Atypical Teratoid Rhabdoid Tumor of the Brain in a Young Adult With Down Syndrome: Case Report and Literature Review.

Atypical teratoid/rhabdoid tumor (ATRT) is an aggressive, malignant embryonal tumor with dismal long-term survival despite aggressive multimodal therapy. While this tumor typically presents in infancy or early childhood, there are published case reports of adult-onset ATRT. Making prognostic conclusions or therapeutic decisions for this older patient population remains challenging due to the paucity of these reports.

Metastasis of Intracranial Meningioma to the Osseous Spine: Systematic Literature Review and Case Report.

Background: Osseous spinal metastases from intracranial meningiomas are rare but represent a serious disease progression. A literature review was performed on this topic to understand the clinical course of patients with this disease entity. We also present a case of spinal metastasis in a patient with a World Health Organization grade III meningioma.

Supracerebellar "Flyover" Approach to Dumbbell Falcotentorial Meningioma Encasing the Galenic Venous System.

Falcotentorial meningiomas involve the tentorial apex and straight sinus, posing challenges when encasing the galenic venous system. Microneurosurgery is considered the best treatment option for large falcotentorial meningiomas because it provides a definitive cure. In contrast, Gamma Knife surgery mainly allows the control of smaller or residual tumors after microsurgical resection.

Cerebrospinal Fluid Drainage in Patients with Acute Spinal Cord Injury: A Multi-Center Randomized Controlled Trial.

Objective: The secondary phase of spinal cord injury (SCI) is characterized by ischemic injury. Spinal cord perfusion pressure (SCPP), calculated as the difference between mean arterial pressure (MAP) and intrathecal pressure (ITP), has arisen as a therapeutic target for improving outcomes. Cerebrospinal fluid drainage (CSFD) may reduce ITP and thereby increase SCPP.

Perioperative Complication Profile of Skull Base Meningioma Resection in Older versus Younger Adult Patients.

 To better understand the risk-benefit profile of skull base meningioma resection in older patients, we compared perioperative complications among older and younger patients.  Present study is based on retrospective outcomes comparison.  The study was conducted at a single neurosurgery institute at a quaternary center.

Residual Tumor Volume and Tumor Progression after Subtotal Resection and Observation of WHO Grade I Skull Base Meningiomas.

 This study investigated the impact of residual tumor volume (RTV) on tumor progression after subtotal resection and observation of WHO grade I skull base meningiomas.  This study is a retrospective volumetric analysis.  This study was conducted at a single institution.

Early Detection and Management of Venous Thrombosis in Skull Base Surgery: Role of Routine Doppler Ultrasound Monitoring.

Background: Venous thromboembolism (VTE), encompassing deep venous thrombosis (DVT) and pulmonary embolism (PE), causes postoperative morbidity and mortality in neurosurgical patients. The use of pharmacological prophylaxis for DVT prevention in the immediate postoperative period carries increased risk of intracranial hemorrhage, especially after skull base surgeries.

Objective: To investigate the impact of routine Doppler ultrasound monitoring in prevention and tiered management of VTE after skull base surgery.

Multimodal Intraoperative Image-Driven Surgery for Skull Base Chordomas and Chondrosarcomas.

Given the difficulty and importance of achieving maximal resection in chordomas and chondrosarcomas, all available tools offered by modern neurosurgery are to be deployed for planning and resection of these complex lesions. As demonstrated by the review of our series of skull base chordoma and chondrosarcoma resections in the Advanced Multimodality Image-Guided Operating (AMIGO) suite, as well as by the recently published literature, we describe the use of advanced multimodality intraoperative imaging and neuronavigation as pivotal to successful radical resection of these skull base lesions while preventing and managing eventual complications.

Resection of a Dumbbell-Shaped Facial Nerve Schwannoma With Preservation of Facial Nerve Function Through the Extended Middle Fossa Approach: 2-Dimensional Operative Video.

Facial nerve schwannomas are rare and can arise from any segment along the course of the facial nerve.1 Their location and growth patterns present as distinct groups that warrant specific surgical management and approaches.2 The management challenge arises when the facial nerve maintains good function (House-Brackmann grade I-II).

Integrating Stereoscopic Video with Modular 3D Anatomic Models for Lateral Skull Base Training.

 Current virtual reality (VR) technology allows the creation of instructional video formats that incorporate three-dimensional (3D) stereoscopic footage.Combined with 3D anatomic models, any surgical procedure or pathology could be represented virtually to supplement learning or surgical preoperative planning. We propose a standalone VR app that allows trainees to interact with modular 3D anatomic models corresponding to stereoscopic surgical videos.

Recurrent Chordoma Resection in the Advanced Multimodality Image Guided Operating Suite: 2-Dimensional Operative Video.

Recurrent skull base chordomas are challenging lesions. They already had maximum radiation, and in the absence of any effective medical treatment, surgical resection is the only treatment.1,2 Surgery on recurrent previously radiated chordomas, however, carries much higher risk and the likelihood of subtotal resection.

Petrosal Approach With Preservation of the Superior Petrosal Sinus (the Graceful Petrosal) for Resection of Giant Trigeminal Schwannoma: 2-Dimensional Operative Video.

Trigeminal schwannomas are benign tumors amendable to curative surgical resection.1 Excellent outcomes, with preservation and improvement of cranial nerve function, including trigeminal nerve function, have been reported with microsurgical resection through skull base approaches.2 Dumbell shaped tumors, involving the middle and posterior fossa, are more challenging.

