BACKGROUND Trigeminal Neuralgia (TN) is a well-recognized facial pain syndrome. Discrete forms with disparate pain symptoms include TN1 and TN2, however, atypical facial pain includes neuralgiform pain along a spectrum. The majority of TN is diagnosed in the adult population. Case reports and series in children present TN as a similar diagnosis which can be similarly treated as in adults. This manuscript reviews pertinent literature and presents two pediatric TN cases successfully treated with microvascular decompression (MVD). CASE DESCRIPTION Two pediatric patients (ages 12 and 15) were identified with TN that was refractory to previous medical therapy. The patients were both deemed appropriate surgical candidates and were treated with MVD to manage their TN. TN compression was arterial in both cases and involved portions of the anterior inferior cerebellar artery. Patient 1 was found to be pain-free 6 months following the procedure. Patient 2 was pain-free immediately following the procedure and has since been weaned off preoperative symptomatic management. The most recent follow-up is 12 and 8 months, respectively, with continued pain freedom. CONCLUSIONS There are few reports on the effectiveness of MVD in the pediatric population for the management of TN. Supporting literature, as well as the cases presented, demonstrate that MVD is an effective treatment for pediatric patients in managing their TN. Furthermore, there appears to be minimal side effects, with excellent pain relief with MVD in this patient population.

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Background: Intraparenchymal brain abscess is a collection of microbes caused by inoculation through direct extension or hematogenous spread. Although rare, intraparenchymal abscesses are potentially fatal and can be detected when patients are symptomatic due to local mass effect on adjacent neural tissue. Brain abscess treatment includes medical management with appropriate antibiotics alone or medical management in combination with surgical debridement. Treatment strategies depend on the size and location of disease, as well as the virulence of the microorganism. Similar to medical management strategies, surgical strategies among providers are not uniform, with variation in approaches from complete extirpation of the abscess, including the abscess wall, to minimally invasive stereotactic needle aspiration. In particular, for children, there are no guidelines for therapy. Case Description: We report a case of giant Actinomycosis right frontal brain abscess in an immunocompetent child without risk factors. A review of the literature for the treatment of brain abscess caused very rarely by Actinomyces in children is performed. Conclusion: Successful treatment of brain access depends on organism and location. The even more uncommon giant intraparenchymal abscesses can be managed with minimal access and prolonged antibiosis, especially when slow-growing organisms are identified. Long-term follow-up should be employed to mitigate missed late failures.