Newly developed or worsening endocrinopathy occurred in 3 patients at the time interval of 6, 15, and 18 months, respectively. Cranial nerve (CN) III neuropathy developed in 1 patient. Two patients required bilateral adrenalectomy at 44 months and 50 months following GKRS, respectively. CONCLUSION GKRS appears to be a safe and reasonably effective treatment option for CCA. Larger numbers of patients from a multicenter study are needed to verify these findings. BACKGROUND Microvascular decompression (MVD) is a commonly performed procedure to treat trigeminal neuralgia and hemifacial spasm. Knowledge of the variable anatomy of the cerebellopontine angle is crucial to avoid injury to cranial nerves. OBJECTIVE Here, we highlight a case of aberrant anatomy of the abducent nerve encountered during MVD, emphasising the importance of visualising the surrounding cranial nerves. METHODS Case report of a 76-year-old lady with right V1 and V2 trigeminal neuralgia, refractory to medical treatment, undergoing elective MVD. RESULTS Intraoperatively, a distorted course of the cisternal component of the abducent nerve was noticed, caused by an ectatic anterior inferior cerebellar artery (AICA). Careful mobilisation of the offending vessel to decompress the trigeminal nerve was carried out; however, abducent nerve decompression was not attempted since its function was not compromised. Facial pain resolved post operatively without new diplopia. CONCLUSION Careful review of imaging prior to surgery is recommended in order to pre-empt such unusual anatomical variations. Crown All rights reserved.BACKGROUND 10-segments intramedullary tumors are rare lesions in adults. CASE DESCRIPTION In this report, we describe the case of one 30-year-old woman who presented with a 2-year history of right lower limb numbness. Spinal magnetic resonance imaging of the patient showed an expansive 10-segments intramedullary lesion and following syringomyelia. The final pathological tests confirmed World Health Organization grade II ependymoma. She received a successful gross-total tumorectomy with no obvious surgical related complication left. The postoperative recovery is far beyond our expectations. Chiari I Malformation (CMI) and the topics concerning it have been the subject of numerous discussions and polarizing controversies over the course of the past 20 years. The opinions of 63 recognized international Neurosurgical CMI experts from 4 continents, with a collective surgical experience of more than 15,000 CMI cases, were gathered through a detailed questionnaire, divided in two parts diagnostic and therapeutic. The therapeutic part was organized into four sections Professional Profile, Technical Preferences, Surgical Opinions, and Clinical Scenarios. The data reflected a wide spectrum of opinions, approaches, and expertise. The second part of the questionnaire dealt with the surgical aspects of CMI care and painted a more complex picture •81% of the surgeons preferred the Intradural technique •88% of the experts agreed that CMI surgery is not indicated for minimal non-debilitating symptoms alone, or as prophylaxis •In the face of given clinical scenarios, a wide spectrum of therapeutic approaches was chosen by the whole group, but the 4 Surgeons with the largest case series expressed the same opinion •Eight out of 63 Surgeons had a surgical experience above 600 cases, were responsible for more than half of the total 15,000 declared CMI cases, and shared a similar profile in terms of technical surgical choices, therapeutic opinions, and low complication rate, with a marked preference for Intradural techniques and tonsillar manipulation •Once large individual case series were accumulated, we did not see any differences in the opinions and preferences between Adult and Pediatric Neurosurgeons. OBJECTIVE Vasospasm after subarachnoid hemorrhage (SAH) plays a vital role in the development of delayed cerebral ischemia. Anti-VEGF antibodies, like bevacizumab, may attenuate VEGF- stimulated angiogenesis, reduced vascular cell proliferation, and improve vasospasm after SAH. METHODS Thirty-two adult male New Zealand white rabbits were randomly divided into four groups of eight rabbits in each group group 1 (control); group 2 (subarachnoid hemorrhage); group 3 (subarachnoid hemorrhage + vehicle); and group 4 (subarachnoid hemorrhage + bevacizumab). BEV (5 mg/kg, intraperitoneally) was administered 5 min after the intracisternal blood injection and continued for 72 h once per day in the same dose for group 4. Animals were sacrificed 72 h after subarachnoid hemorrhage. Basilar artery cross-sectional areas, arterial wall thicknesses, and hippocampal degeneration scores were evaluated in all groups. RESULTS VEGF is associated with the narrowing of the basilar artery. Treatment with BEV statistically significantly increased the cross-sectional area of the basilar artery when compared to the SAH and the vehicle groups. Basilar artery wall thicknesses in the BEV group was statistically significant smaller than in the SAH and vehicle groups. The hippocampal degeneration scores for the BEV and control groups were similar and significantly lower than those for the SAH and vehicle groups. CONCLUSION Cellular proliferation and subsequent vessel wall thickening is reason to delayed cerebral ischemia and deterioration of the neurocognitive function. Intraperitoneal administration of bevacizumab was found to attenuate cerebral vasospasm and prevent delayed cerebral ischemia and improve neurocognitive function after subarachnoid hemorrhage in rabbits. INTRODUCTION In recent decades there has been a significant expansion of neurosurgical capabilities in low-and-middle income countries and particularly in Southeast Asia. Despite these developments, little is known about the structure and quality of local neurosurgical training paradigms. METHODS A 36-question survey was administered to neurosurgical trainees in-person at the Southeast Asian Neurosurgical Bootcamp to assess demographics, structure, and exposure of neurosurgical training in Southeast Asia. RESULTS 45 out of 47 possible respondents participated in the survey. 