Use of BoneScalpel Ultrasonic Bone Dissector in Anterior Clinoidectomy and Posterior Fossa Surgery: Technical Note.

BackgroundFirst popularized by Dolenc, anterior clinoidectomies were performed with rongeurs, before the adoption of modern high-speed drills. We describe a novel application of the piezoelectric BoneScalpel™ in anterior skull base and posterior fossa surgeries. In the literature, to date, there are no mentions of anterior clinoidectomies performed with piezosurgical devices.

Efficacy of endoscopic management of primary central nervous system lymphoma: a multicentric study and literature review.

Introduction: To date, confined intra-ventricular localization of primary central nervous system lymphoma (PCNSL) has been usually managed with open surgical resection and/or stereotactic biopsy; nonetheless, the endoscopic approach to such localization can provide many advantages over standard microsurgery and/or stereotactic biopsy. Here we present our experience in managing such a rare pathology through the endoscopic approach.

Method: In order to gather more information about such a rare pathology, a retrospective multicentric study on a prospectively built database has been performed during a 5 year period.

Thoracic Spinal Angiolipomas: A Systematic Review.

Background:  Spinal angiolipomas (SAs) are rare, benign tumors, representing 0.0004 to 1.2% of angiolipomas, usually located at the extradural and posterior thoracic level, with multimetameric extension.

A Review of Remote Intracerebral Hemorrhage after Chronic Subdural Hematoma Evacuation.

Background:  Remote intracerebral hemorrhage (RICH) is a severe complication following chronic subdural hematoma (cSDH) drainage, and only case reports and small case series have been reported to date. The authors present an emblematic patient affected by RICH following cSDH drainage. A systematic review of the literature on diagnosis and management of patients affected by RICH following cSDH evacuation has also been performed.

Diamond-Shaped Mini-Craniotomy: A New Concept in Neurosurgery.

Background:  We describe, step by step, a modified, less invasive, diamond-shaped mini-craniotomy that optimizes dural opening and can be performed in elderly patients affected by acute subdural or intracerebral hematomas, in therapy with antiplatelets or anticoagulants.

Methods:  We retrospectively analyzed the clinical records of 67 patients (mean age of 78.5 years) treated in our institution, during a period of 10 years, with this novel diamond-shaped craniotomy.

Multimodal Simulation of a Novel Device for a Safe and Effective External Ventricular Drain Placement.

Background: External ventricular drain (EVD) placement is mandatory for several pathologies. The misplacement rate of the EVD varies widely in literature, ranging from 12.3 to 60%.

Vertebrobasilar Dolichoectasia, Hypoplastic Third Ventricle, and Related Biventricular Hydrocephalus: Case Report and Review of the Literature.

Background:  Vertebrobasilar dolichoectasia (VBDE) is defined as a symptomatic dilatation and tortuosity of the vertebrobasilar arteries. The risk of hydrocephalus development is due to direct compression of the third ventricle outflow or brainstem compression and related aqueduct stenosis. We present an uncommon case of a patient with symptomatic VBDE with the uniqueness of a hypoplastic third ventricle associated with biventricular hydrocephalus.

Use of Gelatin-thrombin Hemostatic Matrix for Control of Ruptured Cerebral Aneurysm.

Background:  The use of thrombin-based hemostatic agents (TBHAs) has become common practice in most neurosurgical procedures, both cranial and spinal.

Methods:  We present the case of a 40-year-old woman who was referred to our institution with intense headache and Fisher grade 3 subarachnoid hemorrhage (SAH) mainly at the level of the right sylvian fissure, caused by a 5.71-mm right middle cerebral artery (MCA) bifurcation aneurysm, with hourglass morphology and a bleb on the bottom.

The one-step edge-to-edge technique in ventriculoperitoneal shunt.

Background: Subcutaneous tunneling of the distal catheter is a potentially risky part of ventriculoperitoneal shunt (VPS) insertion. We describe our institutional experience with a simple trick to improve functional and aesthetic results in VPS by reducing the distal catheter tunneling to a single passage.

Materials And Methods: The one-step edge-to-edge technique has been performed in our institution over 14 years in 46 patients with a mean age of 63.

Perimedullary arteriovenous fistulas of the craniovertebral junction: A systematic review.

Perimedullary arteriovenous fistulas (PMAVFs) are uncommon vascular malformations, and they rarely occur at the level of the craniovertebral junction (CVJ). The therapeutic management is challenging and can include observation alone, endovascular occlusion, or surgical exclusion, depending on both patient and malformation characteristics. A systematic literature search was conducted using MEDLINE, Scopus, and Google Scholar databases, searching for the following combined MeSH terms: .

