Pituitary Stalk Hemangioblastoma: Complete Resection through Orbitozygomatic Approach with Extradural Anterior Clinoidectomy.

 Pituitary stalk hemangioblastomas (PSHBLs) are rare vascular tumors and their surgical removal is challenging due to the proximity with several fundamental anatomic structures including the pituitary stalk, third ventricle, hypothalamus, and optic pathways. To date, only few descriptions of transcranial and transsphenoidal approaches for PSHBLs have been reported in the literature and none in video, with suboptimal outcomes in terms of pituitary function preservation. Here, we describe the use of orbitozygomatic (OZ) craniotomy with extradural anterior clinoidectomy (EAC) for the removal of a PSHBL with preservation of the pituitary stalk.

Full-Endoscopic Removal of Lumbar Juxtafacet Cysts: A Prospective Multicentric Study.

Background: Lumbar juxtafacet cysts are benign lesions that grow at the level of facet joints or within neighboring structures. Recently, there is an ongoing trend toward less invasive procedures for treating degenerative spine diseases. Here we report a multicenter study of full-endoscopic surgery for juxtafacet cyst removal.

Is Full Endoscopic Lumbar Discectomy Less Invasive Than Conventional Surgery? A Randomized MRI Study.

Background: In the present randomized prospective study, we compared the surgical invasiveness using a quantitative volumetric analysis of postoperative paravertebral muscle signal intensity changes between transforaminal full endoscopic lumbar discectomy (FELD) and open discectomy (OD).

Methods: We prospectively collected the data from 50 patients with a single-level lumbar foraminal herniation, invalidating radicular pain, and adequate imaging studies available (postoperative magnetic resonance imaging [MRI] <24 hours). These patients had been randomly assigned to FELD (n = 25) or OD (n = 25).

Ruptured Tentorial Arteriovenous Fistula: Endoscopic-Assisted Microsurgical Disconnection Using Indocyanine Green Videoangiography Guidance.

Tentorial dural arteriovenous fistulas are rare causes of intracranial hemorrhage and nervous tissue venous congestion. Due to their extensive arterial supply and difficult transvenous endovascular navigation, they are frequently managed microsurgically. Precise identification of the venous drainage, its retractorless exposition, and real-time verification of arteriovenous disconnection are the mainstays of surgery.

Subarachnoid hemorrhage in the eighties: to treat or not to treat.

Background: Life expectancy has in the last few years increased and, as a consequence, also the number of elderly patients admitted to an Emergency Department with aneurysmal subarachnoid hemorrhage. We wanted to detect any difference in term of outcomes and adverse events between two groups of patients of different age, in relation to types of treatment and clinical status at presentation.

Methods: We selected and analyzed two groups of patients (group A and group B) among 458 retrospectively collected cases admitted to two neurosurgical centers with a diagnosis of aneurysmal subarachnoid hemorrhage over a 7.

A Novel Hybrid Endoscopic Approach for Anterior Cervical Discectomy and Fusion and a Meta-Analysis of the Literature.

Background: We describe our experience in the endoscopic treatment of cervical spondylosis. We present a "hybrid" technique that is similar to an open anterior cervical discectomy with fusion but is performed endoscopically. We also analyzed data from studies on endoscopic cervical discectomies published in the past 2 decades.

Purely Endoscopic Resection of Cavernoma of the Septum Pellucidum.

The intraventricular location of a cavernoma is a rare entity and accounts for approximately 2.5% of all cavernomas of the central nervous system. They are commonly found in the lateral ventricle followed by the third and fourth ventricles.

Microsurgical Disconnection of Ruptured Intracranial Pial Arteriovenous Fistula Guided by Indocyanine Green Videoangiography.

Intracranial arteriovenous fistulas, rare causes of spontaneous intracerebral bleeding, are direct communications between an arterial feeder and an arterialized vein that drains a normal brain. Arteriovenous disconnection is the only effective treatment for this type of vascular malformation, which is often reached microsurgically due to the difficult endovascular access. Intraoperative indocyanine green videoangiography (ICG-VA) is a valuable help in identifying the arterialized draining vein and its direct communication with the arterial feeder and in confirming real-time interruption of the fistula.

Preliminary results of a novel pure endoscopic procedure in the treatment of degenerative lumbar spinal disorders: double endoscopic technique.

Background: With increased experience and the availability of new technical instrumentations, the surgical endoscopic indications for lumbar spinal pathologies have moved from simple prolapsed disk to canal stenosis. The available endoscopes come in two different sizes (10 mm and 6.3 mm in diameter); however, one is too bulky to use inside the spinal canal and the other is too small to achieve a fast bone decompression.

Skin Glue for Wounds Closure in Brain Surgery: Our Updated Experience.

