Trigeminal neuralgia (TN) is a debilitating neuropathic pain involving the fifth cranial nerve. There has been no study investigating the clinical and socioeconomical characteristics of patients with TN in Indonesia. A total of 100 patients were included in this study. Symptoms indicating a later stage of the illness, namely, involvement of all the trigeminal nerve branches, numbness, and concomitant persistent pain, were the common presentations found in our cohort. Only one TN diagnosis was made by a general practitioner (GP). None were immediately referred to a neurosurgeon following their diagnosis. Access to our clinic took as long as 4.7 ± 5.1 years (mean ± SD) from the onset. Older age was a significant predictor of an increased likelihood of not knowing their illness upon the referral (21.9%, p = 0.008). Upon their first presentation, 25.5% of patients had experienced drug-related side effects due to prolonged medication. Only 50% of patients were compensated by the universal health coverage (UHC) system. Seven patients spent ≥ 50 million rupiahs and eight patients had already lost their jobs. In conclusion, early contact with a neurosurgeon contributes to better management of TN, both for the patients and healthcare system in Indonesia. A refined understanding of TN nature is still needed in this country.

Chronic subdural hematoma (CSDH) is a condition in which blood accumulates within the subdural space and may cause neurologic deficits. CSDH patients with neurologic deficits usually will undergo surgery, but reoccurrence is common. Middle meningeal artery (MMA) embolization has been proposed as one of the CSDH treatment options, either being used as a single treatment for the neurologically stable patients or certain conditions that may not allow patients to undergo surgery, or as a perioperative treatment. The authors reported a CSDH case with neurologic deficits who was on antiplatelet treatment that underwent both burr hole and MMA embolization for curation and prevention of rebleeding. The result showed near-complete blood resorption and no neurologic deficits.

Background To assess efficacy and safety of a newly developed decompression technique in microvascular decompression for hemifacial spasm (HFS) with vertebral artery (VA) involvement. Methods A rigid Teflon (Bard® PTFE Felt Pledget, USA) with the ends placed between the lower pons and the flocculus creates a free space over the root exit zone (REZ) of the facial nerve (bridge technique). The bridge technique and the conventional sling technique for VA-related neurovascular compression were compared retrospectively in 60 patients. Elapsed time for decompression, number of Teflon pieces used during the procedure, and incidences of intraoperative manipulation to the lower cranial nerves were investigated. Postoperative outcomes and complications were retrospectively compared in both techniques. Results The time from recognition of the REZ to completion of the decompression maneuvers was significantly shorter, and fewer Teflon pieces were required in the bridge technique than in the sling technique. Lower cranial nerve manipulations were performed less in the bridge technique. Although statistical analyses revealed no significant differences in surgical outcomes except spasm-free at postoperative 1 month, the bridge technique is confirmed to provide spasm-free outcomes in the long-term without notable complications. Conclusions The bridge technique is a safe and effective decompression method for VA-involved HFS.

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