Surgical management of tumors of the cervical spine and craniovertebral junction involving the vertebral artery: A narrative review.

Background: The vertebral artery (VA) is in close proximity to bony structures, nerves and nerve sheaths of the cervical spine and craniovertebral junction (CVJ). These structures can be sources of tumors that are responsible for displacement, encasement and sometimes invasion of the VA. Removing these tumors while minimizing the risk of vascular injury requires thorough knowledge of the vascular anatomy, risk factors of vascular injury, the relationships of each tumor type with the VA, and the different surgical approaches and techniques that result in the best outcomes in terms of vascular control, tumoral exposure and resection.

Nonaneurysmal perimesencephalic subarachnoid hemorrhage on noncontrast head CT: An accuracy, inter-rater, and intra-rater reliability study.

Background And Purpose: To evaluate the reliability and accuracy of nonaneurysmal perimesencephalic subarachnoid hemorrhage (NAPSAH) on Noncontrast Head CT (NCCT) between numerous raters.

Materials And Methods: 45 NCCT of adult patients with SAH who also had a catheter angiography (CA) were independently evaluated by 48 diverse raters; 45 raters performed a second assessment one month later. For each case, raters were asked: 1) whether they judged the bleeding pattern to be perimesencephalic; 2) whether there was blood anterior to brainstem; 3) complete filling of the anterior interhemispheric fissure (AIF); 4) extension to the lateral part of the sylvian fissure (LSF); 5) frank intraventricular hemorrhage; 6) whether in the hypothetical presence of a negative CT angiogram they would still recommend CA.

Craniovertebral and spinal adhesive arachnoiditis: a late complication of ruptured vertebral and posterior inferior cerebellar arteries aneurysms.

Background: Adhesive arachnoiditis is a rare yet serious complication that may occur following subarachnoid hemorrhage (SAH). In this circumstance, it is mainly due to ruptured vertebral artery (VA) or posterior inferior artery (PICA) aneurysms. It disrupts cerebrospinal fluid (CSF) flow leading to complications such as spinal arachnoiditis, syringomyelia, trapped 4th ventricle, or a combination of these conditions.

Spontaneous intracranial vertebral artery dissections presenting with subarachnoid hemorrhage.

Background: Vertebral artery dissection (VAD) is an infrequent source of subarachnoid hemorrhage (SAH), with a high mortality rate, primarily due to the risk of rebleeding both before and after medical intervention. This paper provides a comprehensive analysis of the anatomy, pathophysiology, clinical presentation, treatment strategies, and outcomes of intracranial vertebral artery dissections that result in subarachnoid hemorrhage.

Methods: Comprehensive five-year literature review (2018-2022) and a retrospective analysis of patient records from our institution between 2016 and 2022.

Anatomy of the craniocervical junction - A review.

An in-depth understanding of the anatomy of the craniocervical junction (CCJ) is indispensable in skull base neurosurgery. In this paper, we discuss the osteology of the occipital bone, the atlas (C1) and axis (C2), the ligaments and the muscle anatomy of the CCJ region and their relationships with the vertebral artery. We will also discuss the trajectory of the vertebral artery and review the anatomy of the jugular foramen and lower cranial nerves (IX to XII).

The Rostral Mucosa: The Door to Open and Close for Targeted Endoscopic Endonasal Approaches to the Clivus.

Background: Extended endoscopic endonasal approaches (EEAs) have progressively widened the armamentarium of skull base surgeons. In order to reduce approach-related morbidity of EEAs and closure techniques, the development of alternative strategies that minimize the resection of normal tissue and alleviate the use of naso-septal flap (NSF) is needed. We report on a novel targeted approach to the clivus, with incision and closure of the mucosa of the rostrum, as the initial and final step of the approach.

Extradural anterior temporal fossa approach to the paranasal sinuses, nasal cavities through the anterolateral and anteromedial triangles: Combined microscopic and endoscopic strategy.

Objective: To demonstrate the utility and limitations of the extradural endoscopic-assisted anterior temporal fossa approach to the pterygopalatine fossa (PPF), infratemporal fossa (ITF), paranasal sinuses (PS), parapharyngeal region (PPR), nasal cavities (NC), epipharynx (EP), and clivus.

