Background: Spinal epidural arachnoid cysts (SEACs) are rare, accounting for ~1% of all spinal tumors. While often incidental, large cysts may compress nerve roots or the spinal cord, leading to motor or sensory deficits. The etiology and pathophysiology of these conditions remain unclear, and no standardized management guidelines exist. Surgical treatment is indicated for symptomatic cases, with dural defect repair essential to prevent recurrence. Case Description: A 25-year-old female presented with paraparesis and intermittent leg pain of one month’s duration. Thoracolumbar magnetic resonance imaging revealed a cystic lesion extending from T11 to L1 with T2 hyperintensity similar to cerebrospinal fluid (CSF). She underwent hemilaminectomy with complete cyst resection and dural defect repair. Postoperatively, the patient demonstrated progressive neurological recovery without complications. Conclusion: SEACs are rare lesions that may cause significant neurological symptoms if untreated. For symptomatic cases, complete cyst excision with dural repair is the preferred management to prevent recurrence and achieve favorable outcomes.

A BSTRACT Traumatic optic neuropathy (TON) is a serious complication of craniofacial trauma that can result in irreversible vision loss. For decades, conservative management with high-dose corticosteroids has been the primary treatment strategy. However, a substantial proportion of patients fail to respond to steroid therapy, prompting increasing use of endoscopic optic nerve decompression (EOND) as a surgical intervention aimed at reducing secondary optic nerve injury and improving visual outcomes. This systematic review aims to evaluate the effectiveness of EOND in improving the visual acuity outcomes in patients with TON and to identify the prognostic factors influencing surgical success. A systematic review was conducted in accordance with PRISMA guidelines. Comprehensive searches of PubMed, MEDLINE, and the Cochrane Library were performed to identify case reports, cohort studies, and clinical trials assessing visual outcomes following EOND in TON patients. Data extraction and methodological quality assessment were independently conducted by reviewers. Nineteen studies met the inclusion criteria. The transnasal sphenoethmoidal approach was the most commonly employed surgical technique. Patients who underwent surgery within 7 days posttrauma demonstrated significantly better visual improvement (63.6%) compared to those operated on after 7 days (35.7%). Patients with residual vision had superior outcomes (78.6%) compared to those presenting with no light perception (38.2%). Cerebrospinal fluid leakage was the most frequently reported complication and generally resolved within 1–2 weeks. EOND is associated with meaningful visual recovery in selected patients with TON, particularly when performed early. Surgical intervention within 7 days of trauma is recommended when no visual improvement is observed after 2–3 days of corticosteroid therapy. Early decompression may mitigate secondary optic nerve damage and improve the long-term visual prognosis.

Background: Intracranial dermoid cysts are rare congenital inclusion cysts derived from ectodermal elements and account for a very small proportion of intracranial lesions. Although they are usually slow-growing and may remain clinically silent for years, they can become symptomatic once they exert mass effect or obstruct cerebrospinal fluid pathways. Posterior fossa involvement is uncommon, and delayed clinical presentation may occur despite long-standing lesion growth. This report describes a posterior fossa dermoid cyst causing obstructive hydrocephalus in an adolescent patient and highlights the radiological, histopathological, and surgical considerations relevant to its management. Case Description: The patient, a 16-year-old female, presented with a 3-year history of progressive visual impairment, daily vomiting, fatigue, and loss of appetite. Radiological studies, including computerized tomography and magnetic resonance imaging scans, revealed a midline cystic lesion within the fourth ventricle, leading to active obstructive hydrocephalus. Clinical manifestations included signs of increased intracranial pressure and fourth ventricle narrowing. Histopathological examination of tissue fragments from the cyst wall demonstrated a lining of squamous epithelium with evidence of parakeratosis. Furthermore, the necessity for careful consideration of surgical techniques is underscored, as dermoid cysts could exhibit adherence to arachnoid tissue. Intraoperatively, the lesion was approached through a posterior fossa craniotomy, and cyst decompression/ excision was performed with careful microsurgical dissection because the capsule was adherent to surrounding arachnoid and neural structures. Conclusion: This report emphasizes the significance of early diagnosis and surgical intervention in managing the intricate challenges posed by posterior fossa dermoid cysts.

