial pressure (ICP) 2.1% (10/500). Group 2 had ventriculomegaly with PVL, and normal opening pressure 1.75% (7/500) and Group three had no ventriculomegaly 95.75% (483/500)., Results: The incidence of radiological PTH in this study was 3.4% (17/500), and it developed after an average interval of 16.43 ± 23.7 (SD) in Group 1 and 19.76 ± 8.9 (SD) weeks in Group 2. Lower Glasgow Coma Score (GCS) (p < 0.001), decompressive craniotomy (p < 0.001) and requirement for prolonged ventilatory support (p < 0.001) were significantly associated with the development of PTH. Significantly better results were found in cases with PTH and high opening CSF pressure (? 15 mmHg) on Lumbar puncture (p < 0.001). Decompressive craniotomy cases required significantly more shunt revisions compared to conservatively managed cases (p < 0.05)., Conclusion: CSF diversion procedures help to improve ventriculomegaly cases with documented evidence of raised ICP but not in cases without raised ICP. The subgroup of PTH, which cannot be treated by CSF diversion procedures, can only be managed by minimizing many of the risk factors for its development. In cases with severe head injury, a low GCS, and prolonged ICU stay, decompressive craniotomy should be used judiciously. The duration of mechanical ventilation should be minimized and combined with necessary measures to improve GCS.

Aim: To compare the outcomes of distal anterior cerebral artery (DACA) aneurysm treatment using endovascular therapy (EVT) and surgical clipping, and to assess their risk factors., Material and Methods: We retrospectively sampled and analyzed 31 patients treated for ruptured Distal anterior cerebral artery (DACA) aneurysms from a larger sample of 250 patients treated for ruptured aneurysms between July 2018 and July 2021. The outcomes of patients who underwent clipping and EVT were compared using chi-square tests. T-tests were used for univariate analysis and a logistic regression analysis was used to determine the risk factors affecting outcomes., Results: Of the 31 patients, 20 were treated with clipping and 11 with EVT. Patients treated with EVT had a mean age of 35.45 ± 6.66. The mean age of the clipping group was 44.4 ± 6.94 years (p=0.002). Intraoperative rupture was significantly more common in the clipping group (p=0.025). There were no significant differences in the postoperative incidence of vasospasm or hydrocephalus (p=0.12). Modified Rankin Scale scores (p=0.017) and Glasgow Outcome Scale scores (p=0.02) both at discharge and 6-month follow-ups were significantly better in the EVT group than in the clipping group. Length of stay in the Intensive Care Unit (ICU) was 9.27 ± 2.6 days following EVT and 23.60 ± 6.29 following clipping (p=0.001). Age (p=0.0136), Hunt and Hess grade (p=0.02), and the occurrence of intraprocedural rupture (p=0.009) were found to significantly affect outcomes., Conclusion: The outcomes of EVT were better than those for clipping and required a shorter stay in the ICU and the hospital. This may be partially attributable to the dual-trained neurovascular surgeon who performed the procedures. Older age, poorer Hunt and Hess grades, and intraoperative aneurysm rupture adversely affected outcomes.

Competing Interests: There are no conflicts of interest.

Background: Multicompartmental intraventricular epidermoids behave differently from multicompartmental extraventricular lesions and localized lesions during its management. Few studies are available which have analyzed risk factors separately in these groups of cases for recurrence of these lesions and time to recur., Materials and Methods: In this retrospective observational study, 72 cases of intracranial epidermoid were treated over a span of 7 years. Cases were categorized into three groups. Group 1 comprised 15% (11/72) of cases with intraventricular multicompartmental, Group 2 with 22% (16/72) extraventricular giant tumors with multicompartmental involvement and size >4.5 cm, and Group 3 comprised 63% (45/72) of patients with lesions <4.5 cm and localized. Data pertaining to demography, clinical and radiological features, surgery performed, postoperative complication, histology, and follow-up were obtained from medical records available in the institute., Results: The average duration to treat was 1.86 ± 0.52 (standard deviation [SD]) years, with headache as a major complaint in all the groups. Combined endoscope-assisted microsurgery was performed in 38.8% (28/72), microsurgery in 54.1% (39/72), and endoscopic excision in 6.9% (5/72) of cases. Tumor calcification was found in 23.6% (17/72) and preoperative capsular enhancement was seen in 19.4% (14/72) which persisted in 79% (11/14) of cases postoperatively on subsequent follow-up suggesting recurrence. On stepwise logistic regression analysis, preoperative capsular enhancement was a strong predictor of recurrence of tumor ( P = 0.001). The average follow-up was 46 ± 14.92 (SD) months in Group 1, 52.34 ± 11.45 (SD) months in Group 2, and 63.36 ± 18.42 (SD) months in Group 3., Conclusion: Although the intracranial epidermoid is known to recur after long interval, tumor with specific characteristics can recur in short span of 5-6 years. Tumor characteristics such as preoperative capsular enhancement, multicompartmental distribution in vertebrobasilar territory, large size, and presence of calcification are strong predictors for recurrence. Performing endoscope-assisted microsurgery can decrease the postoperative morbidities but does not reduce the recurrence risk., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Asian Journal of Neurosurgery.)

On behalf of all authors, I respectfully request the retraction of our article, “Primary Cerebellopontine Angle Rathke’s Cleft Cyst: Case Report” (Turk Neurosurg, published online 2014, Vol: 24, No: 3; DOI: DOI: 10.5137/1019-5149. JTN.8084-13.1). This request is based on multiple problems with our study.