Background: Neurovascular conflict (NVC) is described as a pathological contact between cranial nerves and vessels. Glossopharyngeal neuralgia (GPN) and hypoglossal nerve palsy (HNP) due to NVC represent rare clinical entities. To our knowledge, we present the first reported case of concomitant GPN and HNP caused by vertebral artery (VA)-posterior inferior cerebellar artery (PICA) complex compression. Case Description: We report an extremely rare case of a 52-year-old man with combined unilateral left-sided GPN and HNP because of NVC involving both the VA and the PICA, successfully treated with a retrosigmoid approach for microvascular decompression (MVD). Postoperatively, the patient immediately recovered without new-onset dysfunction of lower cranial nerves, and a complete remission of symptoms was achieved. Conclusion: As far as we know, in this article, we present the first singular case in the literature of concomitant classical GPN and HNP due to NVC involving both the VA and the PICA. Despite the low incidence of GPN and HNP, clinical picture and intraoperative findings represent clear and reliable elements for their diagnosis. MVD is a successful therapeutic strategy that offers a long-term cure for GPN and HNP.

Intracranial hypertension is a life-threatening complication of traumatic brain injury (TBI) and a major target in neurocritical care. While ventriculostomy for cerebrospinal fluid diversion and the emerging technique of cisternostomy are used on a regular basis in different areas of the world, their application is heterogeneous on indications, timing, and technical aspects in the surgical procedures. This variability highlights a critical lack of standardized protocols, particularly in resource-constrained environments where optimized recommendations are most needed. What are the specific, expert-consensus recommendations to standardize the use of ventriculostomy and cisternostomy within a protocol for TBI management? The Neurotrauma Committee of the World Federation of Neurosurgical Societies develop an international consensus, including a methodological group and a panel of 16 expert neurosurgeons following a Delphi process, involving systematic literature review, statement formulation, and iterative blinded voting using a 5-point Likert scale. Consensus was predefined as ≥75% agreement. The panel ratified 69 consensus statements. Core recommendations advocate for ventriculostomy as an early therapeutic intervention for TBI requiring fluid drainage and define cisternostomy as an adjunctive procedure for selected patients with TBI and significant traumatic subarachnoid hemorrhage. Protocols with algorithms were proposed for both procedures. This consensus provides a practical framework to guide surgical management of TBI using ventriculostomy and or cisternostomy as techniques. It promotes a strategic shift towards prior heterogeneous concepts on ventriculostomy and defines a specific, consensus-guided role for cisternostomy. The statements aim to harmonize global practice and direct future research.

Background: Vertebral body replacement (VBR) with expandable cages after corpectomy is a critical procedure in spinal surgery, addressing conditions like fractures and tumors that compromise the anterior column of the spine. The eXtreme Lateral Interbody Fusion (XLIF) approach has revolutionized this technique by minimizing muscle dissection and reducing recovery times compared to traditional approaches. Methods: A retrospective clinical study was conducted on 23 consecutive patients who underwent single-level corpectomy and VBR between 2018 and 2023. Surgical outcomes were evaluated using visual analog scale (VAS) for pain and American Spinal Injury Association (ASIA) for neurological status. Radiological assessments included preoperative and postoperative CT scans to measure regional angulation and stability. Results: Postoperatively, patients showed significant pain reduction (median VAS score decreased from 8 to 2) and neurological improvement (82.6% ASIA E classification). Radiologically, there was a median kyphotic angle correction of 5° post-dorsal stabilization and 9° post-ventral stabilization. Complications included pleural injuries (8.7%) and hypoesthesia (8.7%), with higher incidence in thoracic VBR cases and patients with osteoporosis. Conclusion: VBR via XLIF is a promising technique for treating vertebral fractures and tumors, offering substantial pain relief, neurological recovery, and spinal stability. Despite some complications, the procedure demonstrates significant clinical and radiological benefits, underscoring its efficacy in complex spinal pathologies.

Background: Spindle cell lipoma (SCL) constitutes just 1.5% of all lipomatous tumors. They typically occur in the upper back and shoulders. Here, we report a 37-year-old female presenting with a SCL in the dorsal epidural thoracic spine, during her 9^th month of pregnancy. Case Description: A 37-year-old female presented with a subacute (2 months) progressive paraparesis during her ^9th month of pregnancy. The MR showed a dorsal epidural mass at the D8 level. Following a cesarean section, the patient underwent a laminectomy for tumor excision. Microscopically, the lesion proved to be a SCL. At 5-year follow-up, there was no tumor recurrence. Conclusion: SCL represents a variant of benign lipomas that may occur in the dorsal thoracic spine. Gross total excision may be followed by a benign clinical course without recurrence or malignant degeneration. Very atypical SCLs need closer follow-up to avoid the misdiagnosis of liposarcoma.

Traditional surgical decision-making in traumatic brain injury (TBI) has relied on static intracranial pressure (ICP) thresholds and fixed volumetric criteria, an approach that inadequately reflects the dynamic physiological nature of secondary brain injury. These conventional metrics fail to capture the critical determinant of clinical deterioration: the progressive loss of intracranial compliance, the brain’s capacity to buffer additional volume without harmful pressure escalation. This manuscript proposes a practical, compliance-based framework for selecting precise, personalized surgical strategies using real-time physiological, imaging, and neuromonitoring indicators. Based on the Intracranial Compartment Syndrome (ICCS) model, this approach translates the loss of compensatory reserve into actionable operative decisions. Compliance is assessed through multimodal tools, including ICP waveform morphology, cerebral oxygenation, and complementary noninvasive neuromonitoring. ICCS staging delineates three operative contexts: Stage 1, preserved compliance; Stage 2, compliance failure with maintained oxygenation requiring physiology-guided interventions to restore buffering capacity; and Stage 3, global decompensation with lost of compliance plus oxygenation failure requiring immediate, aggressive intervention for partial or total brain tissue survival. By shifting surgical reasoning from fixed anatomical thresholds to a physiology-centered assessment of intracranial compliance, this framework aims to enhance the timing, selection, and overall effectiveness of neurosurgical interventions in TBI.