Transorbital Approach Clipping of Middle Cerebral Artery Aneurysm: A Virtual Reality Morphometric Anatomic Study.

Background: The transorbital approach (TOA) has a unique advantage to the more common lateral approaches as it provides direct access to the anterior middle fossa and medial sylvian fissure (SF) without significant dissection or retraction. However, when to use the TOA for surgical treatment of middle cerebral artery (MCA) aneurysms remains unclear. This study details the feasibility of clipping unruptured MCA aneurysms via the TOA by highlighting the anatomic features that either facilitate or hinder the approach.

Application of Topographical Anatomy of the Trochlear Nerve in Transtentorial Approaches: An Anatomic Study.

Background And Objectives: Transection of the free edge of tentorium (FET) might be necessary when approaching cavernous sinus lesions, clip placement in certain posterior communicating artery aneurysms, or during transpetrosal and retrosigmoid transtentorial approaches. No anatomic study has investigated the relationship of the trochlear and oculomotor nerve and FET in an attempt to identify a safe zone for such maneuver.

Methods: Ten embalmed specimens (20 sides) were studied and the following morphometric measurements were taken using digital microcalipers: trochlear (TP) to oculomotor porus (OP), length of the intratentorial segment of cranial nerve (CN) IV, nerve free FET, and distance along the oculomotor (CN III) from its OP to CN III/trochlear (CN IV) crossing and angle between the long-axis petrous ridge and TP (petrotrochlear angle).

Endoscopic third ventriculostomy (ETV) for Chiari 1 malformation: a systematic review and meta-analysis.

Meta-analysis and systematic review. To understand the role of endoscopic third ventriculostomy (ETV) for the treatment of concurrent Chiari Malformation Type I (CMI) and hydrocephalus in adults. A literature search on PubMed and Medline with MeSH terms relating to ETV and CMI identified 155 articles between 1988 and 2024.

Timing of Embolization, Radiosurgery, and Resection of Arteriovenous Malformations in Pediatric Patients: A Retrospective, Descriptive Study.

Objective: Cerebral arteriovenous malformations (AVMs) are a challenging pathology in pediatric patients, carrying a high risk of morbidity and mortality. Treatment modalities include resection, endovascular embolization, and stereotactic radiosurgery. There is currently no consensus favoring one modality over another.

Temporal lobe injury with middle fossa approach to intracanalicular vestibular schwannomas: a systematic review.

There are several surgical approaches for vestibular schwannoma (VS) resection. However, management has gradually shifted from microsurgical resection, toward surveillance and radiosurgery. One of the arguments against microsurgery via the middle fossa approach (MFA) is the risk of temporal lobe retraction injury or sequelae.

Endoscopic endonasal obliteration of the frontal recess and anterior skull base.

Background: Although endoscopic techniques have become more widespread in repair of frontal sinus (FS) defects, certain pathologies still require open approach (extensive trauma or tumors). Under certain circumstances even multiple complex open reconstructive procedures might fail to resolve persistent pneumocephalus or CSF leak and subsequently surgeons tend to escalate the invasiveness and employ even more complex and aggressive approaches. We present our experience treating persistent pneumocephalus or CSF leak after previously failed transcranial reconstruction utilizing an endoscopic endonasal approach (EEA).

Clival-Meckel's Cave Angle: A Predictor of Glycerol Displacement in Percutaneous Glycerol Rhizotomy for Trigeminal Neuralgia.

Background And Objectives: Percutaneous glycerol rhizotomy successfully treats trigeminal neuralgia although failure rates and durability of the procedure are variable. Some of this variability in clinical outcome might be due to egress of glycerol from Meckel's cave (MC) because of surgical positioning and individual patient anatomy. In this article, we quantitatively analyzed the anatomic variances that affect glycerol fluid dynamics to better predict patients more amenable for percutaneous glycerol injections.

Nasofrontal meningiomas: retrospective series and review of literature.

Introduction: Lesions affecting the anterior skull base and involving the paranasal sinuses (PNS), nasal cavity (NC), and orbit are infrequent and include predominantly a wide variety of sinonasal malignancies. Less than 3% of intracranial meningiomas extend extracranially and involve PNS and NC. Given their relatively low incidence, little is known about the treatment outcome of this subset of meningiomas.

Preliminary experience with diffuse correlation spectroscopy in acute ischemic stroke neurointerventional procedures.

Background: Diffuse correlation spectroscopy (DCS) is a non-invasive optical technique that enables continuous blood flow measurements in various organs, including the brain. DCS quantitatively measures blood flow from temporal fluctuations in the intensity of diffusely reflected light caused by the dynamic scattering of light from moving red blood cells within the tissue.

Methods: We performed bilateral cerebral blood flow (CBF) measurements using a custom DCS device in patients undergoing neuroendovascular interventions for acute ischemic stroke.

Endoscopic Placement of Intracystic Catheters: A Technical Note.

Background: Intraventricular neuroendoscopic surgery for tumor resection, biopsy, or cyst fenestration frequently requires precise placement of an intraventricular or intracystic catheter. Placement under direct visualization is not feasible because of small bore of working channel of the standard small ventriculoscope. Various techniques have been reported using a separate transcortical trajectory, endoluminal endoscope, or endovascular guide wire.

