Anterior Skull Base Reconstruction in Multiportal Approaches: Insight into Vascularized Flap Techniques.

: To evaluate the outcomes of anterior skull base (ASB) reconstruction using single versus double vascularized flap techniques following multiportal cranio-endoscopic approaches (CEA), based on a 12-year experience. : A retrospective analysis was conducted on 46 patients who underwent ASB reconstruction after a CEA at our department between 2010 and 2022. Patients were divided into two groups: Group 1 received a pericranial flap (PF) reinforced with a fascia graft, while Group 2 underwent multiple flap reconstruction with PF, fascia graft, and nasoseptal flap (NSF).

Endoscopic Transpterygoid Approach to Meckel's Cave: Technical Considerations and Retrospective Analysis of a Clinical Series.

Objective: Tumors located within the Meckel's cave (MC) pose a significant surgical challenge. Although several corridors to access this complex region have been described, the endoscopic transpterygoid approach (ETPA) and the endoscopic transorbital superior eyelid approach (ETOA) have emerged in recent years, as viable alternatives to traditional microsurgical transcranial approaches (MTA). To date, there is a limited literature on surgical series considering endoscopic-assisted approaches to the MC.

Preliminary Experience with 3-Dimensional-Exoscopic Untethering of a Type II Diastematomyelia: Technical Note and Review of the Literature.

Objective: To describe the use of a high-definition 3-dimensional (3D) exoscope (VITOM 3D exoscope; KARL STORZ GmbH) for the neurosurgical treatment of a rare pediatric disease, type II diastematomyelia with associated tethered cord.

Methods: A 13-year-old girl who presented with diastematomyelia type II with a tethered cord was surgically treated with the aid of a high-definition 3D exoscope, with a third operator moving and pivoting its arm. Intraoperative monitoring and mapping were arranged.

Ultrahigh-Definition-3-Dimensional Exoscope-Assisted Clipping of a Right Middle Cerebral Artery Unruptured Aneurysm with Indocyanine Green Video Angiography: Operative Video.

Ultrahigh-definition 3-dimensional exoscopes represent an excellent technologic innovation in contemporary neurosurgery. They combine the advantages of operating microscopes and endoscopes, offering excellent magnification and lighting, maintaining a relatively small footprint and optimal ergonomic features. One of the most interesting employments of exoscopes in neurosurgery is represented by intracranial vascular surgery.

Endoscopic Endonasal Pituitary Hemi-Rotation Approach to the Upper Clivus: Anatomical Study and Clinical Report.

Aim: To report on the endoscopic endonasal pituitary hemi-rotation approach (EPHRA) in a preclinical setting and in a preliminary clinical experience.

Material And Methods: EPHRA was performed in five fresh-frozen head and neck specimens (a total of 10 sides) and in a selected case of a right-sided dorsum sellae chordoma.

Results: The approach described allowed exposure of the lateral part of the upper clivus in all the specimens and in the case reported.

The "DOLPHINS" Project: A Low-Cost Real-Time Multivariate Process Control From Large Sensor Arrays Providing Sparse Binary Data.

The "DOLPHINS" project started in 2018 under a collaboration between three partners: CNH Industrial Iveco (CHNi), RADA (an informatics company), and the Chemistry Department of the University of Turin. The project's main aim was to establish a predictive maintenance method in real-time at a pilot plant (CNHi Iveco, Brescia, Italy). This project currently allows maintenance technicians to intervene on machinery preventively, avoiding breakdowns or stops in the production process.

CERN-MEDICIS: A Review Since Commissioning in 2017.

The CERN-MEDICIS (MEDical Isotopes Collected from ISolde) facility has delivered its first radioactive ion beam at CERN (Switzerland) in December 2017 to support the research and development in nuclear medicine using non-conventional radionuclides. Since then, fourteen institutes, including CERN, have joined the collaboration to drive the scientific program of this unique installation and evaluate the needs of the community to improve the research in imaging, diagnostics, radiation therapy and personalized medicine. The facility has been built as an extension of the ISOLDE (Isotope Separator On Line DEvice) facility at CERN.

