Background Intracranial hypotension due to cerebrospinal fluid (CSF) leak is often associated with secondary chronic subdural hematoma (CSDH). Although epidural blood patch (EBP) treatment for the CSF leak site has been reported to result in spontaneous regression of the CSDH in most cases, it is still debatable whether blocking CSF leak first in the patients with intracranial hematoma is always safe. Case description A 72-year-old woman presented with orthostatic headache after a head injury and was diagnosed with intracranial hypotension. Computed tomography myelography and radioisotope cisternography failed to reveal the CSF leak point. The overflow leak test, a novel diagnostic method for intracranial hypotension, revealed a leakage at the cervical spine. Bilateral CSDHs were also observed by a CT scan of the head. We performed EBP at the cervical spine and anticipated subsequent regression of the CSDH by normalizing intrathecal pressure. However, the patient became delirious the morning after EBP, and an emergency burr hole trepanation was performed. The patient's consciousness fully recovered, and her orthostatic headache improved as well. Conclusions This case presentation demonstrated that in the case of intracranial hypotension with secondary CSDH, performing EBP and waiting for subsequent spontaneous regression of CSDH is not necessarily safe. Immediate burr hole trepanation should be prepared for the subsequent rapid symptomatic change of the CSDH after EBP.Objective This article aimed to introduce a novel technique, the "seesaw technique," for failed anterior cervical corpectomy and fusion (ACCF) in the treatment of cervical ossification of the posterior longitudinal ligament. Methods A patient who underwent ACCF 12 years ago and suffered gradually deteriorating neurologic function was referred to our institution. Preoperative imaging showed residual ossified mass at C5/6 level, causing compression to his spinal cord. He patient was treated by the seesaw technique. The main surgical procedures include removal of the plate and screws, removal of the osteophytes and diskectomy of C4/5, resection of the anterior part of C5 vertebral body, establishment of a transverse hinge at C7 vertebral body, installation of cervical plate and hoisting tool, and antedisplacement of C5 vertebral body and titanium mesh. Images were investigated before and after the procedure. The Japanese Orthopaedic Association score was used to evaluate his neurologic function, and surgery-related complications were also analyzed. Results The patient acquired significant improvement of his neurologic function 2 days after the surgery, and he could walk by himself without assistance. Postoperative images showed his spinal canal was enlarged sufficiently and the compression at C5/6 level was also released. At 13 months follow-up, his Japanese Orthopaedic Association score increased from 9 before surgery to 14, with an improvement rate of 62.5%. No surgery-related complications were observed during the whole follow-up. selleck chemicals llc Conclusion The seesaw technique provides satisfactory outcomes with wide enough decompression window and serves as a safe, effective surgical alternative for patients with failed ACCF.Background Posterior decompression & fusion surgery is one of commonest performed surgery for thoracolumbar tuberculosis with destruction of vertebral bodies. Tuberculosis causes gross destruction of the vertebral bodies and surrounding tissue, making them friable. Case description We present an unusual but dreaded complication which we encountered during posterior decompression and instrumentation surgery in a 65-year-old female with T10-T11 tuberculosis of spine. During the surgical exposure while reflecting posterior paraspinal muscles on left side, there was accidental slip of Cobb elevator around transverse process to the extent of two third of its length on left side anteriorly. The instrument was immediately withdrawn. There was no active bleeding in the field. Rest of the surgery was uneventful. In postoperative period, however, patient developed severe abdominal pain with abdominal distention. General surgery opinion was immediately taken and the patient was immediately investigated in the form of a CT scan. It was found that there was a traumatic laceration of pancreas. Patient underwent emergency exploratory laparotomy & repair of pancreatic laceration. The patient required intensive monitoring and ICU stay and ultimately went on to recover fully over the next few weeks. Conclusion This case illustrates that possibility of pancreatic injury should always be kept in mind if patient develops acute abdominal discomfort in post-operative period. Also, a multidisciplinary approach along with intensive care back-up and vigilant post-operative monitoring are of utmost importance, especially when an unusual event has occurred during the surgery.Background Publications are considered as a major factor for advancement in academia. An effort has been made to study authorship trends in Neurosurgery publications. Objective To investigate authorship trends in Neurosurgery literature for the last twenty years (1998-2018). Methods Articles for the year 1998, 2008 and 2018 were extracted from Neurosurgery, Journal of Neurosurgery and World Neurosurgery for this retrospective study. Only original articles, case reports, and review articles were included. The sex of the first, senior, and corresponding author was determined. Subspecialty topic, type of paper, geographical origin of articles, and the number of citations for each article were also collected. Results A total of 3912 articles were included. The number of articles, the total number of authors, and non-experimental studies increased in the successive decades. A total of 744 (19.0%) females were first authors and 520 (13.3%) were female senior authors of their respective publications. A decreasing trend (P=0.00) was noted between female first authors and male senior authors over time. All three journals showed an increasing pattern of female authorships across the two decades. Conclusion A rapid rise in female authorship positions in particular and authorship positions, in general, demonstrates the diversity that is slowly burgeoning to cater to perspectives and issues that require a multidimensional approach in Neurosurgery. Increasing linkages amongst researchers in Neurosurgery on a global scale are evident by the increase in multi-national collaborations. Expansive efforts are needed at institutional and individual levels to eradicate gender-based pitfalls that hinder excellence in Neurosurgery research.