Meges of Sidon: The "Most Learned" of Surgery's Founding Fathers.

This paper aims to bring back to life an underrated, even forgotten surgeon of the late first century B.C.E.

Transcavernous Approach in Vascular Neurosurgery.

The cavernous sinus is no more considered no man's land. It is a very well organized anatomic entity that can safely be navigated. It is both a route and a destination.

Cisternal, Falciform, and Optic Canal Decompression Influencing Optic Nerve Biomechanics: A Microsurgical Anatomic Study.

Background: Questions remain regarding optic nerve (ON) physiology, mechanical compliance, and microvasculature, particularly surgical outcomes and atypical visual field defects associated with sellar/parasellar pathology (eg, tumors and aneurysms).

Objective: To study the microsurgical/histological anatomy of each ON segment and corresponding microvasculature, calculate area of optic-carotid space at each decompression stage, and measure ON tension before/after compression.

Methods: Five cadaveric heads (10 sides) underwent sequential dissection: (1) intradural (arachnoidal) ON dissection; (2) falciform ligament opening; (3) anterior clinoidectomy, optic canal decompression, and ON sheath release.

The Asterion-to-Transverse Process of the Atlas Line as a Surgical Landmark.

 Proposed landmarks to predict the anatomical location and trajectory of the sigmoid sinus have varying degrees of reliability. Even with neuronavigation technology, landmarks are crucial in planning and performing complex approaches to the posterolateral skull base. By combining two major dependable structures-the asterion (A) and transverse process of the atlas (TPC1)-we investigate the A-TPC1 line in relation to the sigmoid sinus and in partitioning surgical approaches to the region.

History, Variations, and Extensions of the Retrosigmoid Approach: Anatomical and Literature Review.

The retrosigmoid approach is the workhorse for posterior fossa surgery. It gives a versatile corridor to tackle different types of lesions in and around the cerebellopontine angle. The term "extended" has been used interchangeably in the literature, sometimes creating confusion.

Simplifying the Surgical Classification and Approach to the Posterolateral Skull Base and Jugular Foramen Using Anatomical Triangles.

Introduction Lesions of the jugular foramen (JF) and postero-lateral skull base are difficult to expose and exhibit complex neurovascular relationships. Given their rarity and the increasing use of radiosurgery, neurosurgeons are becoming less experienced with their surgical management. Anatomical factors are crucial in designing the approach to achieve a maximal safe resection.

First documented clinical account of brachial plexus palsy from the 12th century.

Objective: Although literary depiction of brachial plexus injury can be traced to Homer's Iliad, there is a scientific consensus that the first clinical description of brachial plexus palsy was not documented until the British physician Smellie reported it in the 18th century. However, the authors' recent review of the Syriac Book of Medicines (12th century) has uncovered a much earlier clinical documentation.

Methods: For this historical vignette, the authors reviewed the historical and anatomical literature regarding earlier descriptions of brachial plexus anatomy and pathology, including a thorough analysis of the Syriac Book of Medicines (attributed to an unknown Syriac physician in the Middle Ages) and Galen's On Anatomical Procedures and On the Usefulness of the Parts of the Body.

Legacy of Syriac-Aramaic Scholars in Transmitting Neurosurgical Knowledge Between Antiquity and the Middle Ages.

The link between ancient Greek medicine and the Arabic translation period in the 9th century cannot be understood without studying the contributions of Syriac scholars. With their mastery of Greek and the related Semitic languages of Syriac and Arabic, they initiated a scientific translation process with methods that prevail to this day. In this paper, we reviewed Hunayn Ibn Isshaq's Ten Treatises on the Eye to elucidate the original contributions of the Syriac physicians to the field of neurologic surgery.

Resection of a Recurrent Cervicomedullary Junction Fibromyxoid Sarcoma through a Far Lateral Approach.

 This study describes a far lateral approach for the resection of a recurrent fibromyxoid sarcoma involving the ventrolateral brainstem, with emphasis on the microsurgical anatomy and technique.  A far lateral craniotomy is performed in the lateral decubitus position and the transverse and sigmoid sinuses exposed. After opening the dura, sutures are placed to allow gentle mobilization of the sinuses.

Far Lateral Approach for Resection of Transverse Ligament Cyst.

 This study was aimed to describe a far lateral approach for microsurgical resection of a transverse ligament cyst, with emphasis on the microsurgical anatomy and technique.  A far lateral craniotomy is performed in the lateral decubitus position. After opening the dura laterally, dural sutures are placed for retraction.

Robotic-Assisted Tubular Transoral Parapharyngeal Approach to the Ventral Craniovertebral Junction.

Background: Transoral robotic surgery (TORS) has become a routine technique for treating benign and malignant lesions of the oropharynx with the advantage of reducing morbidity compared to open surgical techniques. However, TORS has not been used routinely for accessing lesions of the spine.

Objective: To describe how TORS can be used to access spinal lesions.

Anterior perforated substance region aneurysms: review of a series treated with microsurgical technique.

Aneurysms arising from the distal carotid, proximal A1, and proximal M1 that project posteriorly and superiorly toward the anterior perforated substance (APS) are rare. Their open surgical treatment is particularly difficult due to poorly visualized origin of the aneurysm and the abundance of surrounding perforators. We sought to analyze the anatomical and clinical characteristics of APS aneurysms and discuss surgical nuances that can optimize visualization, complete neck clip obliteration, and preservation of adjacent perforators.

Temporary Clipping of the Intracavernous Internal Carotid Artery: A Novel Technique for Proximal Control.

