A prospective study on the usefulness of high-resolution intraoperative infrared thermography in intracranial tumors.

Introduction: Infrared thermography (IT) is a non-invasive real-time imaging technique with potential application in different areas of neurosurgery. Despite technological advances in the field, intraoperative IT (IIT) has been an underestimated tool with scarce reports on its usefulness during intracranial tumor resection. We aimed to evaluate the usefulness of high-resolution IIT with static and dynamic thermographic maps for transdural lesion localization, and diagnosis, to assess the extent of resection, and the occurrence of perioperative acute ischemia.

Surgical salvage for recurrent vestibular schwannoma after primary stereotactic radiosurgery.

Background: The management of vestibular schwannoma has evolved over the past hundred years. In the last decades, surgery has been gradually replaced by radiation therapy as a primary treatment modality, particularly for small tumors, due to the less invasive nature and the compared reported outcomes in tumor control and hearing preservation. However, irradiation sometimes fails to stop tumor growth.

Safety of withholding perioperative steroids for patients with pituitary resection with an intact hypothalamus-pituitary-adrenal axis: A meta-analysis of randomized clinical trials.

Introduction: Several observational studies have evaluated the effects of pre-operative steroids (STER) for transsphenoidal pituitary removal in patients with an intact hypothalamus-pituitary-adrenal axis. However, a consensus built upon randomized studies has not been previously performed.

Purpose: To comprehensively evaluate the clinical effects of patients receiving STER when compared to those not receiving steroids (NOSTER) in transsphenoidal pituitary resection, a meta-analysis of randomized clinical trials (RCT) was conducted.

Foramen magnum meningioma approached by the midline subtonsilar approach - Revisiting Cushing's classification of craniospinal meningiomas.

Background: The management of foramen magnum meningiomas (FMMs) has been a challenge for skull base neurosurgeons. Since the initial description of a FMM in 1872, various surgical approaches have been described. Posterior and posterolateral FMMs are safely removed through a standard midline suboccipital approach.

Large Vestibular Schwannoma: A Two-Stage Surgery.

Treatment of large vestibular schwannoma (VS) has historically centered on total resection of the lesion. Staged surgery has been used for VS that is highly vascularized, unexpected events during surgery, and thinned and stretched facial nerve with serious adherence causing difficult dissection. We present a case of a patient with a large VS resected through a two-stage surgery through the same retrosigmoid craniotomy.

Volumetric measurement of intracranial meningiomas: a comparison between linear, planimetric, and machine learning with multiparametric voxel-based morphometry methods.

Purpose: To compare the accuracy of three volumetric methods in the radiological assessment of meningiomas: linear (ABC/2), planimetric, and multiparametric machine learning-based semiautomated voxel-based morphometry (VBM), and to investigate the relevance of tumor shape in volumetric error.

Methods: Retrospective imaging database analysis at the authors' institutions. We included patients with a confirmed diagnosis of meningioma and preoperative cranial magnetic resonance imaging eligible for volumetric analyses.

Use of diffusion tensor imaging as a prognostic biomarker after decompression surgery for carpal tunnel syndrome.

Background: Magnetic resonance diffusion tensor imaging (MR-DTI) has been increasingly applied for carpal tunnel syndrome (CTS) diagnosis, but relatively little is known about the effect of CTS treatment on median nerve (MN) integrity and functional outcome prediction.

Purpose: To assess how structural changes in MR-DTI of the MN correlates with symptom severity, functional status, and electrophysiological parameters in patients suffering from CTS before and after decompression surgery.

Material And Methods: Nine wrists were prospectively enrolled to perform MR-DTI pre- and postoperatively.

Anterior petrosal approach for petroclival solitary plasmacytoma.

Background: Primary solitary plasmacytoma (PSP) of the skull base is a rare localized monoclonal plasma cell dyscrasia with normal or low plasma cell infiltration. Differentiating from other skull base tumors based on radiologic findings is difficult due to nonspecific features. PSP has a better prognosis after surgical resection and adjuvant radiotherapy, unless the tumor progresses to multiple myeloma (MM).

A Giant Internal Carotid Bifurcation Aneurysm as a Rare and Dangerous Differential Diagnosis of a Craniopharyngioma.

Craniopharyngiomas are supra/parasellar lesions that often present with general, unspecific symptoms. Similarly, internal carotid artery (ICA) bifurcation giant aneurysms may also produce calcified, heterogeneous, parasellar expansive lesions, posing a relevant differential diagnosis due to their inherently different surgical strategies and risks. We report the case of a 54-year-old female presenting with progressive disorientation and apathetic behavior.

Hypoplasia of C1's posterior arch: Is there an ideal anatomical classification?

Background: Congenital anomalies of the atlas are rare and usually occur in conjunction with other congenital variants. They include a wide spectrum of anomalies ranging from clefts to hypoplasia or aplasia of its arches that may contribute to spinal cord compressive syndrome.

Case Description: A 54-year-old male presented with the sudden onset of a severe quadriparesis and loss of proprioception after a minor fall.

Orbitozygomatic approach for large orbital cavernous hemangioma.

