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Objective The incidence of typical trigeminal neuralgia (TN) increases with age, and neurologists and neurosurgeons frequently observe patients with this disorder at age 65 years or older. Microvascular decompression (MVD) of the trigeminal root entry zone in the posterior cranial fossa represents the etiological treatment of typical TN with the highest efficacy and durability of all treatments. This procedure is associated with possible risks (cerebellar hematoma, cranial nerve injury, stroke, and death) not seen with the alternative ablative procedures. Thus the safety of MVD in the elderly remains a topic of discussion. This study was conducted to determine whether MVD is a safe and effective treatment in older patients with TN compared with younger patients. Methods In this retrospective study, 28 patients older than 65 years (elderly cohort: mean age 70.9 ± 3.6 years) and 38 patients < 65 years (younger cohort: mean age 51.7 ± 6.3 years) underwent MVD via the keyhole retrosigmoid approach for type 1 TN (typical) or type 2a TN (typically chronic) from November 2011 to November 2017. A 75-year-old patient and three nonelderly patients with type 2b TN (atypical) were excluded. Elderly and younger cohorts were compared for outcome and complications. Results At a mean follow-up 26.0 ± 5.5 months, 25 patients of the elderly cohort (89.3%) reported a good outcome without the need for any medication for pain versus 34 (89.5%) of the younger cohort. Twenty-three elderly patients with type 1 TN were compared with 30 younger patients with type 1 TN, and no significant difference in outcomes was found (p > 0.05). Five elderly patients with type 2a TN were compared with eight younger patients with type 2a TN, and no significant difference in outcomes was noted (p > 0.05). There was one case of cerebrospinal fluid leak and one of a cerebellar hematoma, both in the younger cohort. Mortality was zero in both cohorts. Conclusions On the basis of our experience and the international literature, age itself does not seem to represent a major contraindication of MVD for TN.

Although percutaneous tracheostomy is a standardized procedure, rare major complications are still being evaluated and discussed. We describe a case of patient, with hemodynamic and respiratory stability, who displayed massive hemorrhage after 16 days of “Ciaglia Blue Rhino” tracheostomy. Unfortunately, neither prompt resuscitation maneuvers nor the surgical approach saved the life of patient.

Background: In 10-15% of cases of vestibular schwannoma (VS) age at diagnosis is 40 years or less.Little is known about the differences in natural history, surgical ndings and postoperative outcomes of such younger patients as compared to those of greater age. Objectives : To analyze clinical and surgical and imaging data of a consecutive series of n=50 patients with unilateral sporadic VS, aged 40 years or younger -separated in a very young group (15-30 years) and a moderately young group (31-40 years). Study design: Retrospective case series Methods: 50 consecutive patients under 40 years of age underwent microsurgical resection of unilateral sporadic VS via the retrosigmoid approach. The study cohort was subdivided into two groups according to the age range: Group A, age range 15-30 years (n=23 patients) and Group B, age range 31-40 years (n=27 patients). The adherence of VS capsule to surrounding nervous structures and the tendency of the tumors to bleed were evaluated by reviewing video records; the course of the FN in relation to the tumor's surface was assessed in each case. Microsurgical removal of tumor was classi ed as total (T), near total (residual tumor volume <5%), subtotal (residual tumor volume 5-10%) or partial (residual tumor volume >10%).Results: Mean tumor size of entire cohort was 2,53 (range: 0,6-5,8) cm: 2,84 cm in Group A and 2,36 cm in Group B (p=NS). Facial nerve course and position within the cerebellopontine angle did not differ signi cantly between the two groups. At 6-month follow-up, FN functional outcome was: HBI-II in 69,5% in Group A, versus 96,3% in Group B (p<,001). Hearing preservation was achieved in 60,0% of patients of Group A and in 58,3% of Group B (p=NS). Total and near-total resection was feasible in 95,6% of cases of Group A and in 88,9% of Group B (p=NS). Tumor capsule was tightly adherent to nervous structures in 69,6% patients of Group A and in 22,2% of Group B (p<,05). Signi cant bleeding was encountered in 56,5% of Group A tumors, and in 29,6% of Group B tumors (p<,01).Conclusions: Microsurgery of VS in patients aged 40 or less is associated with good functional results, and with high rates of total and near total tumor removal. Patients <30 years of age have more adherent tumor capsules. Furthermore, their tumors exhibit a tendency to larger sizes, to hypervascularization, to profuse intraoperative bleeding and they present worse long-term functional FN results when compared to patients in their fourth decade of life. Our limited experience seems to suggest that a near total resection in very young VS patients with large tumors should be preferred in adherent and hypervascularized cases, in order to maximize resection and preserve function.