The relationships of the lesser petrosal nerve in the middle cranial fossa have been described. An understanding of these relationships will reduce the likelihood of it being confused with the greater petrosal nerve during surgical approaches to the middle fossa.

The petrosal artery is at risk of being damaged during procedures in which the dura is elevated from the floor of the middle fossa, the middle fossa floor is drilled, or the middle meningeal artery is embolized or sacrificed. Several recommendations are offered to avoid damaging the facial nerve supply while performing such interventions.

Background: Shunt migration after Lumboperitoneal [LP] shunt procedures can occur upward into the spinal subarachnoid space and downward into the abdominal cavity. Cranial migrations are less common than downward migration into the abdominal cavity. Defects of the fixation devices in the shunt system are considered the main cause. Aim of the work: To evaluate fixed node maneuver, a new technique to avoid shunt migration. Patients and methods: Among many cases of shunt installations, we selected 30 patients who received a first-time shunt installation for different causes [pseudotumor cerebri [24 cases], primary cerebrospinal fluid [CSF] rhinorrhea [5 cases] and one case for persistent postoperative lumbar CSF leak]. All cases underwent LP shunt with fixed node in group [A; 15 patients] and the traditional mode of fixation in group [B; 15 patients], with evaluation of postoperative clinical improvement and shunt migration. Results: Clinical improvement occurred in 27 [90%] patients. However, shunt migration was recorded in 2 [13.3%] patients of the second group [B], while in group [A], no recorded shunt migration. Conclusion: We advocated clinical efficacy of fixed node maneuver of lumboperitoneal shunt to avoid shunt migration.