Diffuse cerebral angiomatosis associated to basilar apex aneurysm.

Background: Diffuse cerebral angiomatosis (DCA) is a diffuse infiltration of normal brain by complex vascular structures. It differs from arteriovenous malformations (AVMs) that are composed of a nidus of vessels through which arteriovenous shunting occurs without interposed functional brain parenchyma. A rare subgroup of AVMs is diffuse with no recognizable nidus with functional neuronal tissue interspersed within the malformed vessels.

Cauda equina syndrome caused by lumbar leptomeningeal metastases from lung adenocarcinoma mimicking a schwannoma.

Background: Cauda equina syndromes (CESs) due to leptomeningeal metastases from primitive lung tumors are rare. Despite recent advancements in neuro-oncology and molecular biology, the prognosis for these patients remains poor. Here, we present a case in which a patient developed lumbar leptomeningeal metastases from lung carcinoma that contributed to a CES and reviewed the appropriate literature.

Slit-like hypertensive hydrocephalus: Report of a late, complex, and multifactorial complication in an oncologic patient.

Background: Several sophisticated techniques and many chemotherapy drugs have improved life expectancy of oncologic patients allowing us to observe late complications which present many years after the initial treatment.

Case Description: We present a unique case of a patient affected by acute lymphoblastic leukemia at the age of 6 years, treated with whole brain radiotherapy and intrathecal chemotherapy, developing meningiomatosis and leptomeningeal alterations as late complications and the interaction of these two entities caused a peculiar form of hydrocephalus without ventricular dilation. The diagnosis of pseudotumor cerebri was excluded due the postradio/chemotherapy development of meningiomatosis, not present in a previously head magnetic resonance imaging, that exerted compression to the Sylvian aqueduct causing intracranial hypertension with papillary stasis without ventricles enlargement due to brain stiffness.

Minimally invasive percutaneous anterior odontoid screw fixation: institutional experience with a simple and effective technique.

Background: The aim of this paper was to show a novel modified technique to perform minimally invasive anterior odontoid screw fixation.

Methods: Twenty-nine patients with a mean age of 45 years were treated with a modified percutaneous anterior odontoid screw fixation. All patients were affected by type II or rostral shallow type III odontoid fractures.

Surgical preference regarding different materials for custom-made allograft cranioplasty in patients with calvarial defects: Results from an internal audit covering the last 20 years.

Background: Secondary cranioplasty (CP) plays a key role in restoring cranial vault anatomy and normal brain function following decompressive craniectomy (DC). The scientific literature provides only fragmentary information regarding the best timing and material for CP, making a direct comparison of different materials difficult.

Object: To identify and report according to STROBE guidelines local trends in choice of materials for CP, complications rate and surgical outcomes.

Chronic Epidural Hematoma Caused by Traumatic Intracranial Pseudoaneurysm of the Middle Meningeal Artery: Review of the Literature with a Focus on this Unique Entity.

Background: Pseudoaneurysms of the middle meningeal artery represent fewer than 1% of all intracranial aneurysms; it can be associated with different patterns of intracranial hemorrhages. A chronic epidural hematoma (CEDH) caused by post-traumatic pseudoaneurysm of the middle meningeal artery (MMA) has not yet been reported.

Case Description: A 17-year-old male patient was referred to our unit after a car accident, with head trauma and presented motor and language deficits.

Posttraumatic Triple Acute Epidural Hematomas: First Report of Bilateral Synchronous Epidural Hematoma and a Third Delayed.

Background: Development of a delayed acute epidural hematoma (DEDH) represents a rare event, characterized by a high mortality rate. It is defined as an extradural bleeding not evident at the first brain computed tomography (CT) scan performed after traumatic brain injury but evidenced by further radiologic evaluations.

Case Description: A 22-year-old male was admitted to our unit after brain injury due to an assault.

Compression Syndromes of the Vertebral Artery at the Craniocervical Junction.

Compression syndromes of the vertebral artery that occur at the craniocervical junction are extremely rare causes of haemodynamic insufficiency of the posterior cerebral circulation. The aetiology of the compression syndrome may be a malformation, trauma, tumour, infection or degenerative pathology. This may lead to dynamic vertebral artery occlusion where the vessel courses around the atlas and the axis-the so-called V3 segment.