Background: Ventriculoperitoneal shunts (VPSs) are frequently employed in neurosurgery to treat hydrocephalus, with a particular focus on pediatric patients. Although VPSs are commonly utilized, they are not exempt from difficulties, such as shunt extrusion. The main aim of this study is to enhance comprehension regarding the occurrence, causes contributing to, and consequences of VPS extrusion in pediatric patients. Methods: A comprehensive search approach was implemented, including electronic databases, including PubMed, Google Scholar, and Scopus, to locate pertinent articles published between January 1950 and May 2023. The utilization of keywords such as “ventriculoperitoneal shunt” and “extrusion,” “ventriculoperitoneal shunt” and “migration,” and “ventriculoperitoneal shunt” and “perforation” was employed. Data on patient demographics, underlying diseases, origin of extrusion, presenting symptoms, treatment, and follow-up were gathered. Statistical studies were conducted to identify potential risk factors connected with the occurrence of shunt extrusion. Results: A study analyzed 80 studies on 120 individuals with extruded VPS catheters. The majority of patients (55.8%) had symptoms such as cerebrospinal fluid leakage and irritation. Hydrocephalus was categorized into congenital (40%), obstructive (36.7%), and communicating (11.7%) groups. Catheter extrusion sites varied, with most from the anal or rectal site. Preoperative meningitis or peritonitis was present in 20% of patients. Treatments ranged from shunt removal to endoscopic third ventriculostomy, resulting in a 90% recovery rate, 1.7% mortality, and 5% follow-up loss. Conclusion: Extrusion of the distal catheter in VPSs is a critical medical situation that necessitates urgent surgical intervention. The presence of an infection raises the likelihood of complications; hence, it is vital to promptly address the issue through the administration of antibiotics and the replacement of the shunt. Timely intervention enhances results.

Objective: In order to properly understand the correlation between TN and Chiari malformation type I (CMI), it is imperative to delve into the underlying processes and develop efficacious treatment strategies. Methods: A comprehensive search was performed regarding trigeminal neuralgia (TN) in individuals diagnosed with CMI. A total of 19 cases were identified in the existing literature. Results: The review of 19 studies showed that the most commonly affected division was V2 (31.6%), followed by V3 (10.5%) and V1 (5.3%). Radiological findings were variable. The medulla oblongata was compressed in 6 patients (31.6%), the cervical spinal cord showed abnormalities in 3 patients (15.8%) abnormalities; one cervical myelocele (5.26%), two cervical syringomyelia (10.53%) while 5 patients (26.3%) showed normal findings. The skull bones in 4 patients (21,1%) showed deformity in the form of small posterior fossa or platybasia. The surgical treatment was conducted in 14 patients (73.7%). The study suggested that posterior fossa decompression (PFD) plus microvascular decompression (MVD) dual surgical modality yielded the best results for V2 distribution (P=0.017). Conclusion: Chiari malformation type I can directly influence the occurrence and severity of trigeminal neuralgia. Therefore, an effective management of this malformation, like neurovascular decompression, PFD or ventriculoperitoneal shunt, can act as a potential treatment for trigeminal neuralgia. While the PFD alone was effective in the V3 and V1 distribution of trigeminal neuralgia, PFD plus microvascularplus plus microvascular decompression (MVD) as a dual surgical modality yielded the best results for V2 distribution.

Introduction: Giant Serpentine Aneurysms (GSA) are a rare subgroup of complex intracranial vascular anomalies characterized by unusually large and convoluted structures within cerebral arteries. This systematic review examines the historical context, clinical presentations, diagnostic methodologies, and evolving treatments specific to GSAs. Its goal is to advance patient care strategies and outcomes within this intricate neurovascular domain. Methods: Research encompassing patients diagnosed with GSAs was gathered from PubMed, Google Scholar, and Web of Science. Only comprehensive human studies published in English were considered, using search terms like giant serpentine aneurysm, thrombosed aneurysm, bypass, and angiography. Data regarding patient age, gender, symptoms upon presentation, treatments, recovery duration, and outcomes were systematically documented. Result: This analysis of 83 patients with GSA found the middle cerebral artery as the most common site (39.8%). Headaches (54.2%) and visual issues (9.8%) prevailed as symptoms. Seizures correlated with more post-op problems. Females encountered more neurological issues post-surgery (46.4%). Treatment methods varied by location but didn’t significantly affect age or hospital stay length. Conclusion: Early recognition and intervention are crucial for mitigating neurological deficits and improving patient prognosis in GSAs. Expanded research and awareness are needed for definitive diagnostic protocols and treatment guidelines.

BACKGROUND: Renal cell carcinoma (RCC), the most common kidney cancer, often metastasizes to bones, lungs, liver, and the central nervous system. Intramedullary spinal metastasis from RCC is rare but can cause significant neurological deficits, necessitating prompt diagnosis and treatment through surgical intervention, radiotherapy, and immunotherapy. OBSERVATIONS: An 86-year-old man presented with progressive right lower-limb weakness and reduced sensation over 3 weeks. His medical history included a right nephrectomy for RCC 15 years earlier and L4–S1 spondylosis. Imaging identified a bleeding lesion in the conus medullaris at T11–12 and an incidental left kidney mass. Urgent surgical exploration led to a T12 laminectomy and en bloc removal of the lesion, which was confirmed as RCC metastasis. Postoperatively, the patient received focused radiotherapy and immunotherapy, showing significant motor and sensory improvement before dying 3 months later. LESSONS: This case underscores the importance of comprehensive diagnostic imaging for the accurate identification and characterization of spinal lesions. An interdisciplinary approach involving neurosurgeons, oncologists, radiologists, and pathologists is crucial for optimal treatment planning. Urgent surgical intervention can effectively address acute neurological deficits caused by intramedullary lesions. Additionally, adhering to postoperative care instructions, such as deep venous thrombosis prophylaxis, is vital to prevent fatal complications. https://thejns.org/doi/10.3171/CASE24349