VNS therapy is combined with a wide spread of possible complications. Technical problems are to be expected, including electrode fracture, dislocation, and generator malfunction. The major complication in younger patients is the electrode fracture, which might be induced by growth during adolescence. Surgically induced complications of VNS implantation are comparably low. Cardiac symptoms and recurrent nerve palsy need to be taken into consideration.

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Hematomas in the lumbar ligamentum flavum are rare and may generate signs and symptoms of lumbar nerve root compression or neurogenic claudication similar to the far more common degenerative diseases. The pathogenesis of these hematomas is unclear. Ruptured irregular vessels of the degenerated and hypertrophic ligamentum flavum were assumed. We diagnosed three patients with a flavum hematoma intraoperatively leading to radicular complaints and spinal claudication. One occurred as a complication of local infiltration therapy, and the other two patients reported minor trauma as the releasing factor. Using spinal magnetic resonance imaging, a preoperative diagnosis is possible but the differentiation to synovial cysts is difficult. Surgical resection of the ligamentum flavum, including the hematoma, provided adequate treatment in these patients.

One-screw fixation might be used as an alternative to two-screw fixation. Assumed BMD should not influence surgical decision making.

Background: Cerebrospinal fluid (CSF) leaks are well-known and frequent complications of intracranial procedures. Numerous studies have focused on the clinical aspects of incidence, risk factors, outcome, treatment, and prevention; however, large prospective multicenter studies are missing. The aim of this study was to prospectively analyze the rate of CSF leaks and their causes. Method: A total of 545 patients with a variety of intracranial procedures (elective and trauma) were recruited in a multicenter, prospective, observational study over a 12-month period. Results: In 545 cranial surgeries, we observed a CSF leak rate of 7.7% (n=42) at the time of discharge from the hospital. Significant risk factors for CSF leaks were posterior fossa surgery, opened pneumatized spaces, patients younger than 66 years, size of craniotomies, craniectomies rather than craniotomies, remaining dura defects larger than 1 cm, and wound closure without using muscle sutures, continuous locked, or unlocked sutures. Non-significant risk factors for CSF leaks were revision craniotomies, craniotomies for different pathologies, previous radiotherapy and/or systemic chemotherapy, augmentation of dura sutures with various materials, and wound drains as well as temporary CSF drains. Conclusion: Despite the number of techniques and developments for dural closure, the problem of CSF leaks remains evident and further improvement has to be made.