Background: Chronic subdural hematomas (CSDHs) usually occur late in adults and older after mild head trauma. Surgical intervention is the first treatment option in CSDH with conservative management being adopted in few cases. Case Description: We report a case of a 71-year-old man who presented a spontaneous resolution of a large CSDH. He presented with a difficulty of speech and an ataxic gait. Head (computed tomography scan) showed a low-density lesion located in the right frontal-temporal-parietal region. Conclusion: In this report, we discuss the spontaneous resolution of a large CSDH in elderly patients, without surgical intervention. Gradually, several successful nonsurgical therapies for the treatment of these hematomas are reported, although further studies are essential to establish the role of these nonsurgical treatments of CSDHs.

Background: Congenital anomalies of the atlas are rare and usually occur in conjunction with other congenital variants. They include a wide spectrum of anomalies ranging from clefts to hypoplasia or aplasia of its arches that may contribute to spinal cord compressive syndrome. Case Description: A 54-year-old male presented with the sudden onset of a severe quadriparesis and loss of proprioception after a minor fall. The magnetic resonance (MR) scan showed cord compression at the C1 level attributed to C1 arch hypoplasia. Two months following a decompressive C1 laminectomy without fusion, and the patient was symptom free. Conclusion: Posterior C1 arch hypoplasia is a rare anomaly that can contribute to cervical cord compression and myelopathy. The optimal surgical management may include, as in this case, a posterior decompression without fusion.

Anterior clinoidectomy (AC) is a key microsurgical step for the safe and successful management of parasellar pathologies that involve the anterior clinoid process (ACP) and the optic canal. Traditionally, extra and intradural ACs are performed separately according to the surgeon's experience or preference. The objective is to present and discuss the tailored AC concept through illustrative cases. We conducted a retrospective record review of three patients who underwent AC as a surgical step for the treatment of parasellar pathologies that involve the ACP and optic canal. A review of the relevant literature on AC was performed in the PubMed, LILACS, and SciELO databases. In all three cases, the pterional craniotomy was the preferred approach for AC. Case 1, a 47-year-old female patient with type III anterior clinoidal meningioma, underwent a tailored intradural technique (optic canal unroofing) with total tumor resection and complete visual recovery. Case 2, a 63-year-old female patient with a complex type II anterior clinoidal meningioma with extensive hyperostosis of the ACP, underwent a hybrid AC technique with complete removal of the tumor and visual improvement. Case 3, a 62-year-old female, underwent a tailored intradural AC for clipping an incidental carotid-ophthalmic aneurysm. Tailored AC aims to provide adequate exposure with less risk of neurovascular injury, allowing enough space to safely treat parasellar lesions. The type, size, and location of the lesion, as well as the surgeon’s experience, should always be considered for surgical planning.

Background: Anterior clinoidal meningiomas are heterogeneous types of lesions that comprise the parasellar lesions group. Due to their close relationship with the optic nerve and internal carotid artery, they become challenging pathologies for neurosurgeons. Case Description: Female 47, presented with superior temporal quadrantanopsia on the right side. Magnetic resonance image revealed type III clinoidal meningioma on the right side. She has undergone a pterional craniotomy for an optic canal unroofing and tumor extraction. Two years of postoperative follow-up the patient underwent a campimetry, which revealed an almost complete visual improvement. Conclusion: To date, the best surgical technique has not yet been defined, so the choice of treatment and surgical technique is based on each case and on the surgeons’ experience.

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