OBJECTIVEDespite rapid development and expansion of neuromodulation technologies, knowledge about device and/or therapy durability remains limited. The aim of this study was to evaluate the long-term rate of hardware and therapeutic failure of implanted devices for several neuromodulation therapies.METHODSThe authors performed a retrospective analysis of patients’ device and therapy survival data (Kaplan-Meier survival analysis) for deep brain stimulation (DBS), vagus nerve stimulation (VNS), and spinal cord stimulation (SCS) at a single institution (years 1994–2015).RESULTSDuring the study period, 450 patients underwent DBS, 383 VNS, and 128 SCS. For DBS, the 5- and 10-year initial device survival was 87% and 73%, respectively, and therapy survival was 96% and 91%, respectively. For VNS, the 5- and 10-year initial device survival was 90% and 70%, respectively, and therapy survival was 99% and 97%, respectively. For SCS, the 5- and 10-year initial device survival was 50% and 34%, respectively, and therapy survival was 74% and 56%, respectively. The average initial device survival for DBS, VNS, and SCS was 14 years, 14 years, and 8 years while mean therapy survival was 18 years, 18 years, and 12.5 years, respectively.CONCLUSIONSThe authors report, for the first time, comparative device and therapy survival rates out to 15 years for large cohorts of DBS, VNS, and SCS patients. Their results demonstrate higher device and therapy survival rates for DBS and VNS than for SCS. Hardware failures were more common among SCS patients, which may have played a role in the discontinuation of therapy. Higher therapy survival than device survival across all modalities indicates continued therapeutic benefit beyond initial device failures, which is important to emphasize when counseling patients.

Background:Spontaneous cervical epidural hematoma (SCEH) is an uncommon cause of acute spinal cord compression. This is a rare idiopathic condition that leads to acute onset of neurologic deficits, which if not diagnosed early can lead to catastrophic consequences.Case Description:Here, we report a 41-year-old male, diagnosed with SCEH, with a presenting chief complaint of cervical pain followed by progressive quadriparesis and urgency of micturition who was managed surgically, along with the review of literature.Conclusion:SCEH is a rare pathologic entity. Due to the high risk of poor neurological outcome without treatment, SCEH should be a diagnostic possibility when the presentation is even slightly suggestive. Prompt surgical evacuation of the hematoma and hemostasis leads to a favorable neurological outcome, whereas delay in treatment can be disastrous.

Schwannomas are benign tumors, which arise from the Schwann cells of the central or peripheral nerves. They form 8% of all intracranial tumors and most of the cases arise from vestibular division of the 8 th cranial nerve. Rare cases are shown to arise from the olfactory or optic nerve, being devoid of myelin sheath. Up to date and according to our best of knowledge, 66 cases have been reported till now. Here we present a review of the literature and a case report of a 56-year-old male with an accidently discovered anterior cranial fossa schwannoma, following a road traffic accident. Tumor was completely excised, using a right frontal approach. Histopathology revealed Antoni-A cellular pattern. Although rare, but olfactory nerve schwannomas should be included in the differential diagnosis in anterior cranial fossa space occupying lesions, and the approach should be designed taking into consideration, this rare entity.

Background: Lumboperitoneal shunt is an easy and effective way of managing benign intracranial hypertension (BIH) and other causes of increased intracranial pressure. Yet, it is associated with a relative high failure rate. Proximal migration of the shunt is rare and only few cases have been reported. Case Description: Here, we present a case of a 16-year-old female, diagnosed with BIH, who had a proximal shunt migration 4 months after surgery and was managed conservatively, along with the review of literature. Conclusion: Although it is associated with a high complication rate, lumboperitoneal shunt is very effective in the management of many disorders. One of the most common complications is shunt migration. While many mechanisms explaining shunt migration have been hypothesized, the most important single preventing factor for preventing shunt migration remains proper fixation of the shunt.

Objectives Traumatic brain injury (TBI) is a worldwide major health problem associated with a high rate of morbidity and mortality. Intracranial hypertension following TBI is the main but not the only cause of early mortality. Decompressive craniectomy (DC) is used to decrease the intracranial pressure (ICP) and prevent brain herniation following TBI; however, the clinical outcome after DC for patients with TBI generates continuous debate. Prediction of early mortality after DC will help in making the surgery decision. The aim of this study is to predict early mortality after DC based on the initial clinical and radiological findings. Methods In this study, 104 patients with severe traumatic brain injury have been treated by decompressive craniectomy and were retrospectively analyzed. Patients were divided into two groups; group I involved 32 patients who died within 28 days while group II involved 72 patients who survived after 28 days. The relationship between initial Glasgow Coma Scale score (GCS), pupil size and reactivity, associated injuries, and radiological findings were analyzed as predictor factors for early mortality. Results A total of 104 patients with severe TBI have been treated by DC and were analyzed; the early mortality occurred in 32 patients, 30.77%. There is a significant difference between groups in gender, mean GCS, Marshall scale, presence of isochoric pupils, and lung injury. After stratification, odds of early mortality increases with the lower GCS, higher Marshall scale, lung injury, and abdominal injury while male gender and the presence of isochoric pupils decrease the odds of mortality. After univariate regression, the significant impact of GCS disappears except for GCS-8 which decreases the odds of mortality in comparison to other GCS scores while higher Marshall scale, presence of isochoric pupils, and lung injury increase the odds of mortality, but most of these effects disappear after multiple regressions except for lung injury and isochoric pupils. Conclusion Prediction of early mortality after DC is multifactorial, but the odds of early mortality after decompressive craniectomy in severe traumatic brain injury are progressively increased with the lower GCS, higher Marshall scale, and the presence of lung or abdominal injury.