Endoscopic Endonasal Transethmoidal-Transsphenoidal Approach to a Cavernous Sinus Chondrosarcoma.

 We illustrate a cavernous sinus chondrosarcoma treated with an endoscopic endonasal transethmoidal-transsphenoidal approach.  Case report of a 15-year-old girl with diplopia and esotropia due to complete abducens palsy. Preoperative images showed a right cavernous sinus lesion with multiple enhanced septa and intralesional calcified spots ( Fig.

Endoscopic Endonasal Odontoidectomy Preserving Atlantoaxial Stability: a Pediatric Case.

 We illustrate endoscopic endonasal odontoidectomy for the Chiari-I malformation respecting craniovertebral junction (CVJ) stability.  Case report of a 12-year-old girl affected by the Chiari-I malformation. Magnetic resonance imaging (MRI) showed tonsillar herniation, basilar invagination, and dental retroversion, causing angulation and compression of the bulbomedullary junction.

Cauda equina syndrome secondary to portal vein thrombosis: case report of favorable outcome with conservative treatment.

Epidural varicosis is a rare though well-known cause of cauda equina syndrome (CES). Although inferior vena cava (IVC) obstruction is the most common finding in such cases, portal vein hypertension can lead to epidural venous plexus engorgement by means of lumbar portocaval shunt activation.A 40-year-old woman presented with right-sided sciatica, which progressed to right foot drop and a 3-day history of vesical tenesmus and fecal retention.

The Role of the Transorbital Superior Eyelid Approach in the Management of Selected Spheno-orbital Meningiomas: In-Depth Analysis of Indications, Technique, and Outcomes from the Study of a Cohort of 35 Patients.

 Primary goal in spheno-orbital meningioma (SOM) surgery still remains complete resection. Nevertheless, given their highly infiltrative nature, a growing body of literature suggests to shift toward function-sparing surgeries. We here present our experience in the management of SOMs through the endoscopic superior eyelid approach (SEA).

Emergency endovascular treatment of cavernous internal carotid artery acute bleeding with flow diverter stent: a single-center experience.

Background And Objective: To describe our single-center experience in the treatment of cavernous internal carotid artery (ICA) acute bleeding with flow diverter stent (FDS), as a single endovascular procedure or combined with an endoscopic endonasal approach.

Methods: We analyze a case series of 5 patients with cavernous ICA acute bleeding, i.e.

Skull-base surgery during the COVID-19 pandemic: the Italian Skull Base Society recommendations.

Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), is highly contagious with devastating impacts for healthcare systems worldwide. Medical staff are at high risk of viral contamination and it is imperative to know what personal protective equipment (PPE) is appropriate for each situation. Furthermore, elective clinics and operations have been reduced in order to mobilize manpower to the acute specialties combating the outbreak; appropriate differentiation between patients who require immediate care and those who can receive telephone consultation or whose treatment might viably be postponed is therefore crucial.

Multicenter external validation of the Zurich Pituitary Score.

Purpose: Recently, the Zurich Pituitary Score (ZPS) has been proposed as a new quantitative preoperative classification scheme for predicting gross total resection (GTR), extent of resection (EOR), and residual tumor volume (RV) in endoscopic pituitary surgery. We evaluated the external validity of the ZPS.

Methods: In three reference centers for pituitary surgery, the ZPS was applied and correlated to GTR, EOR, and RV.

The Helmet-Visor Pericranial Flap as a Viable Option for Anterior Cranial Base Reconstruction in Complex Oncologic Cases.

Objective: To describe a novel bilaterally pedicled pericranial flap for anterior cranial base reconstruction after removal of complex frontobasal cancers extending to the frontal region, thus precluding the use of standard reconstructive techniques.

Methods: In selected oncologic cranial base surgeries, the use of the standard galea frontalis pericranial flap for reconstructive purposes may be precluded by tumor infiltration. In such cases, dura mater reconstruction and exclusion of frontal sinuses from the intracranial space can be performed using a large superficial temporal artery bilaterally pedicled pericranial flap obtained from both temporoparietal regions.

