Background and Objectives: Idiopathic normal pressure hydrocephalus (iNPH) primarily affects older patients. Ventriculoperitoneal (VP) shunt surgery is a standard treatment. Many iNPH patients have high cardiovascular risks and require aspirin (ASA) therapy to prevent thromboembolic events. Discontinuing ASA increases the risk of these events. This study evaluates the impact of perioperative ASA use on hemorrhagic complications in iNPH patients undergoing VP shunt surgery. Methods: This retrospective cohort study included patients who underwent VP shunt surgery for iNPH from January 2020 to September 2024. Patients were divided into two groups based on perioperative ASA use: no ASA ( n = 50) and ASA continued ( n = 51). Data collected included demographics, surgery details, ASA dosage, and indications for ASA use. Primary outcomes were early and late postoperative hemorrhage incidences. Postoperative follow-up included MRI or CT scans at regular intervals (mean ≈ one year). Statistical analyses were performed using SPSS version 23.0, with Chi-square tests and independent samples t-tests or Mann–Whitney U tests used to analyze differences between groups. Results: The study cohort had 101 patients with a mean age of 69.5 ± 7.6 years, 41.6% female and 58.4% male. Early postoperative hemorrhage occurred in 5% of patients, including epidural (1), intraparenchymal(3), and intraventricular hematoma(1). Late postoperative hemorrhages occurred in 4% of patients ( 4 patients in the no-ASA group), with two cases each of unilateral and bilateral subdural hematoma. No significant differences in hemorrhagic outcomes were observed between the ASA continuation and non-use groups ( p = 0.092). The mean follow-up period was 300 days. One patient died in non-ASA group due to neurodegenerative disease. Conclusion: Perioperative ASA use does not significantly impact the incidence of postoperative hemorrhages in iNPH patients undergoing VP shunt surgery. These findings suggest that ASA can be safely continued without increasing hemorrhagic risks. This is a particularly significant issue for patients with high cardiovascular risk.

Rapid identification of the type and origin of a stroke is crucial for prompt and appropriate treatment, which can significantly influences patient outcomes. We report a multidisciplinary management case involving a 76-year-old man who presented with left-sided weakness and mild dysarthria. Imaging revealed a completely occluded right internal carotid artery. Despite multiple endovascular recanalization attempts, adequate flow could not be achieved, leading to the decision to perform an open thrombo-endarterectomy. The patient underwent carotid endarterectomy with microsurgical techniques under general anesthesia. The atheroma plaque and central thrombus were removed, which reestablished flow. Continuous intraoperative neuromonitoring was utilized to ensure patient safety. The patient woke up without new deficits and was discharged for rehabilitation. Follow-up imaging confirmed arterial patency, and the patient eventually made an excellent recovery, including being independent over one and a half years. Emergent recanalization with carotid endarterectomy following a failed endovascular recanalization is both safe and feasible, emphasizing the need for collaboration between different treatment providers to ensure optimal patient outcomes. Our report highlights the importance of a multidisciplinary approach and the advantages of a hybrid operating room in the treatment of acute complete carotid artery occlusion.

Background/Objectives: Translabyrinthine (TL) surgery is established for vestibular schwannomas, but its role in a homogeneous posterior petrous face meningioma (PPFM) cohort remains undefined. We characterized surgical, functional, and oncological outcomes and associations with extension and tumor burden. Methods: We retrospectively reviewed 14 patients undergoing TL-only resection at a single institution (2006–2024). Petrosal zones (anterior, middle, posterior) were modeled independently. Outcomes included extent of resection, Simpson grade, complications, tumor control, House–Brackmann (HB) facial nerve (FN) grade, modified Rankin Scale (mRS), and Glasgow Outcome Scale (GOS). Results: Preoperatively, 10 (71.4%) had non-serviceable or absent hearing, and the median diameter was 33.5 mm. Gross or near-total resection was achieved in 85.7% (median extent, 96.2%). At 1 year, 13 of 14 (92.9%) had HB I–II, including all 12 with favorable preoperative function; all had favorable outcomes (mRS 0–2; GOS 4–5). Over a median 65.5-month follow-up, one recurrence and three regrowths occurred, with five patients (35.7%) receiving adjuvant radiation. In exploratory analyses, anterior involvement was associated with a lower likelihood of Simpson grade 1–2 resection (p = 0.025), but not with volumetric extent; tumor diameter correlated with complication burden (ρ = 0.585; p = 0.028), and tumor volume correlated with operative duration (ρ = 0.607; p = 0.021) and hospital stay (ρ = 0.753; p = 0.002). Conclusions: In this first TL-only PPFM series, FN and functional outcomes were favorable and tumor control was acceptable under multimodal management. These findings describe outcomes achievable through the TL corridor in appropriately selected patients rather than an advantage over alternative approaches. Exploratory associations between anterior extension, tumor burden, and outcome require confirmation in larger cohorts.