Methods: A frontotemporal orbitozygomatic craniotomy is performed. The dura is elevated from the cavernous sinus (CS).

Use of high dose cyproterone acetate and risk of intracranial meningioma in women: cohort study.

Objective: To assess the risk of meningioma associated with use of high dose cyproterone acetate, a progestogen indicated for clinical hyperandrogenism.

Design: Observational cohort study.

Setting: Data from SNDS, the French administrative healthcare database, between 2007 and 2015.

Chiasmapexy for secondary empty sella syndrome: diagnostic and therapeutic considerations.

Purpose: Secondary empty sella syndrome (SESS) following pituitary surgery remains a diagnostic and therapeutic challenge. The aim of this study was to specify the diagnostic criteria, surgical indications and results of chiasmapexy in the SESS.

Methods: Three cases from two experienced neurosurgical centers were collected and the available literature was reviewed.

Endoscopic endonasal approach to the mesial temporal lobe: anatomical study and clinical considerations for a selective amygdalohippocampectomy.

Background: Selective amygdalohippocampectomy (AH) is a surgical option for patients with medically intractable seizures from mesial temporal lobe pathology. The transcranial route is considered the best method to achieve this goal. However, the standard approach through the neocortex is still invasive.

From the Occipital Condyle to the Sphenoid Sinus: Extradural Extension of the Far Lateral Transcondylar Approach with Endoscopic Assistance.

Background: Surgical management of extensive skull base tumors, such as chordoma and chondrosarcoma, remains very challenging. The need for gross total removal to improve survival must be weighed against the risk of injury to neurovascular structures and the loss of stability at the craniovertebral junction. In cases of tumors that are already compromising craniovertebral junction stability, the occipital condyle can be exploited as a deep keyhole to reach the clivus, petrous apex, and sphenoid sinus.

Supracerebellar transtentorial resection of a ruptured thalamomesencephalic cavernous malformation.

Thalamomesencephalic cavernous malformations are located high in the brainstem and may be difficult to reach. We present a case of such a lesion which was successfully approached via the supracerebellar transtentorial route. Our enclosed video provides elements to justify this posterior approach and illustrates the steps required for the cavernoma's safe removal, which include opening of the tentorium and gentle retraction of the exposed temporal lobe.

Visualization of Dark Side of Skull Base with Surgical Navigation and Endoscopic Assistance: Extended Petrous Rhomboid and Rhomboid with Maxillary Nerve-Mandibular Nerve Vidian Corridor.

Background: Lesions located at the petrous apex, cavernous sinus, clivus, medial aspect of the jugular foramen, or condylar regions are still difficult to fully expose using the operating microscope. Although approaches to this region through the middle cranial fossa have been previously described, these approaches afford only limited visualization. We have confirmed a transcranial infratemporal fossa combined microsurgical and endoscopic access to the petrous apex, clivus, medial aspect of the jugular foramen, and occipital condyle.

Efficacy of antiseizure prophylaxis in chronic subdural hematoma: a cohort study on routinely collected health data.

Objective: Chronic subdural hematoma (CSDH) is a common neurosurgical condition that can result in significant morbidity. The incidence of epileptic events associated with CSDH reported in the literature varies considerably and could potentially increase morbidity and mortality rates. The effectiveness of antiepileptic prophylaxis for this indication remains unclear.

Surgery and protontherapy in Grade I and II skull base chondrosarcoma: A comparative retrospective study.

Objective: Skull base chondrosarcoma is a rare tumour usually treated by surgery and proton therapy. However, as mortality rate is very low and treatment complications are frequent, a less aggressive therapeutic strategy could be considered. The objective of this study was to compare the results of surgery only vs surgery and adjuvant proton therapy, in terms of survival and treatment adverse effects, based on a retrospective series.

A Staged Strategy for Craniocervical Junction Chordoma with Combination of Endoscopic Endonasal Approach and Far Lateral Approach with Endoscopic Assistance: Case Report.

 While the endoscopic endonasal approach (EEA) has gained widespread acceptance for the resection of clivus chordomas, conventional transcranial approaches still have a crucial role in craniocervical junction (CCJ) chordoma surgery. In repeat surgery, a carefully planned treatment strategy is needed. We present a surgical treatment plan combining an EEA and a far-lateral craniotomy with endoscopic assistance (EA) in the salvage surgery of a recurrent CCJ chordoma.