While cerebrospinal fluid (CSF) diversion procedures following primary intracranial tumors resection are commonly employed, precise indications in pediatric population remain unclear. This study aims to establish evidence-based indicators for CSF diversion in this population. Systematic searches of ScienceDirect, Medline, and Cochrane databases identified longitudinal studies up to April 2024. Analysis compared risk factors for CSF diversion based on preoperative parameters, surgical technique, tumor characteristics, and postoperative parameters. Subgroup analysis considered ethnicity, tumor location, and presenting hydrocephalus. Our meta-analysis of 7 cohort studies included 844 children (mean age 7.30 ± 1.05 years) with a mean tumor volume of 27.90 ± 14.56 cm3. Preoperative hydrocephalus (OR 2.91, 95

Introduction Cushing and Eisenhardt first classified globoid sphenoid wing meningiomas (SWM) into medial, middle and lateral groups. The authors examined 29 consecutive patients with globoid shape SWMs that were surgically treated by the senior author (NG). Based on our results, we would like to modify Cushing's classification system of globoid SWM. Methods All patients who had undergone surgery at two hospitals between 2000 and 2017 were identified. All data from different tumor locations along the sphenoid ridge were compared to determine whether these tumors had different behaviors in presenting symptoms, surgical observation and post-op surgical outcomes. Results All 29 consecutive patients with globoid shape of SWM underwent microsurgical resection during this period. The rates of cavernous sinus (CS) invasion (medial 46.1%, lateral 0%, pterional 0%; p 0.01) and vascular encasement (medial 76.9%, lateral 36.3%, pterional 0%; p 0.008) were all highest in medial SWMs. Gross total removal (GTR) was found less in medial SWMs (medial 23%, lateral 63.6%, pterional 100%; p 0.008). Complication rate was higher in medial SWMs (medial 53.8%, lateral 18.1%, pterional 20%, p 0.04). Visual impairment was higher in medial SWMs (medial 92.3%, lateral 36.3%, pterional 40%; p 0.01). Conclusion The authors report different entities of meningiomas located along the sphenoid wing, including the presenting symptoms, imaging studies, microsurgical observation, extension of surgical resection, surgical outcome and surgical complication. Our results support the idea to modify Cushing's classification system.

Primary intracranial malignant melanoma (PIMM) is an exceedingly rare central nervous system tumor, accounting for only 1% of melanoma cases and 0.07% of primary CNS tumors, with limited documentation in adolescents. This case report describes an 18-year-old male who presented with a seizure, marking the onset of his symptoms. Following an emergency assessment, MRI identified a heterogeneous mass in the right parasagittal frontal region, initially misdiagnosed as a cystic meningioma. A craniotomy allowed for total tumor resection, and histopathological analysis revealed a malignant melanoma characterized by neoplastic cells with pronounced nuclear pleomorphism and significant mitotic activity. Postoperative evaluations, including a PET scan, confirmed no extracranial melanoma, affirming the diagnosis of primary CNS melanoma. The patient demonstrated no neurological deficits or seizures one year post-surgery and was managed with adjuvant radiotherapy. This report emphasizes the necessity of considering PIMM in differential diagnoses for seizures in young patients and highlights the importance of comprehensive diagnostic evaluations, including MRI and histopathology, in rare cases. Additionally, the findings underscore the critical role of complete surgical resection in improving outcomes, with adjuvant therapies potentially enhancing long-term management and surveillance. As PIMM presents with nonspecific symptoms, awareness among clinicians is essential for early detection and appropriate intervention, warranting further research to develop standardized treatment protocols and enhance understanding of this rare tumor's pathophysiology.