Optimizing Workflow in Combined Petrosectomy Approaches: Surgical Technique and Case Series.

Background And Objective: The combined petrosectomy is one of the workhorse skull base approaches to the petroclival region. Traditionally, this approach starts with a temporosuboccipital craniotomy, followed by the mastoidectomy/anterior petrosectomy, and completed with the dural opening/tumor resection. This sequence of events (neurosurgery-neuro-otology-neurosurgery) involves at least 2 handoffs and change of surgical teams and instrumentation.

Kyphoplasty of C2 Pathological Fractures Using an Anterior Midline Approach and Steerable Osteotome: Technical Note and Case Series.

Background: Malignant lesions involving the C2 vertebral body (axis) may be challenging to treat, and not all patients with cancer are good candidates for posterior cervical or occipitocervical instrumentation.

Objective: To describe a modified technique of the direct anterolateral C2 kyphoplasty using a steerable osteotome, commonly used for the treatment of thoracolumbar spinal lesions. We also report a case series of 11 patients treated with this technique at our institution.

Postoperative magnetic resonance imaging signal changes in middle cerebral peduncle after vestibular schwannoma surgery.

Background And Purpose: Preoperative compression of middle cerebellar peduncle (MCP) is often observed in vestibular schwannomas. Its re-expansion is expected after tumour resection, however, frequently its thickness remains unchanged or undergoes further atrophy. Similarly, increased MCP FLAIR signal is often observed and thought to be associated with intraoperative MCP injury.

Resection of Giant Remote Recurrence of Ependymoma After 41 Years.

Ependymomas are rare primary tumors of the brain and spinal cord that arises from the ependymal cell layer. Cranial ependymomas commonly occur in the posterior fossa; however, approximately 30% of all tumors can be found in the supratentorial region. Supratentorial ependymomas have a shorter progression-free and overall survival than their infratentorial counterparts.

The Final Cut: Evolution of Cavernous Sinus Decompression Beyond the Dolenc Cut.

Background: Meningiomas involving the cavernous sinus (CS) represent a formidable challenge to neurosurgeons. Because of high morbidity, aggressive tumor resection within the CS has been largely replaced by extracavernous tumor resection and decompression of the CS. The widely used Dolenc method involves blind dural transection over the oculomotor nerve, potentially placing the crossing trochlear nerve at risk.

Factors associated with in-stent stenosis after cerebral aneurysm embolization using a Pipeline embolization device.

Background: Flow-diverting (FD) stents, with or without coiling, are a mainstay in endovascular treatment of intracranial aneurysms (IAs). One observed complication from flow diverter stent (FDS) insertion has been in-stent stenosis. Though previously studied in the short-term period, the long-term history of this complication has yet to be described.

The ventral pathway of the human brain: A continuous association tract system.

The brain hemispheres can be divided into an upper dorsal and a lower ventral system. Each system consists of distinct cortical regions connected via long association tracts. The tracts cross the central sulcus or the limen insulae to connect the frontal lobe with the posterior brain.

Subarachnoid Hemorrhage and Internal Carotid Artery Dissection and Occlusion Following Self-Enucleation.

Self-enucleation is an uncommon type of major self-injury, which may lead to severe neurological deficits and life-threatening complications, such as subarachnoid hemorrhage (SAH) and internal carotid artery (ICA) dissection and occlusion. Our patient is a 53-year-old man with a history of bipolar disorder and schizophrenia who presented with SAH, intraventricular hemorrhage, ICA dissection and occlusion, and right cerebral infarct following self-enucleation. Despite a Glasgow Coma Score of 6 on initial presentation, he improved with conservative management.

Interdisciplinary treatment of posterior fossa dural arteriovenous fistulas.

Background: Posterior fossa dural arteriovenous fistulas (dAVFs) are rare vascular lesions with variable risk of hemorrhage, mostly depending on the pattern of the venous drainage. While endovascular embolization is the mainstay treatment for most dAVFs, some posterior fossa lesions require a multidisciplinary approach including surgery. The goal of our study was to examine the outcome of an interdisciplinary treatment for posterior fossa dAVFs.

Transpalpebral transorbital neuroendoscopic (TONES) repair of orbital meningoencephalocele: a technical note.

Purpose: Intraorbital encephalocele (OMEC) is a rare entity in adults, usually secondary to an orbital pathology or prior trauma, in particular orbital roof fractures. Treatment of the OMEC is warranted to alleviate the pulsating exophthalmos and prevent potential visual decline. OMEC and orbital roof fractures have been predominantly treated via a craniotomy with a reconstruction of the orbital roof using various implants.

Contralateral Transfalcine Approach to Deep Parasagittal Arteriovenous Malformations-Technical Note.

Background: Resection of deep medial frontal and parietal arteriovenous malformations (AVMs) is often challenging due to a tangential angle of attack and deep, narrow working corridor. Adequate visualization of the AVM and its feeding arteries without brain retraction is of particular importance when operating in or near eloquent cortical areas, where brain manipulation could inadvertently result in neurologic deficits. The aim of this paper is to provide a step-by-step description of surgical approach and report our experience with the contralateral transfalcine approach for resection of deep-seated parasagittal AVMs.