With worsening clinical picture, he was transitioned to comfort care and passed away. CONCLUSION This is the first report in literature describing global vasospasm and delayed cerebral ischemia in a patient carrying COL4A1 mutation, following hemispherectomy. Despite minimal residual postoperative subarachnoid hemorrhage burden, we postulate that his COL4A1 gene mutation might have resulted in this exaggerated vasospasm. This needs to be studied in animal models of this genetic disorder. OBJECTIVE Objective of this study is to review the types of IDs occurred during the endoscopic stenotic lumbar decompression through interlaminar approach(ESLD) and discuss the management strategies according to our classification. MATERIALS AND METHODS A retrospective evaluation was performed for patients with spinal stenosis who underwent ESLD. Out of 330 patients, 27patients of ID were clinically evaluated pre and postoperatively on the basis of a Visual Analogue Scale (VAS) score, Oswestry Disability Index(ODI)and MacNab's criteria. ID patterns are classified according to the size, location and involvement of neural elements. Intra- and post-operative surgical management were evaluated. RESULTS Intra-operative incidence of ID was 8.2%. According to lumbar levels, 11 (40.7%) occurred at L3-4, 12(44.4%) at L4-5 and 4(14.8%) at L5-S1 ID cases. ID's divided into 4 types, 29.6% are type 1, 70% are type 2, 7.4% are type 3 and 3.7% are type 4. Overall for mean and standard deviation preoperative, 1 week post-operative, 3 months and final follow up for VAS are 7.6±1.4, 3.3±1.1, 2.6±1.1, 1.9±1.3 and for ODI are 74.5± 9.0, 32.3±9.4, 27.3±7.2, 24.4±6.5 after Patch Blocking Dura Repair of ID. CONCLUSION ID is a more common surgical complication in ESLD compared to transforaminal approach. Endoscopic Patch Blocking Dura Repair technique should be considered in type 1 to type 3A of dura tear with good prognosis and clinical outcome. Consideration is made for conversion to open repair in type 3B, C and 4 dura tear with fair to poor outcome. BACKGROUND Recent molecular investigations for craniopharyngiomas have investigated possible predictive biological markers. Growth hormone receptor (GHR) is thought to be involved in tumor aggressiveness, and high expression of GHR is associated with shorter duration of postoperative stable disease. CASE DESCRIPTION A 27-year-old man with a large suprasellar tumor underwent an inexplicable clinical course, illustrating the remaining diagnostic problems and implications for surgical strategy. Transsphenoidal surgery achieved gross total removal of the tumor. Histological diagnosis was adamantinomatous craniopharyngioma and immunohistochemistry revealed very low GHR expression. He was discharged with multiple hormonal supplements except for growth hormone (GH).  https://www.selleckchem.com/pharmacological_epigenetics.html  Eighteen months later recurrence was detected, and second tumor removal was performed with coagulation of the superior surface of the remaining pituitary gland. GH supplementation was started in the following period and he could return to employment. However, further recurrence was detected. Head magnetic resonance imaging showed almost the same pattern of tumor recurrence as preoperative imaging of the second surgery, and simultaneous removal of the tumor and the normal pituitary gland was performed. Re-evaluation of histology revealed no morphological differences between the first and the third surgical specimens, but immunohistochemical staining for GHR showed diffuse and high expression in the third specimen. The difference was thought to reflect the heterogeneity of GHR, and appearance of histological hot spots could greatly affect the postoperative prognosis. CONCLUSION Extensive removal of the possible tumor bed may be necessary for patients requiring GH supplementation even after gross total removal of craniopharyngioma. BACKGROUND This report presents the third case of trochlear schwannoma arising from the pineal region and the first case to be resected using a paramedian infratentorial supracerebellar approach. Schwannomas of cranial nerves have traditionally been thought to arise from the transitional point where the axonal envelopment switches from glial cells to Schwann cells; however, recent temporal bone histopathologic evidence from vestibular schwannomas challenges this view. Of the 38 cases of pathology-confirmed trochlear schwannoma in the literature, there are only 2 cases arising from the pineal region, where the nerve sheath transition zone is located. Here, we discuss an unusual case of trochlear schwannoma arising from this transition zone. CASE DESCRIPTION A 65-year-old man was admitted to our institute after a traffic accident. He complained of headache and dizziness, and a computed tomography scan revealed an isodense mass in the pineal region with obstructive hydrocephalus. Magnetic resonance imaging with contrast showed an enhancing mass in the pineal region. The tumor was subtotally resected using a paramedian infratentorial supracerebellar approach, and pathology confirmed the diagnosis of trochlear schwannoma. CONCLUSIONS Trochlear schwannoma should be considered when a mass is identified in the pineal region. This diagnosis should still be entertained for mass lesions along the free tentorial edge because the tumor may arise distant from the glial-Schwann transition zone located by the dorsal midbrain. We propose a treatment algorithm for this rare tumor that seeks to maximize functional outcome. The chronic inability of alcoholics to effectively cope with relapse-inducing stressors has been linked to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and corticotropin-releasing factor (CRF) signaling. However, the cellular mechanisms responsible for this dysregulation are yet to be identified. After exposure of male Sprague Dawley rats to chronic intermittent ethanol (CIE; 5-6 g/kg orally for 35 doses over 50 days) or water, followed by 40-60 days of protracted withdrawal, we investigated CIE effects on glutamatergic synaptic transmission, stress-induced plasticity, CRF- and ethanol-induced NMDAR inhibition using electrophysiological recordings in parvocellular neurosecretory cells (PNCs) of the paraventricular nucleus. We also assessed CIE effects on hypothalamic mRNA expression of CRF-related genes using real-time polymerase chain reaction, and on HPA axis function by measuring stress-induced increases in plasma adrenocorticotropic hormone, corticosterone, and self-grooming. In control rats, ethanol-mediated inhibition of NMDARs was prevented by CRF1 receptor (CRFR1) blockade with antalarmin, while CRF/CRFR1-mediated NMDAR blockade was prevented by intracellularly-applied inhibitor of phosphatases PP1/PP2A, okadaic acid, but not the selective striatal-enriched tyrosine protein phosphatase inhibitor, TC-2153.