Primary intracranial cholesteatomas are rare, benign lesions of keratinizing squamous epithelium, often arising from middle ear extension. However, their occurrence in the thalamus is exceptionally rare, with only one prior case reported. A 48-year-old male presented with progressive headaches over 3 years and difficulty with upward gaze. Neurological examination revealed bilateral upward gaze palsy. Magnetic resonance imaging demonstrated an intra-axial cystic mass with a solid component in the right thalamus extending to the midbrain, causing obstructive hydrocephalus. A craniotomy with subtotal tumor resection was performed. Histopathology confirmed cholesteatoma. Postoperatively, the patient's symptoms improved, but hydrocephalus recurred, necessitating an endoscopic third ventriculostomy. Five months later, imaging showed an increase in residual mass size, but further, surgical intervention was declined due to financial constraints. The patient continued outpatient follow-up and maintained functional independence despite persistent symptoms. Thalamic cholesteatomas are rare and diagnostically challenging. Their deep-seated location complicates surgical resection, often necessitating subtotal removal to preserve neurological function. Close postoperative monitoring is essential due to the high recurrence risk. Further research is needed to optimize diagnostic strategies and explore alternative treatment approaches for these rare lesions.

Background:Traumatic brain injury (TBI) remains a leading cause of death and disability, particularly in younger populations, with significant clinical and socioeconomic burdens in both developed and developing countries. Despite extensive research, outcomes for TBI patients, especially those with subarachnoid hemorrhage (SAH), remain poor. Oxidative stress and ischemia, both typical sequelae of TBI, contribute to secondary brain injury, which worsens clinical outcomes. SAH exacerbates brain damage by degrading hemoglobin, forming oxyhemoglobin, and increasing oxidative stress. This cascade ultimately leads to lipid peroxidation, with malondialdehyde (MDA) as a key product. This study aims to evaluate the potential of elevated MDA levels as a prognostic biomarker for predicting poor clinical outcomes in patients with moderate-to-severe TBI complicated by SAH. Methods:This prospective cohort study included patients with moderate to severe TBI and SAH who were evaluated at RSUP Prof. Dr. I.G.N.G. Ngoerah Denpasar, Bali, Indonesia from January to June 2024. Serum MDA levels were tested at admission and classed as high or low using receiver operating characteristic (ROC) curve analysis. Additional clinical characteristics, such as demographic information and clinical condition, were also collected. Fifty-eight patients were followed for 3 months to determine clinical results, which were divided into two categories: good and poor. ROC curve analysis, descriptive statistics, proportion comparisons, and Cox regression were all performed using IBM Statistical Package for the Social Sciences version 26. Results:Patients with high MDA levels had a significantly higher mean age compared to those with low MDA levels (42.36 vs. 38.13 years). ROC analysis revealed that high MDA levels were a significant predictor of poor clinical outcomes in TBI patients with SAH, with an area under the curve of 0.714 (P = 0.0006). The relative risk for poor outcomes in patients with high MDA was 2.6 compared to those with low MDA (P = 0.004). Cox regression analysis confirmed that elevated MDA is an independent predictor of poor clinical outcomes in this patient population. Conclusion:Elevated serum MDA levels are a reliable biomarker for predicting poor clinical outcomes in patients with moderate to severe TBI complicated by SAH.

Neurenteric cysts, rare benign tumors, are most often found in the cervical or thoracic spinal cord, with intracranial occurrences being extremely uncommon. This case report describes a 52-year-old female with a neurenteric cyst in the cerebellopontine angle, presenting with headaches and balance disturbances. Magnetic resonance imaging (MRI) revealed a cystic lesion causing hydrocephalus, and surgical removal was performed using a retrosigmoid approach. Histopathological analysis confirmed the cyst as Type A neurenteric, characterized by ciliated columnar epithelium and goblet cells. Postoperatively, the patient showed significant improvement with resolved symptoms. Neurenteric cysts can mimic other cystic lesions radiologically, complicating diagnosis. Management typically involves surgical excision, although complete removal is often challenging due to cyst adherence to nearby structures. Recurrence rates remain high, necessitating long-term follow-up. This case highlights the importance of differential diagnosis and careful surgical planning in managing neurenteric cysts to optimize patient outcomes.