Transtemporal Suprajugular Approach with Neck Dissection for Jugular Foramen Tumor Resection: Operative Video.

This video demonstrates the transmastoid suprajugular approach with neck dissection to a solitary fibrous tumor involving the jugular foramen and upper cervical region. This patient was a 39-year-old man who presented with dysphagia and cranial nerve (CN) XI and CN XII palsies. Imaging revealed a large homogenously enhancing lesion involving the jugular foramen and extending into the retropharyngeal space ( Fig.

Prognostic value of the Simpson grading scale in modern meningioma surgery: Barrow Neurological Institute experience.

Objective: Recently, the prognostic value of the Simpson resection grading scale has been called into question for modern meningioma surgery. In this study, the authors analyzed the relationship between Simpson resection grade and meningioma recurrence in their institutional experience.

Methods: This study is a retrospective review of all patients who underwent resection of a WHO grade I intracranial meningioma at the authors' institution from 2007 to 2017.

Dissection of the Petrosal Presigmoid-Retrolabyrinthine Approach for the Petroclival Region on a Cadaver: 2-Dimensional Operative Video.

Skull base epidermoid tumors, meningiomas, and schwannomas can be accessed by different techniques depending on the location and size of the lesion. Small lesions located anterior to the internal acoustic meatus (IAM) can be accessed via the subtemporal approach, and lesions located posterior to the IAM can be approached via retrosigmoid craniotomy. However, expansive lesions that are located anterior to the IAM and extend posteriorly toward the lower clivus can be accessed via the petrosal approach.

Preoperative embolization versus no embolization for WHO grade I intracranial meningioma: a retrospective matched cohort study.

Objective: The controversy continues over the clinical utility of preoperative embolization for reducing tumor vascularity of intracranial meningiomas prior to resection. Previous studies comparing embolization and nonembolization patients have not controlled for detailed tumor parameters before assessing outcomes.

Methods: The authors reviewed the cases of all patients who underwent resection of a WHO grade I intracranial meningioma at their institution from 2008 to 2016.

Combining Stereoscopic Video and Virtual Reality Simulation to Maximize Education in Lateral Skull Base Surgery.

Mastery of lateral skull base (LSB) surgery requires thorough knowledge of complex, 3-dimensional (3D) microanatomy and techniques. While supervised operation under binocular microscopy remains the training gold standard, concerns over operative time and patient safety often limit novice surgeons' stereoscopic exposure. Furthermore, most alternative educational resources cannot meet this need.

Functional improvement in hand strength and dexterity after surgical treatment of cervical spondylotic myelopathy: a prospective quantitative study.

Objective: Cervical spondylotic myelopathy (CSM) is the primary cause of adult spinal cord dysfunction. Diminished hand strength and reduced dexterity associated with CSM contribute to disability. Here, the authors investigated the impact of CSM severity on hand function using quantitative testing and evaluated the response to surgical intervention.

Posterior Petrosal Transotic Approach for Cerebellopontine Angle Hemangioblastoma: Technical Case Report.

Background And Importance: Although posterior petrosal approaches are utilized less frequently in many practices today, they continue to provide distinct surgical advantages in carefully selected cases. Here, we report a case of a recurrent cerebellopontine angle (CPA) hemangioblastoma that had failed a prior, more conservative, surgical approach. We provide cadaveric dissections of variations of posterior petrosal approaches to illustrate the advantages of the selected approach.

Endoscope-Assisted, Transmastoid, High Cervical Approach for Resection of a Jugular Foramen Schwannoma: 2-Dimensional Operative Video.

Jugular foramen schwannomas (JFSs) are relatively rare, benign lesions that account for 10% to 30% of all tumors in the region of the jugular foramen. Given their slow-growing nature, JFSs can become quite large before causing symptoms of lower cranial nerve (LCN) dysfunction, making microsurgical resection a challenge. Successful resection of any JFS is dependent on the identification and preservation of the adjacent, uninvolved LCNs to alleviate nerve compression and preserve function.

Three-Dimensional Printed Models for Lateral Skull Base Surgical Training: Anatomy and Simulation of the Transtemporal Approaches.

Background: Three-dimensional (3D) printing holds great potential for lateral skull base surgical training; however, studies evaluating the use of 3D-printed models for simulating transtemporal approaches are lacking.

Objective: To develop and evaluate a 3D-printed model that accurately represents the anatomic relationships, surgical corridor, and surgical working angles achieved with increasingly aggressive temporal bone resection in lateral skull base approaches.

Methods: Cadaveric temporal bones underwent thin-slice computerized tomography, and key anatomic landmarks were segmented using 3D imaging software.

CyberKnife radiosurgery for acoustic neuromas: Tumor control and clinical outcomes.

Fractionated CyberKnife radiosurgery (CKRS) treatment for acoustic neuromas may reduce the risk of long-term radiation toxicity to nearby critical structures compared to that of single-fraction radiosurgery. However, tumor control rates and clinical outcomes after CKRS for acoustic neuromas are not well described. We retrospectively reviewed all acoustic neuroma patients treated with CKRS (2004-2011) in a prospectively maintained clinical and radiographic database.

Variation in Coding Practices for Vestibular Schwannoma Surgery.

 Nationwide databases are frequently used resources for assessing practice patterns and clinical outcomes. However, analyses based on billing codes may be limited by the inconsistent application of current procedural terminology (CPT) codes to specific operations. We investigated the variability among commonly used CPT codes for vestibular schwannomas resection and sought to identify factors that underlie this variation.