Background: Securing proximal control in complex paraclinoid aneurysm surgery through traditional techniques may be challenging and risky in certain situations. Advancements of anatomical knowledge of the cavernous sinus (CS) and hemostasis have made it more accessible as a surgical option.

Objective: To describe the technique of temporary clipping of the horizontal segment of the intracavernous internal carotid artery (IC-ICA) in preparation for permanent clipping of complex paraclinoid aneurysms.

Morphometric Comparison of the Pterional Trans-Sylvian and the Pretemporal Trans-Clinoidal Approaches to the Posterior Communicating Artery.

Background: Posterior communicating (Pcom) aneurysms in the modern era have tended toward increased complexity and technical difficulties. The pretemporal approach is a valuable extension to the pterional approach for basilar apex aneurysms, but its advantages for Pcom aneurysms have not been previously elucidated.

Objective: To quantify characteristics of the pretemporal approach to the Pcom.

Predicting Surgical Intervention in Cerebellar Stroke: A Quantitative Retrospective Analysis.

Background: Debate still exists regarding whether preventive surgical decompression should be offered to high-risk patients experiencing cerebellar stroke. This study aimed to predict neurologic decline based on risk factors, volumetric analysis, and imaging characteristics.

Methods: This retrospective cohort study comprised patients ≥18 years who presented with acute cerebellar ischemic stroke (CIS) between January 2011 and December 2016.

The Evolutionary Development of the Brain As It Pertains to Neurosurgery.

Background Neuroanatomists have long been fascinated by the complex topographic organization of the cerebrum. We examined historical and modern phylogenetic theories pertaining to microneurosurgical anatomy and intrinsic brain tumor development. Methods Literature and history related to the study of anatomy, evolution, and tumor predilection of the limbic and paralimbic regions were reviewed.

The Ultimate Skull Base Maneuver Does Not Involve Removing Bone: Quantifying the Benefits of the Interfascial Dissection.

 Several adjunctive osteal skull base maneuvers have been proposed to increase surgical exposure of the anterolateral approach. However, one of the easiest methods does not involve bone: the interfascial temporalis muscle dissection.  Sequential dissections were performed bilaterally on five fixed silicone-injected cadaver heads.

Far Lateral Approach for Clipping of a Posterior Inferior Cerebellar Artery Aneurysm.

 To describe a far lateral approach for microsurgical clipping of a ruptured posterior inferior cerebellar artery (PICA) aneurysm involving the hypoglossal nerve, with emphasis on the microsurgical anatomy, and technique.  A far lateral craniotomy is performed in the lateral decubitus position and the transverse and sigmoid sinuses were exposed. After opening the dura, sutures are placed to allow gentle mobilization of the sinuses.

Deconstruction of the Surgical Approach to the Jugular Foramen Region: Anatomical Study.

 The jugular foramen occupies a complex and deep location between the skull base and the distal-lateral-cervical region. We propose a morphometric anatomical model to deconstruct its surgical anatomy and offer various quantifiable target-guided exposures and angles-of-attack.  Six cadaveric heads (12 sides) were dissected using a combined postauricular infralabyrinthine and distal transcervical approach with additional anterior transstyloid and posterior far lateral exposures.

Microvascular Decompression for Geniculate Neuralgia through a Retrosigmoid Approach.

 To describe a retrosigmoid approach for the microvascular sectioning of the nervus intermedius and decompression of the 5th and 9th cranial nerves, with emphasis on microsurgical anatomy and technique.  A retrosigmoid craniectomy is performed in the lateral decubitus position. The dura is opened and cerebrospinal fluid (CSF) is released from the cisterna magna and cerebellopontine cistern.

Ischemic stroke following elective craniotomy in children.

OBJECTIVE An ischemic stroke following an elective craniotomy in a child is perceived to be a rare event. However, to date there are few papers on this topic. The purpose of this study was to investigate the occurrence of stroke following elective intracranial surgery at a children’s hospital.

Extended Retrosigmoid Approach for the Resection of a Pontomedullary Junction Cavernous Malformation.

 To describe an extended retrosigmoid approach for the resection of a cavernoma involving the ponto-medullary junction, with emphasis on the microsurgical anatomy and technique.  A retrosigmoid craniotomy is performed in the lateral decubitus position and the sigmoid sinus exposed. After opening the dura, sutures are placed medial to the sinus to allow its gentle mobilization.

Orbitopterional Approach with Extradural Clinoidectomy for the Resection of a Tuberculum Sellae Meningioma: Adapting the Strategy to the Microsurgical and Pathological Anatomy.

 To describe the orbitopterional approach with extradural clinoidectomy for the resection of a tuberculum sellae meningioma, with an emphasis on the microsurgical and pathological anatomy of such lesions.  After completing the orbitopterional craniotomy in one piece, the optic nerve is identified extradurally, unroofed, and the clinoid process resected. The falciform ligament is divided and the optic nerve is decompressed extradurally.

Orbitopterional Approach for the Resection of a Suprasellar Craniopharyngioma: Adapting the Strategy to the Microsurgical and Pathologic Anatomy.

 To describe the orbitopterional approach for the resection of a suprasellar craniopharyngioma with emphasis on the microsurgical and pathological anatomy of such lesions.  After completing the orbitopterional craniotomy in one piece including a supraorbital ridge osteotomy, the Sylvian fissure was split in a distal to proximal direction. The ipsilateral optic nerve and internal carotid artery were identified.