Background: Hirschsprung-Associated Enterocolitis (HAEC) is a life-threatening consequence of Hirschsprung Disease (HD) that was initially documented in the late 19th century. The occurrence of HAEC did not exhibit any changes from the preoperative phase to the postoperative phase and can manifest at any point from infancy to adulthood. To date, no research has been conducted on the factors influencing the occurrence of HAEC in Hirschsprung patients who undergo a one-stage procedure. Thus, this study aims to investigate the factors that influence the occurrence of HAEC in patients with Hirschsprung’s disease after undergoing a one-stage operation. Methods: This study is a retrospective cohort study. The study was carried out at RSUP Prof. Dr. I G.N.G. Ngoerah Denpasar Bali, examining the medical records of pediatric surgery patients for a period of three years (January 2019 to December 2021). Descriptive and bivariate statistical analyses are conducted. The bivariate test employed is the Chi Square Test, utilizing the assistance of statistical software called SPSS (Statistical Package for the Social Sciences) version 25.0. Results: The overall sample based on gender was 42 (75%) male patients in the HAEC group and 33 (63.5%) in the non-HAEC group. The findings of statistical analysis demonstrate that the difference between these groups is (p=0.193) with an RR value of 1.320 (95%CI: 0.846 – 2.060). The findings of the examination of the connection between patient age at diagnosis and the incidence of HAEC indicated that there were 39 (69.9%) patients with age >1 month at diagnosis in the HAEC group and 26 (50%) in the non-HAEC group. Based on analysis utilizing chi-square, a significant difference in percentage was discovered between patients aged < 1.5 months and above 1.5 months regarding the occurrence of HAEC (p=0.037). Multivariate analysis indicated significant findings for the variable age at diagnosis with an RR of 2.610 (95%CI: 1.129–6.031; p<0.05) while the lengthy segment had an RR of 12.702 (95%CI: 1.142 – 111.916; p<0.05). Conclusion: Patients with long segments and are diagnosed after 1 month of age have a higher chance of HAEC. Pendahuluan: Hirschsprung-associated enterocolitis (HAEC) merupakan komplikasi dari Hirschsprung disease (HD) yang mengancam nyawa dan pertama kali dideskripsikan pada akhir abad ke-19. HAEC dapat bermanifestasi kapan saja mulai dari bayi hingga dewasa. Sampai saat ini belum ditemukan adanya penelitian mengenai faktor-faktor yang mempengaruhi terjadinya HAEC pada pasien Hirschsprung yang menjalani prosedur satu tahap. Oleh karena itu, penelitian ini bertujuan untuk mengetahui faktor-faktor yang mempengaruhi terjadinya HAEC pada pasien penyakit Hirschsprung setelah menjalani operasi satu tahap. Metode: Penelitian ini merupakan penelitian kohort retrospektif. Penelitian dilakukan di RSUP Prof.Dr. I G.N.G. Ngoerah Denpasar Bali, menggunakan rekam medis pasien bedah anak periode tiga tahun (Januari 2019 – Desember 2021). Analisis statistik deskriptif dan bivariat dilakukan. Uji bivariat yang digunakan adalah Uji Chi-square dengan menggunakan bantuan software statistik SPSS (Statistical Package for the Social Sciences) versi 25.0. Hasil: Total sampel berdasarkan jenis kelamin adalah sebesar 42 (75%) pasien laki-laki pada kelompok HAEC dan 33 (63,5%) pada kelompok non-HAEC. Hasil analisis statistik menunjukkan bahwa perbedaan diantara kelompok ini (p=0,193) dengan nilai RR sebesar 1,320 (95%CI: 0,846 – 2,060). Hasil analisis hubungan antara usia pasien saat diagnosis dengan kejadian HAEC terdapat 39 (69,9%) pasien dengan usia >1 bulan saat diagnosis pada kelompok HAEC dan 26 (50%) pada kelompok non-HAEC. Berdasarkan analisis dengan menggunakan chi-square, didapatkan perbedaan proporsi yang signifikan antara pasien dengan usia dibawah 1,5 bulan dan diatas 1,5 bulan terhadap kejadian HAEC (p=0,037). Analisis multivariat menunjukan hasil yang signifikan pada variabel usia terdiagnosis RR 2,610 (95%CI: 1,129–6,031; p<0,05) sementara long segment sebesar RR 12,702 (95%CI: 1,142 – 111,916; p<0,05). Simpulan: Pasien dengan segmen yang panjang dan pasien yang terdiagnosis setelah usia 1 bulan memiliki risiko yang lebih tinggi mengalami HAEC.