Regression of Giant Olfactory Groove Meningioma and Complete Visual Acuity Recovery after Discontinuation of Cyproterone Acetate.

Purpose: To report on the medical management of meningioma with compression of the optic chiasm associated with the use of cyproterone acetate (CA).

Case Report: A 65-year-old woman who was being treated with CA presented with a recent decrease in visual function, leading to discovery of a giant olfactory groove meningioma with compression of the optic chiasm. CA was discontinued immediately, and her visual function improved dramatically.

The Chopsticks Technique for Endoscopic Endonasal Surgery-Improving Surgical Efficiency and Reducing the Surgical Footprint.

Background: Variations and additions to the endoscopic endonasal exposure have been proposed around a modular strategy. These extensions are often necessary to provide additional working space and reduce conflict between the instruments and the endoscope. Resection of endonasal structures, which affects negatively the sinonasal quality of life, is thus undertaken not only to obtain tumor exposure but also to improve the maneuverability of the instruments.

Resection of an Optic Canal Meningioma through a Contralateral Subfrontal Approach with Endoscopic Assistance: A 2D Operative Video.

 To review the use of the contralateral subfrontal approach for the resection of an optic canal meningioma.  Operative video.  A meningioma, located in the inferomedial side of the optic canal ( Fig.

Endoscopic Endonasal Approach to the Anteromedial Temporal Fossa and Mobilization of the Lateral Wall of the Cavernous Sinus Through the Inferior Orbital Fissure and V1-V2 Corridor: An Anatomic Study and Clinical Considerations.

Objective: The aim of this study was to identify key anatomic landmarks useful in gaining access to the anteromedial temporal region via the corridor formed by the inferior orbital fissure (IOF), the ophthalmic branch of the trigeminal nerve (V1), and the maxillary branch of the trigeminal nerve (V2) via an endoscopic endonasal approach (EEA).

Methods: An anatomic dissection of 6 cadaver heads was performed to confirm the feasibility and applicability of an EEA for accessing the anteromedial temporal region.

Results: After middle turbinectomy, the lateral recess of the sphenoid sinus was opened, the orbital apex was exposed, and the posterior wall of the maxillary sinus was removed, in sequence.

Combined Nasoseptal and Inferior Turbinate Flap for Reconstruction of Large Skull Base Defect After Expanded Endonasal Approach: Operative Technique.

Backround: Increasing indications for endoscopic endonasal approaches have led neurosurgeons to develop new reconstruction techniques for larger skull base defects. Vascularized grafts have been a great adjunction to reduce the rate of cerebrospinal fluid leak and can also be used to cover exposed critical structures such as the internal carotid artery. The nasoseptal flap and the inferior or middle turbinate flap are thus widely used in endoscopic skull base surgery, but may be insufficient for very large defects.

The Posterior Transpetrosal Approach in a Case of Large Retrochiasmatic Craniopharyngioma: Operative Video and Technical Nuances.

 To discuss the use of the posterior petrosal approach for the resection of a retrochiasmatic craniopharyngioma.  Operative video.  In this case video, the authors discuss the surgical management of a large craniopharyngioma, presenting with mass effect on the third ventricle and optic apparatus.

The Occipital Artery as an Alternative Donor for Low-Flow Bypass to Anterior Circulation After Internal Carotid Artery Occlusion Failure prior to Exenteration for an Atypical Cavernous Sinus Meningioma.

Background: In skull base tumors involving the cavernous sinus, indications for aggressive resection are sparse and must be carefully examined because of their invasiveness. With careful evaluation, techniques including internal carotid artery sacrifice with or without extracranial-intracranial bypass may still be an option in some cases. Moreover, previous surgery with the sacrifice of potential donor vessels requires adjusting the revascularization strategy.

Tentorial meningioma supplied by a marginal tentorial artery arising from the superior cerebellar artery: Anatomic and technical considerations.

Background and importance The marginal tentorial artery runs over the free edge of the tentorium. Different origins have been described, always involving branches of the carotid artery. We report the superior cerebellar artery as an unknown origin of this artery.