Impact of the newly proposed ICRU/ICRP quantities on neutron calibration fields and extended range neutron rem-counters.

In July 2017, the International Commission on Radiation Units and Measurements (ICRU) and the International Commission on Radiological Protection (ICRP) proposed the introduction of new operational quantities for external radiation exposure, with the aim of improving coherence between protection quantities and operational quantities within the system of radiological protection. A change in operational quantities will impact both instrumentation and reference radiation fields used for their calibration. This paper evaluates the potential impact of the new quantity ambient dose, H*, meant to replace ambient dose equivalent, H*(10), on two neutron reference fields, the Am-Be source and the CERF high-energy workplace field, and on the response of two models of extended-range neutron rem counters (LINUS and LUPIN).

Combined Multiportal Endoscopic Endonasal and Transcranial Approach for Recurrent Tuberculum Sellae Meningioma: Operative Video.

Surgery for anterior cranial base lesions is challenging because tumors often spread from their origin to sinuses, orbits, and middle cranial fossa, resulting in risky surgeries. To approach such complex diseases, recently combined multiportal approaches have been proposed. At the best of our knowledge, operative application of a combined endoscopic endonasal and transcranial surgery for complex anterior cranial base lesions has not been described.

Endoscopic Endonasal Approaches for Treatment of Craniovertebral Junction Tumours.

Tumours involving the craniovertebral junction (CVJ) are challenging because of their local invasiveness and high recurrence rates, as well as their proximity to critical neurovascular structures and the difficulty of reconstructing the resulting skull base defect at this site. Several surgical techniques are currently available to access these lesions, including the far lateral, extreme lateral, direct lateral, transcervical, transoral and transnasal approaches. In this paper, application of the endoscopic endonasal approach (EEA) in the treatment of CVJ tumours is analysed.

Emergency placement of a Flow Diverter Stent for an Iatrogenic Internal Carotid Artery Injury During Endoscopic Pituitary Surgery.

Background: Internal carotid artery (ICA) injury is 1 of the most feared complications in endoscopic pituitary surgery. Different endovascular techniques are available for the management of early and delayed ICA injuries.

Case Report: We report a case of emergency endovascular treatment with a flow diverter stent for an ICA injury that occurred during endoscopic transphenoidal surgery for pituitary macroadenoma in a 66-year-old man.

CERN IRRADIATION FACILITIES.

CERN provides unique irradiation facilities for applications in dosimetry, metrology, intercomparison of radiation protection devices, benchmark of Monte Carlo codes and radiation damage studies to electronics.

Transorbital endoscopic approaches to the skull base: current concepts and future perspectives.

Introduction: Transorbital endoscopic surgery is one of the most recent fields of skull base surgery. This paper presents the emerging applications of transorbital endoscopic approaches to the skull base and their current results on the treatment of selected extradural and intradural lesions, based on a review of meta-analysis and recent clinical series.

Evidence Acquisition: A PubMed, Cochrane and Ovid search for articles published from 2000 to 2015 was performed using the search terms "endoscopic skull base surgery", "transorbital endoscopic approach", and "transorbital neuroendoscopic surgery".

New radiation protection calibration facility at CERN.

The CERN radiation protection group has designed a new state-of-the-art calibration laboratory to replace the present facility, which is >20 y old. The new laboratory, presently under construction, will be equipped with neutron and gamma sources, as well as an X-ray generator and a beta irradiator. The present work describes the project to design the facility, including the facility placement criteria, the 'point-zero' measurements and the shielding study performed via FLUKA Monte Carlo simulations.

Vertebroepidural metastasis of an ethmoid adenocarcinoma: A case report.

Ethmoid adenocarcinoma is the most frequent ethmoid tumor. To date, only a single case of spinal cord compression resulting from ethmoid adenocarcinoma has been reported. The current case study presents a recent case of vertebroepidural metastasis of an ethmoid adenocarcinoma leading to spinal cord compression.