Background: Penile curvature is caused by decreased elasticity of one or more fascial layers, leading to the shortening of one of the corpus cavernosum. The most common cause of penile curvature is chordee, but ventral curvature can also be found in men without hypospadias. The incidence of the ventral type is found to be higher than the other types at around 70-80%. Histopathology of inflammatory cells in the urethral plate (UP) and deep chordee (DC) is often found in hypospadias patients although the association with ventral penile curvature is unknown. Method: A cross-sectional study design was conducted by making one observation in each sample to determine the condition of the incidence of increased inflammation with ventral penile curvature. This study was conducted in Denpasar City Bali from May 2021 – May 2022 with the target of all hypospadias patients aged 0-18 years. Data analysis was performed with the help of SPSS for bivariate tests. Results: This study involved 100 respondents with hypospadias who had a mean age of 6.4 ± 3.8 years, the most curvature degree was severe > 300 which was 62%, and mild ≤ 300 as much as 36%. The degree of inflammation was found to be mild 89% and moderate 11%. Bivariate analysis using chi-square found no statistically significant between the degree of inflammation and the degree of penile ventral curvature in hypospadias patients (r=0.144; p=0.154). Conclusion: No correlation between the degree of inflammation of the tunica dartos chordee and the degree of ventral curvature of the penis in hypospadias patients.

Background: The most typical site of spinal cord damage is in the subaxial cervical region. Cervical stabilization and cord decompression are the surgical treatments. There is debate regarding when decompression should occur. The purpose of this study was to compare individuals with subaxial cervical spinal cord damage to gradual and early decompression. Methods: A systematic literature search was done on the online databases of MEDLINE, CENTRAL, and E.M.B.A.S.E. This review included articles comparing early and late decompression in subaxial cervical spinal cord injury with a 24-hour cut-off point. Meta-analysis was performed using the software Review Manager 5.4. Results: Systematic searching yielded 11 cohort articles and one randomized clinical trial. Postoperative neurological clinical improvement was higher in subjects who underwent early decompression (R.R. = 1.17; 95%CI = 1.03 – 1.34; p = 0.02). In central cord syndromes, incomplete and complete neurologic deficits, clinical neurologic improvement tended to be higher in subjects who underwent early decompression but not statistically significant. Length of stay in hospital was shorter in subjects who underwent early decompression (MD = 2.39; 95%CI = (-3.46) - (1.32); p < 0.0001). There was no complication difference between early and late decompression (R.R. = 0.98; 95%CI = 0.69–1.38; p = 0.89). Mortality tended to be lower in subjects in the late decompression group but not statistically significant (R.R. = 1.31; 95%CI = 0.87–1.98; p = 0.20). Conclusion: When decompression occurred within a day, patients with subaxial cervical spinal cord injuries experienced improved neurological recovery and shorter hospital stays.