Background: Cavernous hemangiomas, more accurately defined as cavernous venous malformations, constitute the most common primary intraorbital tumors of adults comprising 4-9% of all tumors,[4] and the second most frequent cause of unilateral proptosis after thyroid-related orbitopathy.[3] Over 80% are located within the intraconal compartment, most commonly in the lateral aspect.[1] Surgical treatment for orbital cavernous hemangioma is generally required in symptomatic cases, optic nerve compression, and cosmetically disfiguring proptosis.

Tailored Anterior Clinoidectomy: Beyond the Intradural and Extradural Concepts.

Anterior clinoidectomy (AC) is a key microsurgical step for the safe and successful management of parasellar pathologies that involve the anterior clinoid process (ACP) and the optic canal. Traditionally, extra and intradural ACs are performed separately according to the surgeon's experience or preference. The objective is to present and discuss the tailored AC concept through illustrative cases.

Intraparenchymal subependymoma: Case report and literature review.

Background: Intracranial subependymomas are rare slow-growing benign tumors typically located in the ventricular system, accounting for 0.07-0.7% of all intracranial neoplasms.

Endoscopic Endonasal Approach to Foramen Magnum Meningioma: Two-Dimensional Surgical Video.

Even for the most experienced neurosurgeons, foramen magnum meningiomas represent a surgical challenge owing to their delicate position surrounded by the brainstem, lower cranial nerves, and vertebral arteries. The treatment goal is gross total resection, but choosing the most appropriate approach is crucial. Basically, 3 surgical approaches are commonly used: posterolateral approach (far-lateral), anterolateral approach (extreme-lateral), and posterior midline approach.

Spontaneous resolution of chronic subdural hematoma: Does only the size matter?

Background: Chronic subdural hematomas (CSDHs) usually occur late in adults and older after mild head trauma. Surgical intervention is the first treatment option in CSDH with conservative management being adopted in few cases.

Case Description: We report a case of a 71-year-old man who presented a spontaneous resolution of a large CSDH.

Predictive Factors for Muscle Injury After Posterior Lumbar Spinal Surgery.

Objective: The aims of this study were to evaluate the risk factors for muscle injury in patients undergoing posterior lumbar spinal surgery and the clearance of postoperative biochemical changes following lumbar fusion and secondarily to evaluate the timing for monitoring postoperative biochemical serum levels and potential clinical correlation.

Methods: The study prospectively enrolled 39 patients with degenerative disease of the lumbar spine. Biochemical markers (creatine phosphokinase [CPK], creatinine, and hemoglobin) were analyzed in 5 predefined stages.

Universal fluorescence module for intraoperative fluorescein angiography-a technical report.

Background: Even in specialized centers, suboptimal aneurysm clipping can be as high as 12%. Intraoperative fluorescence angiography with indocyanine green and, more recently, fluorescein sodium have been shown to be a good method for intraoperative flow assessment. However, the cost with the apparatus it entails limits its widespread use.

Cavernous Sinus Hemangioma: Surgical Aspects.

Resection of lesions in the cavernous sinus remains a challenge to neurosurgeons due to its complex anatomy. This video (Video 1) presents the most relevant landmarks of the cavernous sinus region, helping to understand the surgical anatomy. A 55-year-old female presented with diplopia, partial ptosis, and facial dysesthesia in the left ophthalmic territory.

Awake craniotomy for right inferior lobule glioma.

Awake craniotomy is a method usually used for brain tumors near or within language and/or sensorimotor areas. Preservation of these important neurological functions, however, may not be enough for a normal life. The authors present a case of a 45-year-old woman with an inferior parietal lobule low-grade glioma who underwent an awake craniotomy with sensorimotor and spatial cognition mapping.

Adult hemispheric cerebellar medulloblastoma.

Background: Medulloblastoma is an embryonal neoplasm and accounts for 1% of all adult intracranial tumors. It is associated with many familiar cancer syndromes, but there is no known cause for medulloblastoma. Many studies have documented differences between childhood and adult medulloblastomas in terms of location, proliferation, and apoptotic indices.

Technical Aspects of Awake Craniotomy with Mapping for Brain Tumors in a Limited Resource Setting.

Background: Brain tumor surgery near or within eloquent regions is increasingly common and is associated with a high risk of neurologic injury. Awake craniotomy with mapping has been shown to be a valid method to preserve neurologic function and increase the extent of resection. However, the technique used varies greatly among centers.

Implementing an epilepsy surgery center. Initial experience at a university hospital in Brazil.

Objective: Epilepsy is a serious neurological condition, often without a full and effective treatment. In some cases, surgery is beneficial, despite being underused. Our aim herein is to describe the implementation of an epilepsy surgery center in a federal university hospital, sharing the initial experience gained, as well as describing the main challenges and first results.

Ablative surgery for Parkinson's disease: Is there still a role for pallidotomy in the deep brain stimulation era?

Posteroventral pallidotomy has already been considered the surgical procedure of choice for Parkinson's disease patients with motor complications. Recently, however, several factors led to its replacement by deep brain stimulation. Nevertheless, pallidotomy has a well-documented efficacy and safety evidence regarding the reduction of parkinsonian motor symptoms.