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BACKGROUND The superficial temporal artery to middle cerebral artery (STA-MCA) end-to-side anastomosis is the most commonly used direct extracranial-to intracranial (EC-IC) bypasses type for Moyamoya disease (MMD). In progressive MMD without suitable scalp arteries other bypass constructs may need to be considered to augment blood flow. CASE DESCRIPTION We present the exceptional case of a 48-year-old woman with progressive MMD and repeated TIAs originating from the right hemisphere despite previous bilateral bypasses. We used the descending branch of the lateral circumflex femoral artery (DLCFA) as an interposition graft for an occipital artery (OA) to M4 MCA bypass with two end-to-side anastomoses to augment blood flow. The ipsilateral OA had already formed bilateral transdural collaterals; the goal was to preserve its supply while using the artery as a donor for an interposition graft. Access to the Sylvian fissure was limited due to the previous STA-MCA bypass with an extensive superficial collateral network necessitating preservation. The posterior aspect of the Sylvian fissure was targeted to revascularize the posterior frontal and parietal region using an interposition graft matching the vessel size of a distal MCA vessel segment. Surgery was technically successful, without complications and the patient recovered without new neurological deficits. The bypass graft was patent on postoperative angiogram CT angiography and transcranioplasty ultrasound. CONCLUSION This case illustrates the need for creative bypass constructs in progressive MMD patients with multiple prior surgeries. Two surgical goals are paramount – flow augmentation with preservation of the existing collateral network to avoid complications and new deficits. INTRODUCTION This anatomical study aimed to more precisely locate the bifurcation of the obturator nerve in relationship to the obturator foramen. Poziotinib molecular weight Such information might improve outcomes in neurotization or other procedures necessitating exposure of the obturator nerve and could increase success rates for obturator nerve blockade. MATERIALS AND METHODS Fourteen sides from fresh-frozen cadaveric specimens were used in this study. Dissection of the obturator nerve was performed and its bifurcation into anterior and posterior branches was documented and classified. Measurements of these branches was also performed. Bifurcations of the obturator nerve were classified as type I when proximal to the obturator foramen, type II when inside the obturator foramen and type III when distal to the obturator foramen. RESULTS Type I, type II, and type III obturator nerve bifurcations were observed in 14.3%, 64.3%, and 21.4% of sides, respectively. In type I nerves, the mean distance from the bifurcation of the obturator nerve to the obturator foramen was 15.8 mm and in type II nerves, the mean was 14.0 mm. The mean diameter of the main trunk, anterior branch, and posterior branch was 3.74 mm, 2.64 mm, and 2.28 mm, respectively. CONCLUSIONS Bifurcation of the obturator nerve can occur proximally, distally or inside the obturator foramen. Therefore, using imaging modalities such as ultrasound is strongly recommended for identifying the main trunk or anterior and posterior branches of the obturator nerve prior to surgery or other procedures aimed at this nerve due to such anatomical variations. BACKGROUND Virchow-Robin or enlarged perivascular spaces (PVS) are benign pial-lined spaces that surround penetrating arteries and arterioles through the brain parenchyma. We present two cases of enlarging perivascular spaces following whole brain radiation therapy in adults. CASE DESCRIPTION We observed two cases of enlarging PVS occurring following whole brain radiation therapy for adult onset medulloblastoma. Neither patient had an enlarged PVS at the time of radiation treatment. They presented in the basal ganglia six and eight years following the completion of radiation, respectively, one of which subsequently decreased in size over time. Neither patient had symptoms, required surgical intervention, or had signs of tumor recurrence. CONCLUSIONS Enlarging PVS can occur years after radiation therapy to the brain parenchyma. The recognition of these benign perivascular spaces is important so as not to mistake the changes for more sinister pathology that could lead to unnecessary intervention. This observation also suggests that focal cystic changes more frequently seen surrounding areas of focal brain radiation therapy may represent enlarged PVS. INTRODUCTION Laser interstitial thermal therapy (LITT) is a stereotactic-guided technique, which is increasingly being performed for brain lesions. The aim of our study was to report the national trends and factors predicting the clinical outcomes following LITT using the Nationwide Inpatient Sample (NIS). METHODS We extracted data from 2011-2016 using ICD-9/10 codes. Patients with a primary procedure of LITT were included. Patient demographics, complications, length of hospital stay (LOS), discharge disposition and index-hospitalization charges were analyzed. RESULTS A cohort of 1768 patients was identified from the database. Mean LOS was 3.2 days, 82% of patients were discharged to home and in-hospitalization cost was $124,225. Complications and mortality were noted in 12.9% and 2.5% of patients following LITT, respectively. Non-Caucasian patients (ER 4.26), those with other insurance (compared to commercial, ER 5.35), 3 and 4+ comorbidity indexes, patients with higher quartile median household income (2nd, 3rd and 4th quartile compared to first quartile) and those who underwent non-elective procedures were likely to have higher complications and less likely to be discharged home. Patients with 4+ comorbidity indexes were likely to have longer LOS (ER 1.39), higher complications (ER 7.95), less likely to be discharged home (ER 0.17) and higher in-hospitalization cost (ER 1.21). CONCLUSION LITT is increasingly being performed with low complication rates. Non-Caucasian race, higher comorbidity index, non-commercial insurance and non-elective procedures were predictors of higher complications and less likely to be discharged home. In-hospitalization charges were higher in patients with higher comorbidity index and those with non-commercial insurance.