The occurrence of ipsilateral hemiparesis in chronic subdural hematoma (SDH) is rare, with documented cases in literature being exceptionally scarce. This case marks the first reported ipsilateral hemiparesis associated with chronic SDH (CSDH). This unique presentation challenges conventional understanding and warrants investigating the underlying pathophysiological mechanisms of the possible Kernohan–Woltman notch phenomenon (KWNP). CSDH typically presents with neurological deficits corresponding to the side of the hematoma, manifesting as contralateral monoparesis due to compression of the ipsilateral cerebral hemisphere. Contralateral hemiparesis occurs when a lesion disrupts the motor pathways within the internal capsule. However, in this case, ipsilateral hemiparesis ensued due to the progressive nature of the CSDH, causing the contralateral cerebral peduncle to compress against the edge of the tentorium. A 63-year-old male patient presented with progressive loss of consciousness. The neurological examination revealed left hemiparesis and ipsilateral anisocoria. A head computed tomography scan suggested a left front-temporal-parietal-occipital CSDH with a marked midline shift 15.33 mm to the right and subfalcine herniation 1.5 cm to the right. KWNP was concluded. The patient showed a significant motor improvement on the third day of postoperative care. CSDH usually occurs among old patients following head trauma due to stretching of the bridging veins. Generally, contralateral monoparesis occurs as a result of the affected homunculus. Hemiparesis can occur when the hematoma extends to the entire homunculus. In contrast to the first clinical observations prior to the radiological diagnosis, our patient’s persistent SDH was observed on the ipsilateral side of the muscular weakness that was hypothesized to be the result of the KWNP. This phenomenon is associated with a herniation. Therefore, surgical outcomes are often poor; nevertheless, our patient’s result was excellent, with minimal neurological damage.

One of the most common causes of death in patients with traumatic brain injury who need urgent decompression surgery is acute subdural hematoma. Even after rigorous treatment and monitoring, the prognosis for patients with acute subdural hematoma is relatively poor. Hereby, we report a 7-month-old male baby with a traumatic acute subdural hematoma that had rapid improvement in clinical condition with a computed tomography scan of a spontaneous resolution of acute subdural hematoma within a day. Several possibilities are explained regarding the spontaneous resolution of acute subdural hematoma. This case can be used as a lesson for us regarding the conservative management of acute subdural hematoma.

Pilocytic astrocytoma is a type of low-grade glioma that can develop in any part of the central nervous system. It primarily affects individuals in the pediatric and young adult age groups. Optic nerve pilocytic astrocytoma is an uncommon, gradually developing type of brain tumor known as a glioma. It is categorized as a grade I tumor by the World Health Organization (WHO). We aim to report rare optic nerve pilocytic astrocytomas and discuss their clinical findings and interconnection with the current literature. A 7-year-old male patient exhibited left-sided eye proptosis and complete loss of vision. A magnetic resonance imaging (MRI) performed before surgery showed the presence of a tumor in the left eye socket. The mass has a spherical shape and smooth boundaries, resulting in the compression of the left optic tract from behind. The left optic tract appears darker on T1-weighted images and brighter on T2-weighted images. On contrast administration, there is heterogenous contrast enhancement. A total resection of the mass was performed. Histopathology results show pilocytic astrocytoma (WHO Grade I). Optic nerve pilocytic astrocytoma is a tumor that can affect the optic nerve pathway. Early diagnosis and multidisciplinary team management are required. Treatment must be individualized, and the options include chemotherapy, radiotherapy, and surgical intervention. Surgery is only recommended in cases of painful or disfiguring proptosis and exposure keratopathy in eyes with severe vision impairment

BackgroundPosterior clinoid process (PCP) meningioma is an exceedingly rare entity. It remains the most challenging skull base lesion for neurosurgeons due to its treacherous location that insinuates amongst critical neurovascular structures. This article will describe the technical notes using the endoscopic endonasal approach that provide the earliest devascularization and detachment of the tumor PCP meningioma.MethodsWe are introducing the surgical implementation of an endoscopic endonasal approach to removing PCP meningioma. Furthermore, we perform a literature review of posterior clinoid process meningioma that undergoes surgical intervention, then summarize the benefits and limitations of each approach.ResultsWe present a case of right PCP meningioma that was removed using an endoscopic endonasal approach through the transposterior clinoid corridor in a 52-year-old-woman. We describe the technical notes in performing this approach to have the earliest devascularization and detachment of the tumor by performing posterior clinoidectomy. Safe tumor removal is performed with a wide and clear view of the surrounding neurovascular structure. Based on our database search, we found nine articles reported on the surgical management of PCP meningiomas, with a total number of 15 cases. All of the reported cases performed the tumor removal using the transcranial approach.ConclusionThe endoscopic endonasal transposterior clinoid approach circumvents all disadvantages faced by the traditional transcranial approach, providing the earliest approach to devascularized and detaching the tumor from its attachment at PCP. This approach demonstrates safety and efficacy, making it an acceptable alternative for PCP meningioma resections.