Background: Traditional wound closure techniques include skin sutures and metal clips. Cyanoacrylate has good neovascularization, epithelialization, and antimicrobial activity properties and a fast application procedure. This study presents our long-term experience.

Type II Fractures in Older Adults: Can They Be Treated Conservatively?: A Single-Center Experience and Review of the Literature.

Background: Odontoid fractures are the most common acute cervical spinal fractures in the geriatric population. Their rate is increasing along with the rising age of the elderly population. Whereas conservative management with external immobilization is reported as the treatment of choice for type I and III odontoid fractures, there are no clear indications concerning the best treatment for type II fractures.

Lumbar canal stenosis: can we treat it endoscopically?

Background: The common treatment for lumbar canal stenosis involves an open surgical decompression with laminectomy and foraminotomy, even if spinal surgery is moving towards minimal invasiveness procedures. Minimally-invasive surgery initially and recently spinal endoscopic techniques are becoming the standard procedures for lumbar disk prolapsed in consideration of the less surgical invasiveness with a considerable reducing in the amount of normal anatomy violation, in less risk of iatrogenic postoperative instability, minimal scar tissue formation and negligible blood loss when compared to the standard open approach. These techniques also reduce the postoperative pain with consequent less need of using pain medications as well as reduced hospital stay.

Hemodynamic Stress, Inflammation, and Intracranial Aneurysm Development and Rupture: A Systematic Review.

Background: There seems to be a pathogenetic link between hemodynamics and inflammatory arterial wall alteration leading to the development and rupture of intracranial aneurysms (IAs). Noninvasive assessment of the inflammatory status of the aneurysm wall may guide the management of unruptured IAs by identifying reliable markers for increased rupture risk.

Methods: We conducted a qualitative systematic review following the ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) framework.

Transforaminal percutaneous endoscopic lumbar discectomy: outcome and complications in 270 cases.

Background: The endoscopic approach was introduced in the clinical practice in 1980 with the aim to remove the prolapsed disk and free the compressed nerve using the least disruptive surgical technique, assuring in the same time, the resolution of the symptoms and a faster return back to normal life activity. Over the years, thanks to an extraordinary technical improvement either in terms of quality of images or development of many different tailored instrumentations there has been a huge spreading of the endoscope use across the different surgical fields. For this reason, the transforaminal percutaneous endoscopic lumbar discectomy can be considered, at the moment, the least invasive procedure for the removal of lumbar disc prolapsed.

Postoperative aseptic intracranial granuloma: the possible influence of fluid hemostatics.

Background. Numerous reports have demonstrated how postoperative intracranial granulomas can often mimic neoplasm clinically, radiologically, and even macroscopically. Herein we present an unusual case of postsurgical intracranial aseptic granuloma secondary to a chronic inflammatory reaction without any identifiable retained foreign body.

Effectiveness and safety of subcutaneous abdominal preservation of autologous bone flap after decompressive craniectomy: a prospective pilot study.

Background: The aim was to assess the effectiveness and safety of reconstructing a cranial bone defect after decompressive craniectomy using an autologous bone flap banked in a subcutaneous pocket in the patient's abdominal wall.

Methods: A prospective pilot study was performed on 12 of 15 consecutive patients who had undergone decompressive craniotomy and subsequent autologous bone flap replacement. The bone flap had been stored in the abdominal wall for an average period of 40 days.

Lumbar microdiscectomy under epidural anaesthesia with the patient in the sitting position: a prospective study.

In a prospective study we compared the surgical outcome, length of hospital stay, complications and patient satisfaction for patients undergoing lumbar microdiscectomy (LM) under spinal anaesthesia (SA) in the sitting position (23 patients) to those of another cohort who underwent LM under general anaesthesia (GA) in the prone or genu-pectoral position during the same time period (238 patients). We aimed to determine: (i) if epidural anaesthesia is safe for lumbar microdiscectomy; and (ii) if placing the patient in a sitting position confers an advantage in performing the operation. For all patients we calculated the time from the end of the operation to the first spontaneous urination and to the first administration of analgesic drugs.

Diagnosis, management and outcome of clinically- suspected spinal infection.

Objectives: Spontaneous spinal infection (SI) is a quite rare but serious entity. This study aimed to evaluate outcome and follow-up data of SI cases without a microbiological diagnosis (suspected SI).

Methods: We undertook a retrospective, comparative study of 82 spontaneous SI cases in adults presenting over an 11-year period to two Italian hospitals.

Use of skin glue versus traditional wound closure methods in brain surgery: A prospective, randomized, controlled study.

Traditional skin sutures (TSS) and metal skin clips (SC) are the most common devices utilized for closure of surgical incisions. They are safe and effective, although they require instruments to apply them, are time consuming and, above all, create an extra staff and cost burden for removal of sutures/staples. The ideal incision closure should be simple, effective, safe, rapid, inexpensive, painless, cosmetic and bactericidal.