Endoscopic Endonasal Clipping of Intracranial Aneurysms: Surgical Technique and Results.

Objective: Microsurgical clipping of intracranial aneurysms requires meticulous technique and is usually performed through open approaches. Endoscopic endonasal clipping of intracranial aneurysms may use the same techniques through an alternative corridor. The aim of this article is to report a series of patients who underwent an endoscopic endonasal approach (EEA) for microsurgical clipping of intracranial aneurysms.

Longitudinal evaluation of corticospinal tract in patients with resected brainstem cavernous malformations using high-definition fiber tractography and diffusion connectometry analysis: preliminary experience.

Object: Brainstem cavernous malformations (CMs) are challenging due to a higher symptomatic hemorrhage rate and potential morbidity associated with their resection. The authors aimed to preoperatively define the relationship of CMs to the perilesional corticospinal tracts (CSTs) by obtaining qualitative and quantitative data using high-definition fiber tractography. These data were examined postoperatively by using longitudinal scans and in relation to patients' symptomatology.

Subcomponents and connectivity of the superior longitudinal fasciculus in the human brain.

The subcomponents of the human superior longitudinal fasciculus (SLF) are disputed. The objective of this study was to investigate the segments, connectivity and asymmetry of the SLF. We performed high angular diffusion spectrum imaging (DSI) analysis on ten healthy adults.

[Transnasal endoscopic anatomy of the clivus and approaches consideration].

Objective: In-depth understanding of endoscopic anatomy of the skull base is the cornerstone of the development of endoscopic endonasal skull base surgery. The purpose of this study is to explore the anatomical landmarks of the clivus for endoscopic endonasal skull base surgery.

Method: Eight silicon-injected adult cadaveric heads (16 sides) were dissected performing endoscopic endonasal approach.

"Round-the-Clock" Surgical Access to the Orbit.

Objective To describe an algorithm to guide surgeons in choosing the most appropriate approach to orbital pathology. Methods A review of 12 selected illustrative cases operated on at the neurosurgical department of University of Pittsburgh Medical Center over 3 years from 2009 to 2011 was performed. Preoperative coronal magnetic resonance imaging and/or computed tomography views were compared using a "clock model" of the orbit with its center at the optic nerve.

Fully endoscopic retrosigmoid approach for posterior petrous meningioma and trigeminal microvascular decompression.

Background: Cerebellopontine angle tumor resection and cranial nerve microvascular decompression are usually performed with the aid of the surgical microscope. The endoscope is commonly used as an adjuvant.

Method: A retrosigmoid craniectomy is done.

Delayed nasoseptal flaps for endoscopic skull base reconstruction: proof of concept and evaluation of outcomes.

Objectives: To assess delayed nasoseptal flaps as a viable reconstructive option for sellar defects, evaluate postoperative vascularity of delayed nasoseptal flaps, and compare cerebrospinal fluid leak and surgery-specific complication rates of primary to delayed nasoseptal flaps.

Study Design: Case series with chart review.

Setting: University of Pittsburgh Medical Center.

Classification of sphenoid sinus pneumatization: relevance for endoscopic skull base surgery.

Objectives/hypothesis: The goal of this study was to present a classification based on the degree of pneumatization of the sphenoid sinus in the coronal plane that can be used to instruct preoperative planning for endoscopic endonasal surgery (EES).

Study Design: Observational anatomical study.

Methods: The geometry of sphenoid sinus pneumatization was characterized (n = 204 hemisinus) on high-resolution computed tomography scans, and its associations with the location of the foramen rotundum (FR) and the vidian canal (VC) were measured.

Validation of a chicken wing training model for endoscopic microsurgical dissection.

Objectives/hypothesis: To determine if training with a chicken wing model improves performance of endoscopic endonasal surgery (EES) with microvascular dissection.

Study Design: Randomized experimental study.

Methods: A single-blinded randomized clinical trial of trainees with various levels of endoscopic experience was conducted to determine if prior training on a nonhuman model augments endoscopic skill and efficiency in a surrogate model for live surgery.

Endoscopic endonasal surgery for olfactory groove meningiomas: outcomes and limitations in 50 patients.

Object: Recently, endoscopic endonasal surgery (EES) has been introduced in the management of skull base tumors, with constantly improving outcomes and increasing indications. The authors retrospectively reviewed the effectiveness of EES in the management of olfactory groove meningiomas.

Methods: Between February 2003 and December 2012, 50 patients (64% female) with olfactory groove meningiomas underwent EES at the University of Pittsburgh Medical Center.

Eustachian tube and internal carotid artery in skull base surgery: an anatomical study.

Objectives/hypothesis: The eustachian tube (ET) is an important landmark in skull base surgery, which has a close relationship with the petrous segment of the internal carotid artery (ICA). The goal of the current study was to establish the detailed anatomic relationship of the ET and petrous segment of the ICA.

Study Design: Anatomical study.

Advanced diffusion MRI fiber tracking in neurosurgical and neurodegenerative disorders and neuroanatomical studies: A review.

Diffusion MRI enabled in vivo microstructural imaging of the fiber tracts in the brain resulting in its application in a wide range of settings, including in neurological and neurosurgical disorders. Conventional approaches such as diffusion tensor imaging (DTI) have been shown to have limited applications due to the crossing fiber problem and the susceptibility of their quantitative indices to partial volume effects. To overcome these limitations, the recent focus has shifted to the advanced acquisition methods and their related analytical approaches.