Background: Immature teratomas are very rare in adults, especially in the suprasellar area, but they should be considered in the differential diagnosis, particularly when dealing with tumors located in the midline structure. Case presentation: In this study, we present a rare case of an immature teratoma in the suprasellar region of a 20-year-old male. A contrast-enhanced brain MRI revealed a multilocular cystic mass in the suprasellar area, accompanied by non-communicating hydrocephalus. To alleviate intracranial pressure, a shunting procedure was performed to redirect the cerebrospinal fluid. Moreover, tumor resection was carried out using an interhemispheric transcallosal approach. Conclusion: Histopathological examinations unveiled the presence of all three germ layers, followed by immature tissue, consistent with the features of an immature teratoma.

PURPOSE:Secondary (TN) caused by an arachnoid cyst in the (CPA) region is a rare finding. Based on the reported literature, there are only 5 cases of secondary trigeminal neuralgia caused by an arachnoid cyst in the cerebellopontine angle region.CASE REPORT:A 27-year-old female presented to our neurosurgery clinic with a 2-year history of brief episodes of paroxysm pain in the left cheek. The pain was described as an electric shock-like pain triggered by simple stimuli. The magnetic resonance imaging (MRI) showed a well-confined cystic lesion in the left CPA, which compresses the left pons and the cisternal segment of the left trigeminal nerve. The patient was managed operatively to fenestrate the cyst and decompress the trigeminal nerve. The histopathological result of the cyst wall was consistent with an arachnoid cyst. Six months after surgery, the patient is in good health condition and symptom-free without medication.CONCLUSION:Arachnoid cyst in the CPA region is one of the rare causes of secondary TN. Preoperative imaging with MRI is important to provide better results to differentiate the pathology. Surgical treatment to fenestrate the arachnoid cyst and decompress the trigeminal nerve have a good result and can improve the patient's quality of life.

Background:Cysticercosis, caused by the larval stage of Taenia solium, is a prevalent parasitic infection affecting the central nervous system, primarily in low-income countries. Surgical intervention becomes necessary when cysticercosis manifests within the ventricular system, with endoscopic techniques increasingly preferred over traditional microsurgical methods due to lower risks and morbidity. However, the microsurgical transcallosal approach, although effective, is infrequently used due to its associated high morbidity. Case Description:We present two cases of multiple intraventricular neurocysticercosis treated through an open microsurgical technique using a transcallosal interhemispheric approach. Patient 1, a 56-year-old male, presented with severe headaches persisting for 6 months, while Patient 2, a 54-year-old male, experienced a sudden decrease in consciousness. Both patients exhibited typical magnetic resonance imaging characteristics indicative of intraventricular neurocysticercosis, leading to the decision for surgical resection. Conclusion:Despite the transcallosal approach's decreased popularity due to associated risks, we achieved relatively good outcomes with minimal morbidity in both cases. Our experience highlights the importance of considering microsurgical approaches, particularly in facilities lacking endoscopic instrumentation, for the effective management of intraventricular neurocysticercosis. Compliance with postoperative medical therapy remains crucial to prevent recurrence.

Spinal meningioma is a benign tumor that arises from meninges. The incidence of the tumor is higher in women than men. Majority of meningiomas are considered to be histopathologically benign, with 80% of them graded as World Health Organization (WHO) grade 1 tumors. Only a small percentage are atypical (WHO grade 2) (5%–25%) or anaplastic (WHO grade 3) meningiomas (1%–5%). However, anaplastic meningiomas are relatively rare in the spinal region compared to intracranial locations. Anaplastic meningiomas are the most aggressive form of meningioma, especially in the spinal cord. Because of the rarity, there is very little information about the management of the tumor.