Background: Meniere’s disease (MD) is a disabling disease, especially in patients who are refractory to medical therapy. Moreover, selective vestibular neurectomy (VN), in these selected cases, can be considered a surgical alternative which preserves hearing function and facial nerve. Methods: We retrospectively studied 23 patients with MD diagnosis and history of failed extradural endolymphatic sac surgery (ELSS) who underwent combined micro-endoscopic selective VN, between January 2019 and August 2023, via a presigmoid retrolabyrinthine approach. All patients were stratified according to clinical features, assessing preoperative and postoperative hearing levels and quality of life. Results: At the maximum present follow-up of 2 years, this procedure is characterized by a low rate of complications and about 90% vertigo control after surgery. No definitive facial palsy or hearing loss was described in this series. One patient required reintervention for a CSF fistula. Statistically significant (p = 0.001) difference was found between the preoperative and the postoperative performance in terms of physical, functional, and emotive scales assessed via the DHI questionnaire. Conclusions: Selective VN via a presigmoid retrolabyrinthine approach is a safe procedure for intractable vertigo associated with MD, when residual hearing function still exists. The use of the endoscope and intraoperative neuromonitoring guaranteed a precise result, saving the cochlear fibers and facial nerve. The approach for VN is a familiar procedure to the otolaryngologist, as is lateral skull base anatomy to the neurosurgeon; therefore, the best results are obtained with multidisciplinary teamwork.

Brain metastases (BMs) represent the most frequent brain tumors in adults. The identification of key prognostic factors is essential for choosing the therapeutic strategy tailored to each patient. Epilepsy can precede several months of other clinical presentations of BMs. This work aimed to study the impact of epilepsy and other prognostic factors on BMs patients’ survival. This retrospective study included 51 patients diagnosed with BMs and who underwent neurosurgery between 2010 and 2021. The impact of BM features and patient’s clinical characteristics on the overall survival (OS) was analyzed through uni- and multivariate analysis. The average OS was 25.98 months and differed according to the histology of the primary tumor. The primary tumor localization and the presence of extracranial metastases had a statistically significant impact on the OS, and patients with single BM showed a superior OS to those with multifocal lesions. The localization of BMs in the temporal lobe correlated with the highest OS. The OS was significantly higher in patients who presented seizures in their clinical onset and in those who had better post-surgical Karnofsky performance status, no post-surgical complications, and who underwent post-surgical treatment. Our study has highlighted prognostically favorable patient and tumor factors. Among those, a clinical onset with epileptic seizures can help identify brain metastasis hitherto silent. This could lead to immediate diagnostic-therapeutic interventions with more aggressive therapies after appropriate multidisciplinary evaluation.

Background and Objectives: The surgical management of three-wall orbital fractures remains a significant challenge due to complex anatomy, limited exposure, and the absence of clear landmarks. These extensive reconstructions are rare and traditionally burdened by high complication rates and inconsistent outcomes. This study presents a standardized surgical protocol for complex three-wall orbital reconstruction, highlighting the role of digital planning and a novel two-piece interlocking patient-specific implant (PSI). Materials and Methods: Between 2018 and 2024, 17 patients with unilateral three-wall orbital fractures underwent reconstruction using digitally planned, patient-specific two-piece titanium implants designed to restore the orbital floor, medial, and lateral walls. Implant positioning was assessed through qualitative evaluation of postoperative CT scans and quantitative comparison between planned and actual implant positions, as well as orbital volume analysis between reconstructed and unaffected orbits. Clinical outcomes were evaluated pre- and postoperatively. Results: Reconstruction was classified as ideal in 16 cases (94.1%) and satisfactory in one case (5.9%). Quantitative analysis demonstrated a high level of concordance between the planned and postoperative implant positions, with a mean deviation of 0.982 ± 0.107 mm (95% CI: 0.927–1.037 mm). All implants were positioned within 1.5 mm of the planned location. Postoperative orbital volumes closely approximated those of the contralateral side, with a mean volume difference of 1.371 ± 0.176 cm³ (95% CI: 1.280–1.461 cm³). Diplopia resolved in all patients, and enophthalmos was fully corrected in 15 cases (88.2%). No major complications or revision surgeries were observed. Conclusions: The proposed two-piece interlocking PSI enabled precise and reproducible reconstruction of complex three-wall orbital fractures. This approach demonstrates that even technically demanding orbital reconstructions can be performed with greater reliability, leading to favorable functional and aesthetic outcomes.