78% were male with an age range of 26-40 years. Neurosurgical training most commonly consisted of three (n=22, 49%) or six years (n=14, 31%). The majority of respondents (70.5%) were from Myanmar with the remainder coming from Indonesia, Cambodia, Thailand, and Nepal. Most residents (n=38, 84%) used textbooks as their primary study resource. Only 24 (53%) residents indicated that they had free access to online neurosurgical journals via their training institution. The majority (n=27, 60%) reported that less than 750 cases were performed at their institution per year; with a median of 70% (interquartile range 50-80%) being emergent. The most commonly reported procedures were trauma craniotomies and ventriculoperitoneal shunting. The least commonly reported procedures were endovascular techniques and spinal instrumentation. CONCLUSIONS While the unmet burden of neurosurgical disease remains high, local training programs are devoting significant efforts to provide a sustainable solution to the problem of neurosurgical workforce. High income country institutions should partner with global colleagues to ensure high-quality neurosurgical care for all people regardless of location and income. BACKGROUND Spinal schwannomas are benign nerve sheath neoplasms which constitute about 30% of extramedullary spinal cord tumors. They are usually small, well-encapsulated tumors with low mitotic activity, and concurrently carry low risk of recurrence. Here, we report a case of atypical histological variant of spinal schwannoma that had higher cellular density, nuclear atypia and lack of encapsulation. To our best knowledge, no such cases of this atypical variant with regards to lumbar spine have been reported in the literature. CASE REPORT A 66-year-old male had an incidental left-sided paraspinal mass discovered while undergoing workup for cholecystitis. On examination, the patient was neurologically intact. Imaging revealed the presence of contrast-enhanced, partially cystic mass arising from L3-4 intervertebral foramen and causing left psoas muscle displacement. A minimally invasive left L3-4 posterior extra-cavitary resection was done. Histopathologic examination revealed partly unencapsulated tumor with higher than usual cellular density and nuclear atypia, resulting in a diagnosis of 'atypical schwannoma.’ Follow-up imaging at 6 months follow-up showed stable post-surgical changes and residual tumor with no evidence of progression/recurrence. CONCLUSION Atypical schwannoma has higher cellular density, nuclear atypia and lack encapsulation. Review of the literature suggests an increased risk of recurrence when compared to typical variants and complete tumor removal should be attempted. STUDY DESIGN Retrospective review. OBJECTIVE Investigate the healthcare resource utilization and the associated 6 months pre- and 6 months post-operative spending among patients undergoing posterior lumbar fusion. METHODS We retrospectively reviewed a private insurance claims database for patients that underwent single level PSF from January 2011 to December 2015. Outpatient health services, prescription pain medications, and inpatient admissions were assessed. RESULTS Among 25,401 patients (mean age 52 years, 58% female) in the final cohort, median spending during the period from 6 months prior to surgery to 6 months following surgery was $60,714 (IQR $46,961 – 79,892)/ patient. Preoperative spending accounted for 7% ($121 million) of the total costs, and postoperative spending accounted for 8% ($135 million). Median preoperative spending was $3,566 (IQR $2,144 – 5,857) per patient, with imaging accounting for the highest proportion (33%) of preoperative spending. In the 6 months period preceding surgery, 46% patients received injections and 47% received physical therapy. The median postoperative spending was $1,954/patient (IQR $735 – 4,416). Total postoperative spending was significantly higher among those not discharged home [$7,525 ($6,779- 19,602)] as compared to those discharged home [$1,617/patient ($648 – 4,033)] and home with home care services [$2,921 ($1,406 – 5,662)]] (p less then 0.001) CONCLUSION Unplanned readmission following PSF was the highest contributor to postoperative spending and the second highest contributor to overall costs. Understanding factors that contribute to the costs in the pre- and post-operative period in patients undergoing single level posterior lumbar fusion for degenerative pathology is essential to identify targets for cost-containment. OBJECTIVES Decompressive Craniectomy (DC) is a last-tier therapy in the treatment of raised intracranial pressure (ICP) after traumatic brain injury (TBI). We report the association of comparative radiographic factors in predicting functional outcomes after DC in patients with severe TBI. METHODS A retrospective analysis of a prospectively maintained database between 2015-2018 at an academic tertiary care hospital was carried out. Univariate and multivariable regression analyses were performed for an array of comparative radiographic variables (pre- and post- DC) in relationship to functional outcome according to Glasgow Outcome Scale Extended (GOSE) at 180 days. GOSE was further dichotomized into favorable (GOSE5-8) and unfavorable (GOSE0-4) functional outcomes. All associations were reported as odds ratio (OR) with 95% confidence interval (CI). RESULTS Statistical analysis included a cohort of 43 patients with a median age of 30.5 years (range, 18-62 years). The median GOSE at 180 days was 7. Multivariable regression analysis after adjusting for confounding variables (age, gender, co-morbidities, site of surgery and size of decompression) showed that comparative radiographic findings of (i) midline shift (MLS) >10mm [OR3.