Extended inferior turbinate flap for endoscopic reconstruction of skull base defects.

Objective When the use of the nasoseptal flap for endoscopic skull base reconstruction has been precluded, the posterior pedicle inferior turbinate flap is a viable option for small midclival defects. Limitations of the inferior turbinate flap include its small surface area and limited arc of rotation. We describe a novel extended inferior turbinate flap that expands the reconstructive applications of this flap.

A 23-year-old female with a mixed germ cell tumor of the pituitary infundibulum: the challenge of differentiating neoplasm from lymphocytic infundibuloneurohypophysitis-a case report and literature review.

The pathologic spectrum of diseases that infiltrate the pituitary infundibulum includes a broad variety of clinical entities. There are significant differences in the prevalence of these etiologies depending on the age of presentation. Lymphocytic infundibuloneurohypophysitis (LINH) predominates over other causes of infundibular disease in adults over age 21.

Detection of white matter injury in concussion using high-definition fiber tractography.

Over the last few decades, structural imaging techniques of the human brain have undergone significant strides. High resolution provided by recent developments in magnetic resonance imaging (MRI) allows improved detection of injured regions in patients with moderate-to-severe traumatic brain injury (TBI). In addition, diffusion imaging techniques such as diffusion tensor imaging (DTI) has gained much interest recently due to its possible utility in detecting structural integrity of white matter pathways in mild TBI (mTBI) cases.

Anatomy of the posterior septal artery with surgical implications on the vascularized pedicled nasoseptal flap.

Background: The purpose of this study was to define the anatomic characteristics of the posterior septal artery related to the design of the vascularized pedicled nasoseptal flap.

Methods: The course and branching pattern of the posterior septal artery and its relationship with landmarks and other regional arteries were studied in 26 vascular latex-injected head sides.

Results: The posterior septal artery is divided into 2 septal branches within the sphenoidal segment, which occurred either close to the sphenopalatine foramen (65.

Endoscopic endonasal transcavernous posterior clinoidectomy with interdural pituitary transposition.

Unlabelled: OBJECT.: The object of this paper was to describe the surgical anatomy and technical nuances of the endonasal transcavernous posterior clinoidectomy approach with interdural pituitary transposition and to report the clinical outcome of this technical modification.

Methods: The surgical anatomy of the proposed approach was studied in 10 colored silicon-injected anatomical specimens.

Use of diffusion spectrum imaging in preliminary longitudinal evaluation of amyotrophic lateral sclerosis: development of an imaging biomarker.

Previous diffusion tensor imaging (DTI) studies have shown white matter pathology in amyotrophic lateral sclerosis (ALS), predominantly in the motor pathways. Further these studies have shown that DTI can be used longitudinally to track pathology over time, making white matter pathology a candidate as an outcome measure in future trials. DTI has demonstrated application in group studies, however its derived indices, for example fractional anisotropy, are susceptible to partial volume effects, making its role questionable in examining individual progression.

Endonasal endoscopic surgery for squamous cell carcinoma of the sinonasal cavities and skull base: Oncologic outcomes based on treatment strategy and tumor etiology.

Background: Oncologic outcomes for sinonasal and skull base squamous cell carcinoma (SCC) treated with an endoscopic endonasal approach (EEA) needs investigation.

Methods: Patients with SCC treated with EEA were stratified by treatment strategy and tumor etiology and reviewed.

Results: Thirty-four patients were treated with EEA, or which 27 had definitive resection and 7 had debulking surgery.

Application of ultrasonic bone curette in endoscopic endonasal skull base surgery: technical note.

Background Endoscopic endonasal surgery (EES) of the skull base often requires extensive bone work in proximity to critical neurovascular structures. Objective To demonstrate the application of an ultrasonic bone curette during EES. Methods Ten patients with skull base lesions underwent EES from September 2011 to April 2012 at the University of Pittsburgh Medical Center.

Endoscopic endonasal surgery for suprasellar meningiomas: experience with 75 patients.

Object: Following the introduction of the neurosurgical microscope, the outcomes in suprasellar meningioma surgery were dramatically improved. More recently, the neurosurgical endoscope has been introduced as a visualization option during removal of skull base tumors, both transcranially and endonasally. The authors retrospectively reviewed the effectiveness of endoscopic endonasal surgery (EES) in the management of suprasellar meningiomas.

Asymmetry, connectivity, and segmentation of the arcuate fascicle in the human brain.

The structure and function of the arcuate fascicle is still controversial. The goal of this study was to investigate the asymmetry, connectivity, and segmentation patterns of the arcuate fascicle. We employed diffusion spectrum imaging reconstructed by generalized q-sampling and we applied both a subject-specific approach (10 subjects) and a template approach (q-space diffeomorphic reconstruction of 30 subjects).

Application of high-definition fiber tractography in the management of supratentorial cavernous malformations: a combined qualitative and quantitative approach.

Background: High-definition fiber tractography (HDFT), an advanced white matter (WM) imaging technique, was evaluated in the management of supratentorial cavernous malformations.

Objective: To investigate the relationship of cavernous malformations to the relevant perilesional WM tracts with HDFT and to characterize associated changes first qualitatively and then quantitatively with our novel imaging measure, quantitative anisotropy (QA).

Methods: Imaging analysis was carried out by researchers blinded to the clinical details.