The incidence of degenerative spinal diseases in the Japanese population has markedly risen in recent years, owing to the demographic shift towards an aging population. Hence, the frequency of surgical interventions for degenerative spinal conditions has increased. Recently, minimally invasive procedures are also being considered as viable options for older patients who may have previously been considered as poor candidates for surgery. Cervical spondylotic myelopathy is one of the most prevalent degenerative spinal disorders. Its pathological mechanism encompasses both static and dynamic factors, and contributes to spinal cord compression and gradual alteration of anatomical structures associated with aging. This mechanism differs significantly from that of intracranial diseases, and must be considered by neurosurgeons during diagnosis and treatment of degenerative spinal conditions. This article provides a comprehensive overview of the current surgical options for the treatment of cervical spondylotic myelopathy, with an emphasis on the diversity of options that currently exist.

  The technology of minimally-invasive surgery (MIS) provides many surgical options for lumbar degenerative diseases (LDD). Indication of each method should be determined according to the patient's condition.

  Microscopic posterior decompression is commonly used by neurosurgeons. This should be primarily considered for LDD. Neural tissues in the spinal canal of vertebral foramen are decompressed by partial laminectomy and facetectomy. Concurrently, the posterior structure must be preserved sufficiently for spinal stability, which is made possible by MIS. The same surgical intervention can be performed in endoscopy-assisted surgeries using tubular retractors.

  Full-endoscopic spinal surgery is another MIS option. An endoscope is introduced into the interlaminar space or intervertebral foramen without dissecting the soft tissues. Surgical manipulation is performed under continuous irrigation. This method is technically difficult and requires a relatively long time to master.

  MIS enables easier lumbar interbody fusion (IBF) surgery. In posterior/transforaminal lumbar IBF, neural tissues are decompressed with laminectomy and facetectomy, and local bone is grafted with interbody cages. In anterior/lateral lumbar IBF (ALIF/LLIF), surgical manipulations are performed via the retroperitoneal approach without injuring the posterior spinal structures. ALIF is often used to treat discogenic pain and kyphotic deformities. However, this method has been utilized only by certain surgeons because it often requires manipulation of major vessels. LLIF is more readily available because of its surgical manipulation using dedicated devices, sparing the major vessels. As a larger cage can be placed between the bilateral edges of the intervertebral space, LLIF has the advantage of correcting scoliosis. However, this method is incapable of direct neural decompression and expects only indirect neural decompression secondary to the restoration of the intervertebral height. MIS-posterior instrumentation is often used in IBF surgeries to promote a higher rate of arthrodesis and early return to daily living.

  Embolization does not require removal of the lamina or vertebral body and allows for multidirectional observation of the spinal cord vessels. However, because the catheter may not reach the shunt due to tortuosity or narrowness, there is a risk of uncertain occlusion and intrusion of embolic substances. Surgery is an easy and reliable method to disconnect the shunt at the accessible sites ; however, there is limited visibility of the spinal cord vessels and it is difficult to reach the ventral or the inner side of the spinal cord.

  In a spinal dural arteriovenous fistula, the radiculomeningeal artery is strongly tortuous ; therefore, surgical dissection is more reliable than embolization. In a spinal epidural arteriovenous fistula, embolization is easy because the dorsal somatic branch is relatively straight and transvenous coil embolization is also possible. Perimedullary arteriovenous fistulas and craniocervical junction arteriovenous shunt can be completely cured with embolization if the shunting point is clear and can be reached with a catheter. However, if a surgical approach is possible, disconnection is easy and safe. In contrast, intramedullary arteriovenous malformations cannot be completely cured. Palliative treatment, such as partially targeted embolization, is indicated.

  The case is a Jordanian 11-year-old boy. He was hospitalized with conscious disturbance due to cerebellar hemorrhage from cerebellar arterio-venous malformation. After urgent operations of hematoma removal and external decompression, the patient was steady recovered.

  During the treatment course, we faced considerable situations related to religious reasons. As the patient and his father are Muslim, we had to pay strict attention to medical materials, foods as well. On the rules of Islamic religious prohibition, not only alcohol and pork but other diets like jelly, soy-sauce which contain those ingredients should not be provided. Also, many medical materials in neurosurgery include heparin and other animal-based products, which are not available for them. In this report, we provide a guide of medical materials and drugs which contain animal-based products, related to neurosurgical treatment.

  Approximately 5.9-10.5% of cases with meningiomas show multiple meningiomas, either sporadically or in association with neurofibromatosis type 2 (NF2). Previous studies have suggested multicentric occurrence and leptomeningeal dissemination of monoclonal lesions as the mechanism of multiple occurrences. However, limited studies have described the intra-case variability of multiple meningioma subtypes and World Health Organization (WHO) grades. This report describes a case of a 34-year-old man with NF2 who presented with multiple meningiomas. The lesion attached to the falx cerebri showed no enlargement after 11-year follow-up and was a psammomatous meningioma (WHO grade 1). The convexity lesion showed rapid growth after 3 years and was an atypical meningioma (WHO grade 2). NF2-associated multiple meningiomas can show different histological subtypes and WHO grades. Thus, the treatment plan should be based on the characteristics and growth rate of each lesion.