BACKGROUND Endoscopic-microvascular decompression (E-MVD) is a well described treatment for trigeminal neuralgia (TGN), but there has been debate of the safety of intraoperative sacrifice of the petrosal vein (PV) due to concern for subsequent venous insufficiency.  https://www.selleckchem.com/products/quinine-dihydrochloride.html  OBJECTIVE To investigate the risk of PV sacrifice during E-MVD in TGN and subsequent post-operative complications and pain outcomes. METHODS A five-year review yielded 201 patients undergoing MVD for TGN. PV sacrifice, vascular compressive anatomy and post-operative complications attributable to venous insufficiency were analyzed. Preoperative and postoperative pain outcomes were analyzed. RESULTS PV was sacrificed in 118/201 (59%) of patients, with 43/201 (21%) of patients undergoing partial sacrifice versus 75/201 (37%) with complete sacrifice. No cases of venous infarction, cerebellar swelling, or fatal complications were noted in either cohort. Non-neurologic complications occurred in 1.69% (2/118) of patients with PV sacrifice and 0% (0/83) of patients with PV preservation. Neurologic deficits (facial palsy, conductive hearing loss, gait instability, memory deficit) occurred in equal proportions in PV preservation and sacrifice groups (2.41% vs 1.69%) Overall, 87.3% (145/166) patients reported their pain as "very much improved" or "much improved" at one month, and no difference between groups was identified. CONCLUSIONS This study did not find higher complication rates in patients undergoing petrosal vein sacrifice during E-MVD for trigeminal neuralgia. In this series where petrosal vein was sacrificed only 59% of the time, it appears to be a safe technique, but larger studies will be needed to determine true incidence of complications following PV sacrifice. BACKGROUND Osteoradionecrosis (ORN) refers to the degenerative changes seen in bone following local radiation, particularly in head and neck cancer. ORN can present as neck or facial pain and may be confused with tumor recurrence. Magnetic resonance imaging (MRI) and positron emission tomography (PET) scans are often inconclusive, requiring percutaneous biopsy to differentiate ORN from infection and recurrent disease. We reviewed the utility of pre-procedural imaging in guiding the decision to biopsy in cases of ORN. CASE DESCRIPTION Eight patients with a history of prior head and neck cancer, radiation therapy and suspected ORN at the skull base, OC junction, and atlantoaxial spine were identified retrospectively from a single academic medical center. In four cases, MRI findings and PET imaging were negative for recurrence. One patient in this group underwent an aborted biopsy. Four patients had MRI concerning for infection or recurrent tumor with PET-positive lesions. Three patients in this group underwent biopsy that was negative for recurrent tumor. One patient developed an arteriovenous fistula after biopsy. The fourth patient was observed and did not demonstrate progression at 5 months. At last follow-up for all patients, there was no evidence of tumor recurrence or metastasis at the index site to indicate a misdiagnosis for recurrent tumor. CONCLUSIONS This case series highlights that PET scanning may not be useful in predicting which patients will benefit from biopsy for ORN, as no patients with PET-positive lesions had histopathological evidence of tumor recurrence or metastasis on biopsy. BACKGROUND Meningioma, a neoplasm of the meninges, is usually a benign localized tumor. Extraneural metastasis is an extremely rare complication of meningiomas, and only a few cases have been reported to date. The present study reports a case of scalp metastasis of an atypical meningioma and discusses the types of atypical meningiomas and their management options. CASE DESCRIPTION A 69-year-old man presented with scalp metastasis of an atypical meningioma. Six years after the right frontoparietal meningioma lesion was completely resected, an isolated subcutaneous metastasis developed at the right frontal region of the scalp, originating at the scar left by the first surgery. Postoperative histological examination of the subcutaneous tumor revealed the features of an atypical meningioma. CONCLUSIONS This study highlights that resection of meningiomas is still associated with a risk of iatrogenic metastasis. Surgeons should carefully wash out the operative field and change surgical tools frequently to avoid the potential risk of metastasis. BACKGROUND Cerebral vasospasm (CVS) following clipping of an unruptured aneurysm is a rare phenomenon. When it does occur, CVS usually occurs on the side ipsilateral to the surgical intervention. CASE DESCRIPTION Here, we report the case of a 68-year-old male who underwent right-sided pterional craniotomy for clipping of an unruptured, anterior communicating artery aneurysm and experienced contralateral vasospasm five days later. CONCLUSIONS We further discuss the pathophysiology underlying vasospasm after uncomplicated craniotomy and non-hemorrhagic aneurysm clipping. BACKGROUND Petroclival tumors and ventro-lateral lesions of the pons present unique surgical challenges. Our cadaveric study provides qualitative and quantitative anatomic comparison for an anterior petrous apicectomy through the transcranial middle fossa (TMF) and expanded endoscopic transphenoidal-transclival (EETT) approaches. METHODS In 10 silicone-injected heads, the petrous apex and clivus were drilled extradurally using middle fossa and endonasal approaches. With in situ and frameless stereotactic navigation, we defined consistent points to compare working areas, bone removal volumes, approach angles, and surgical freedom. RESULTS Mean exposed TMF area (21.03 ± 3.46 cm2) achieved a 44.71 ± 4.13° working angle to the brainstem between cranial nerves (CNs) V and VI. Kawase's rhomboid area measured 1.76 ± 0.34 cm2 and bone removal averaged 1.20 ± 0.12 cm3 at the petrous apex. Surgical freedom on the lateral brainstem was higher halfway between CNs V and VI at the center of the rhomboid compared to midline at the basilar sulcus (P less then 0.01). After clivectomy and petrous apicectomy, mean exposed EETT area was 5.29 ± 0.66 cm2. Approach from either nostril showed no statistically significant differences in surgical freedom at the foramen lacerum and midpoint basilar sulcus. At the petrous apex, bone volume removed and area exposed were significantly larger for TMF approach (P less then 0.001). CONCLUSIONS Expanded transclival anterior petrosectomy through the TMF approach provides an adequate corridor to lesions in the upper ventro-lateral pons. The EETT approach better fits midline lesions not extending laterally beyond CN VI and C3 carotid when evaluating normal anatomical parameters.