The Anterolateral Limit of the Occipital Lobe: An Anatomical and Imaging Study.

 The boundaries of the temporal lobe, the parietal lobe, and the anterior portion of the occipital lobe (OL) are poorly defined. Lesions in these areas can be difficult to localize. Therefore, we studied the anterolateral limit of the OL to identify reliable anatomical landmarks.

Chen Jingrun, China's famous mathematician: devastated by brain injuries on the doorstep to solving a fundamental mathematical puzzle.

Chen Jingrun (1933-1996), perhaps the most prodigious mathematician of his time, focused on the field of analytical number theory. His work on Waring's problem, Legendre's conjecture, and Goldbach's conjecture led to progress in analytical number theory in the form of "Chen's Theorem," which he published in 1966 and 1973. His early life was ravaged by the Second Sino-Japanese War and the Chinese Cultural Revolution.

Infraorbital nerve: a surgically relevant landmark for the pterygopalatine fossa, cavernous sinus, and anterolateral skull base in endoscopic transmaxillary approaches.

OBJECTIVE Endoscopic transmaxillary approaches (ETMAs) address pathology of the anterolateral skull base, including the cavernous sinus, pterygopalatine fossa, and infratemporal fossa. This anatomically complex region contains branches of the trigeminal nerve and external carotid artery and is in proximity to the internal carotid artery. The authors postulated, on the basis of intraoperative observations, that the infraorbital nerve (ION) is a useful surgical landmark for navigating this region; therefore, they studied the anatomy of the ION and its relationships to critical neurovascular structures and the maxillary nerve (V2) encountered in ETMAs.

Comparison of CT versus MRI measurements of transverse atlantal ligament integrity in craniovertebral junction injuries. Part 1: A clinical study.

OBJECTIVE Craniovertebral junction (CVJ) injuries complicated by transverse atlantal ligament (TAL) disruption often require surgical stabilization. Measurements based on the atlantodental interval (ADI), atlas lateral diameter (ALD1), and axis lateral diameter (ALD2) may help clinicians identify TAL disruption. This study used CT scanning to evaluate the reliability of these measurements and other variants in the clinical setting.

Comparison of CT versus MRI measurements of transverse atlantal ligament integrity in craniovertebral junction injuries. Part 2: A new CT-based alternative for assessing transverse ligament integrity.

OBJECTIVE The rule of Spence is inaccurate for assessing integrity of the transverse atlantal ligament (TAL). Because CT is quick and easy to perform at most trauma centers, the authors propose a novel sequence of obtaining 2 CT scans to improve the diagnosis of TAL impairment. The sensitivity of a new CT-based method for diagnosing a TAL injury in a cadaveric model was assessed.

Midline as a landmark for the position of the superior sagittal sinus on the cranial vault: An anatomical and imaging study.

Background: Craniotomies involving the midline are regular practice in neurosurgery, during which injury to the superior sagittal sinus (SSS), an uncommon yet devastating event, may occur. The midline tends to be the most common landmark used to identify the position of the SSS. In this study we examined the reliability of the midline as a landmark for the SSS.

Carotid Endarterectomy Surgical Simulation Model Using a Bovine Placenta Vessel.

Background: Carotid endarterectomy (CEA) is a common, well-developed surgical procedure. Although surgical simulation is gaining in importance for residency training, CEA practice opportunities for surgical residents are limited.

Objective: To describe a new haptic CEA model.

Surgical efficacy of minimally invasive thoracic discectomy.

We aimed to determine the clinical indications and surgical outcomes for thoracoscopic discectomy. Thoracic disc disease is a rare degenerative process. Thoracoscopic approaches serve to minimize tissue injury during the approach, but critics argue that this comes at the cost of surgical efficacy.

Minimally Invasive Endoscopic Supracerebellar-Infratentorial Surgery of the Pineal Region: Anatomical Comparison of Four Variant Approaches.

Objective: The endoscopic supracerebellar-infratentorial (SCIT) approach is a viable method to access pathology of the posterior incisura, but a narrow working space and frequent instrument conflict can potentially limit its surgical efficacy. Until now, no rigorous studies were available comparing surgical freedom and angle of attack for four previously well-described approaches to pineal region targets.

Methods: Four formalin-fixed cadaver heads were dissected bilaterally (eight sides).

In vitro hydrodynamic, transient, and overtime performance of a miniaturized valve for hydrocephalus.

Reliable cerebrospinal fluid (CSF) draining methods are needed to treat hydrocephalus, a chronic debilitating brain disorder. Current shunt implant treatments are characterized by high failure rates that are to some extent attributed to their length and multiple components. The designed valve, made of hydrogel, steers away from such protracted schemes and intends to provide a direct substitute for faulty arachnoid granulations, the brain's natural CSF draining valves, and restore CSF draining operations within the cranium.

Long-term functional outcomes and predictors of shunt-dependent hydrocephalus after treatment of ruptured intracranial aneurysms in the BRAT trial: revisiting the clip vs coil debate.

Background: Acute hydrocephalus is a well-known sequela of aneurysmal subarachnoid hemorrhage (SAH). Controversy exists about whether open microsurgical methods serve to reduce shunt dependency compared with endovascular techniques.

