BACKGROUND Neurogenic Thoracic Outlet Syndrome (nTOS) treatments have high morbidity and recurrence rates. We present a minimally invasive spine surgery (MISS) technique for complete resection of a cervical rib via a costotransversectomy approach, not previously described. CASE DESCRIPTION We report on a patient with 8 years of progressive TOS with right C8 pain, weakness, and atrophy of her right forearm and thenar eminence. After nTOS was confirmed via electromyography (EMG) and imaging revealed bilateral cervical ribs (right more than left), the patient underwent a minimally invasive spine surgery (MISS) resection of the rib via a costotransversectomy and was discharged home the same day. The patient gradually improved in her pain and weakness over a two year follow up period. CONCLUSIONS Resection of a cervical rib via MISS costotransversectomy is safe and well tolerated, compared to existing surgical treatments such as trans-axillary, supra-clavicular, and infraclavicular approaches. BACKGROUND Basilar perforator aneurysms are rare causes of subarachnoid hemorrhage and their natural history is poorly characterized. While various treatment strategies have been reported, conservative management is an option that has been associated with a high likelihood of spontaneous resolution. CASE DESCRIPTION Here we present two cases of subarachnoid hemorrhage, one diffuse and the other perimesencephalic, due to small ruptured basilar perforator artery aneurysms. These aneurysms were only identified after repeat angiography. Conservative management with serial imaging was pursued. https://www.selleckchem.com/products/Trichostatin-A.html Both patients did well clinically and repeat imaging demonstrated spontaneous resolution of the ruptured aneurysms. We also provide a literature review of ruptured basilar perforator aneurysms, showing a ∼10% rerupture rate within the early post-rupture period but otherwise a high rate of spontaneous resolution. CONCLUSIONS Although basilar perforator aneurysms can rerupture, there is also a high likelihood of spontaneous resolution. Given the challenges of treatment, conservative management is an option that can be considered. BACKGROUND True posterior inferior cerebellar artery (PICA) aneurysms outside the vertebral artery-PICA (VA-PICA) region are rare, with approximately 30 cases reported in just a few papers; no treatment paradigm has been advocated. The objective of this study was to present detailed clinical features and outcomes for several treatments for true PICA aneurysms and suggest an algorithm for treatment strategies. METHODS We retrospectively analyzed outcomes of patients treated for PICA aneurysms with microsurgical and endovascular treatments. We also investigated the influence of several factors on the modified Rankin Scale (mRS) score. RESULTS Cases with PICA aneurysms (n=36) outside the VA-PICA region were identified angiographically. Aneurysm locations included anterior medullary (n=7), lateral medullary (n=10), tonsillomedullary (n=4), telovelotonsillar (n=12), and cortical (n=3) segments of the PICA. Aneurysm morphology was as follows dissecting 22; fusiform 6; saccular 8. On multivariate analysis, age (P=.028) and lack of vermian infarction (P=.037) were associated with a significantly better prognosis. Prognosis was not significantly different for the five aneurysm locations and among the four treatment groups clipping/coiling, trapping/parent artery occlusion (PAO), trapping/PAO+bypass, and observation including external ventricular drainage (EVD). CONCLUSION This study suggests that factors associated with significantly better prognosis include age, clip/coil treatments, and no vermian infarction complication. A treatment algorithm for true PICA aneurysms was supported according to pre-treatment H and K grade, PICA segments, aneurysm morphology, and three types of ischemia linked to the brainstem, cerebellar hemisphere, or vermis. INTRODUCTION Ventriculopleural shunt (VPLS) is recognized as an alternative method when the standard ventriculoperitoneal shunt (VPS) is not applicable. Nevertheless, there is limited clinical evidence of its effectiveness including long-term patency. METHODS Data on 35 consecutive patients who underwent VPLS at a single institution was retrospectively analyzed. The rates of shunt survival as well as incidence of symptomatic pleural effusion were calculated, and risk factors evaluated. RESULTS Mean follow-up following VPLS was 64.1 months. The cumulative overall shunt survival rates were 70%, 44%, and 28% at 1, 3, and 5 years, respectively. Among patients with shunt failure, 3 (8.6%) with overdrainage underwent simple valve replacement (from fixed to programmable valve) and retained a VPLS. If these patients are excluded, shunt survival rates were 76%, 51%, and 34% at 1, 3, and 5 years, respectively, and the median shunt survival time was 3.0 years. No factor was significantly associated with shunt survival. Cumulative rates of symptomatic pleural effusion were 18%, 23%, and 46% at 1, 2, and 3 years, respectively. Median time from VPLS placement to symptomatic pleural effusion was 1.1 years. CONCLUSIONS It seems that VPLS survival has improved with more modern shunt technology. VPLS is a reasonable second-line option when VPS is not feasible. The possibility of pleural effusion is not negligible but asymptomatic/mild effusions may be managed conservatively. INTRODUCTION Pressure gradients across venous stenosis are used as a marker for physiologically significant narrowing in idiopathic intracranial hypertension. Performing such measurements under conscious sedation (CS) more likely reflects physiologic conditions, but can be uncomfortable, leading some operators to perform measurement under general anesthesia (GA), though this may not be equivalent. METHODS We performed a retrospective analysis of patients who received endovascular transverse sinus stenting due to IIH between August 2013 and May 2017. Patients' demographics and anesthetic parameters were collected along with venous pressure measurements. RESULTS We identified 15 patients (14 female). The mean (SD) age was 30.5 (9.0) years and the mean BMI (SD) was 39.5 (9.6) kg/m2. After measurements during CS, GA was induced with propofol and maintained with a volatile anesthetic. The median [IQR; range] transverse sinus pressure gradient under CS was 18 [12, 25; 6,38] mmHg compared to 14 [8, 21; 3, 26] mmHg under GA.