A 35-year-old female visited emergency department for a sudden onset of headache with vomiting after management for abortion at local department. Neurological examination revealed drowsy mentality without focal neurological deficits. CT showed 3.2×3.4 cm hyperdense intraventricular mass with intraventricular hemorrhage. The intraventricular hemorrhage was found in lateral, 3rd, and 4th ventricles. MRI showed well enhancing intraventricular mass abutting choroid plexus in the trigone of the right lateral ventricle. CT angiography showed tortuous prominent arteries from choroidal artery in tumor. Her neurological status deteriorated to stupor and contralateral hemiparesis during planned preoperative workup. Urgent transtemporal and transcortical approach with decompressive craniectomy for removal of intraventricular meningioma with hemorrhage was done. Grossly total removal of ventricular mass was achieved. Pathological finding was meningotheliomatous meningioma of World Health Organization (WHO) grade I. The patient recovered to alert mentality and no motor deficit after intensive care for increased intracranial pressure. However, visual field defect was developed due to posterior cerebral artery territory infarction. The visual deficit did not resolve during follow up period. Lateral ventricular meningioma with spontaneous intraventricular hemorrhage in pregnant woman is very uncommon. We report a surgical case of lateral ventricular meningioma with rapid neurological deterioration for intraventricular hemorrhage.

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This study will evaluate the outcomes of coiling versus clipping of unruptured anterior communicating artery (A-com) aneurysms treated by a hybrid vascular neurosurgeon to suggest the best protocol of management for these conditions. Methods: We retrospectively reviewed the records of 70 patients with an unruptured A-com aneurysm treated with coiling or clipping performed by a hybrid vascular neurosurgeon between March 2012 and December 2019. The patients were dichotomized, into the coil group or clip group. Treatment-related complications, clinical and radiological results were evaluated. Results: Of the 70 patients identified, 37 underwent coiling and 33 clipping. Procedure-related symptomatic complications occurred in 2 patients (5.4%) in the coil group and 3 patients (9.1%) in the clip group. Poor clinical outcome (modified Rankin Scale [mRS] of 3 to 6) at 6 months of follow-up was seen in only one patient (2.7%) for the coil group, and none for the clip group. The one poor outcome was the result of intra-procedural rupture during coiling. Follow-up conventional angiography data (mean duration, 15.0 months) revealed that the major recanalization rate is 5.6% for the coil group and 10.0% for the clip group. Conclusions: Management of A-com aneurysms requires more collaboration between microsurgical clipping and endovascular therapy. Evaluation of patient and aneurysm characteristics by considering the advantages and disadvantages of both techniques could provide an optimal treatment modality. A hybrid vascular neurosurgeon is expected to be a proper solution for the management of these conditions.

The purpose of this report was to present successful cases and technical notes of the patients with up migrated cervical disc herniation to the upper level who were successfully treated using anterior cervical discectomy and fusion (ACDF), describing the evaluation of treatment outcomes and perioperative complications. The cases of two patients who had ACDF in symptomatic up migrated cervical disc herniation to the upper level in February 2021 and November 2021 were reviewed. Two patients presented with a six-week history of posterior neck pain and radiating pain. Preoperative magnetic resonance imaging (MRI) confirmed a diagnosis of up migrated cervical disc extrusion. The patients were admitted to Daegu Wooridul Spine Hospital in Daegu, Korea. ACDF was performed under general anesthesia. Treatment outcomes were examined by comparing pre and postoperative Numeric Rating Scale (NRS), and MRI. Treatment outcomes were favorable: posterior neck pain and radiating pain showed a significant reduction in NRS. Postoperative MRI showed that the up migrated discs were successfully removed in both cases. Neither patient developed perioperative complications. Anterior cervical discectomy can be feasible in patients with symptomatic up migrated cervical disc herniation to the upper level.

This report aimed to present successfully treated cases of lumbar spinal stenosis coexisting with mild segmental instability and vertebral body fracture. Two patients presented with chief complaints of sciatica and back pain that had lasted for 2 months. Preoperative images revealed lumbar spinal stenosis with mild segmental instability and compression fracture. Interspinous ligamentoplasty was done under general anesthesia. Treatment outcomes were assessed by numeric rating scale (NRS) scores, postoperative magnetic resonance imaging (MRI), and X-ray examinations. Favorable treatment outcomes were observed: Sciatica and back pain improved and the patients’ NRS scores also improved. Postoperative MRI showed sufficient decompression, and X-rays showed stabilization at the index level. Postoperative complications were not reported. Interspinous ligamentoplasty can be a good surgical option for lumbar spinal stenosis that coexists with mild segmental instability and vertebral body fracture.