Objective: To determine predictors of shunt-dependent hydrocephalus and functional outcomes after aneurysmal SAH.

Evaluation of surgical freedom for microscopic and endoscopic transsphenoidal approaches to the sella.

Background: Microscopic and endoscopic transsphenoidal approaches to the sellar are well established. Surgical freedom is an important skull base principle that can be measured objectively and used to compare approaches.

Objective: To compare the surgical freedom of 4 transsphenoidal approaches to the sella turcica to aid in surgical approach selection.

Quantitative study of the opticocarotid and carotid-oculomotor windows for the interpeduncular fossa, before and after internal carotid artery mobilization and posterior communicating division.

Background: The management of basilar apex (BX) aneurysms remains problematic.

Objective: We quantified the surgical exposure of the BX through the opticocarotid window (OCW) and the carotid-oculomotor window (COW), before and after mobilization of the internal carotid artery and division of the posterior communicating artery (PCoA).

Methods: Eleven silicone-injected cadaveric heads were dissected bilaterally.

Spontaneous subarachnoid hemorrhage of unknown origin: hospital course and long-term clinical and angiographic follow-up.

Object: Hemorrhagic origin is unidentifiable in 10%-20% of patients presenting with spontaneous subarachnoid hemorrhage (SAH). While the patients in such cases do well clinically, there is a lack of long-term angiographic followup. The authors of the present study evaluated the long-term clinical and angiographic follow-up of a patient cohort with SAH of unknown origin that had been enrolled in the Barrow Ruptured Aneurysm Trial (BRAT).

Comparison of surgical freedom and area of exposure in three endoscopic transmaxillary approaches to the anterolateral cranial base.

Objective Endoscopic ipsilateral endonasal transmaxillary, contralateral endonasal transseptal transmaxillary, and Caldwell-Luc approaches can access lesions within the retromaxillary space and pterygopalatine fossa. We compared the exposure and surgical freedom of these transmaxillary approaches to assist with surgical decision making. Design Four cadaveric heads were dissected bilaterally using the three approaches just described.

Malleable endoscope increases surgical freedom compared with a rigid endoscope in endoscopic endonasal approaches to the parasellar region.

Background: One challenge when performing endoscopic endonasal approaches is the surgical conflict that occurs between the surgical instruments and endoscope in the crowded nasal corridor. This conflict decreases surgical freedom, increases surgeon frustration, and lengthens the learning curve for trainees.

Objective: To evaluate the impact a malleable endoscope has on surgical freedom for endoscopic approaches to the parasellar region.

Revascularization and pediatric aneurysm surgery.

Object: Aneurysms are relatively rare in the pediatric population and tend to include a greater proportion of large and giant lesions. A subset of these large and giant aneurysms are not amenable to direct surgical clipping and require complex treatment strategies and revascularization techniques. There are limited data available on the management of these lesions in the pediatric population.

Carotid endarterectomy: comparison of complications between transverse and longitudinal incision.

Background: Cranial nerve injury (CNI) is the most common neurological complication associated with carotid endarterectomy (CEA). Some authors postulate that the transverse skin incision leads to increased risk of CNI.

Objective: We compared the incidence of CNI associated with the transverse and longitudinal skin incisions in a high-volume cerebrovascular center.

Potential application of a handheld confocal endomicroscope imaging system using a variety of fluorophores in experimental gliomas and normal brain.

Object: The authors sought to assess the feasibility of a handheld visible-wavelength confocal endomicroscope imaging system (Optiscan 5.1, Optiscan Pty., Ltd.

Pharmacophysiology of bone and spinal fusion.

Background Context: In recent years, the number of complex spinal surgeries has increased significantly in the elderly population, where the prevalence of low bone density is highest. Consequently, spine surgeons often treat osteoporotic patients who are associated with higher rates of instrumentation failure. Therefore, establishing a successful fusion requires an appropriate substrate for bone formation and local bone remodeling.

Multimodality management of vertebral artery injury sustained during cervical or craniocervical surgery.

Background: Iatrogenic vertebral artery (VA) injury is a rare but potentially devastating complication associated with cervical and craniocervical surgery.

Objective: To retrospectively evaluate treatment modalities and outcomes associated with iatrogenic VA injury.

Methods: Our institutional surgical database was queried for patients who underwent cervical or craniocervical surgery from January 1997 to August 2012.

Fedor Krause: the first systematic use of X-rays in neurosurgery.

Within a few months of Wilhelm Conrad Röntgen's discovery of x-rays in 1895, Fedor Krause acquired an x-ray apparatus and began to use it in his daily interactions with patients and for diagnosis. He was the first neurosurgeon to use x-rays methodically and systematically. In 1908 Krause published the first volume of text on neurosurgery, Chirurgie des Gehirns und Rückenmarks (Surgery of the Brain and Spinal Cord), which was translated into English in 1909.

The journey of discovering skull base anatomy in ancient Egypt and the special influence of Alexandria.

The field of anatomy, one of the most ancient sciences, first evolved in Egypt. From the Early Dynastic Period (3100 BC) until the time of Galen at the end of the 2nd century ad, Egypt was the center of anatomical knowledge, including neuroanatomy. Knowledge of neuroanatomy first became important so that sacred rituals could be performed by ancient Egyptian embalmers during mummification procedures.