Background/Objectives: Indocyanine green video angiography, integrated into the operative microscope, is frequently used in cerebrovascular surgery. This technology is often preferred, for cost or availability, to Doppler or intraoperative DSA (digital subtraction angiography). With the same assumption it was possible, in our preliminary experience, to partially vicariate the aforementioned devices using the SPY mode of the Stryker endoscope; it allowed the visualization of fluorescence in high definition. Methods: A retrospective analysis was conducted on a series of five patients suffering from cerebral aneurysm or AVM (arteriovenous malformation) who underwent, during the last year, surgical treatment with the aid of the microscope supported by the Stryker endoscope in the SPY mode for the visualization of the fluorescence emitted by indocyanine green. Results: All aneurysms were completely excluded from the cerebrovascular circulation in the absence of residues in the collar and occlusion of adjacent vessels; the complete removal of the nidus in all the AVMs was achieved with no residues. Conclusions: The intraoperative use of indocyanine green was a safe, rapid, and effective technique within a preliminary case study of “regular—not giant” aneurysms and superficially located AVM. The endoscopic technique in the SPY mode has allowed to partially vicariate the use of Doppler, intraoperative angiography, and integrated microscope video angiography. For these purposes, we propose, in selected cases, the support of the endoscope in the SPY mode during the microsurgical procedure in order to visualize the green fluorescence of indocyanine.

Background/Objectives: Indocyanine green videoangiography, integrated in the operative microscope, is frequently used in cerebrovascular surgery; it is believed to be a simple and reliable method for capturing high-resolution images in a real-time setting. This technology is often preferred, for cost or availability, to Doppler or intraoperative angiography DSA (Digital substraction angiography): with the same assumption it was possible, in our preliminary experience, to partially vicariate the aforementioned devices using the SPY mode of the Stryker endoscope; it allowed the visualization of fluorescence in high definition.; Methods: A retrospective analysis was conducted on a series of 5 patients suffering from cerebral aneurysm or AVM who underwent, during the last year at our institution, surgical treatment with the aid of the microscope supported by the Stryker endoscope in SPY mode for the visualization of fluorescence emitted by indocyanine green; Results: The intraoperative use of indocyanine green was a safe, rapid and effective technique within a preliminary case study of "regular - not giant" aneurysms and AVM located superficially in the cerebral parenchyma. The endoscopic technique in SPY mode has allowed to partially vicariate, in selected cases, the use of Doppler, intraoperative angiography and integrated microscope video angiography; Conclusions: the main purpose of aneurysm surgery is to completely exclude them from the cerebral vascular circulation in the absence of residues in the collar and occlusion of adjacent vessels; similarly, in AVM surgery the goal is the early identification of the nidus and to avoid residues within it given the high risk of new rupture. For these purposes, we propose, in selected cases and keeping in mind the limitations of the technique already described in the literature, the support of the endoscope in SPY mode during the microsurgical procedure in order to visualize the green fluorescence of indocyanine.

Study design: A series of 26 patients, submitted to decompressive craniectomy for su-pratentorial cerebral ischemia was retrospectively analyzed. Objectives: The aim of this study is to highlight the experience with this surgical tech-nique in our Institution and to analyze comparatively the preoperative and postoperative clinical and radiological data, as well as the prognostic factors verifying the agreement between our findings and the relevant literature data. Methods: From January 2018 to January 2023, we recruited 26 patients that underwent decompressive craniectomy for supratentorial cerebral ischemia. Demographic, medical history, clinical, laboratory, radiological and surgical data were collected. Statistical analysis was also performed to determine if any variable had a significant impact pre-viously and post-operatively or if they were predictive of favorable outcome. Results: The average age of the patients was 56.55 y, range between 26-80 y. Patients under 60 y were 51.8% and 59,25% of the whole sample were male. The outcome score calculated with the Modified Ranking Scale after about 1 year was < =4 in 11 patient; it distributed as follows: 2 pts with MRS 2, 5 pts with MRS 3 and 4 pts with MRS 4. The remaining were dead or in a vegetative state. Univariate statistical analysis was focused on neuroradiological parameters, studied both in pre- and post-operative CT scans. The variables that proved to be statistically significant were the presence or absence of visible cortical sulci, basal cisterns compression (cisterna ambiens in particular), quadrigeminal and sylvian cisterns. Of these parameters, the only one that maintained statistical sig-nificance even in the multivariate analysis was the presence of visible cisterna ambiens in post-operative radiological studies proving to be associated with a favorable outcome. Conclusions: Our study confirmed that decompressive craniectomy in cerebral ischemic stroke is an effective life-saving treatment in a subgroup of patients with intracranial hypertension. Standardization of the surgical indication remains a challenge and our analysis could suggest potentially useful work patterns in daily clinical practice, eventough our expe-rience had the important limitation of measuring only physical disability; further studies considering psychosocial, financial and caregiving aspects are needed. Moreover, sur-gical management remains in our opinion a tailored choice based on the experience of the surgeon and on the expectations of the patient and family.