Microsurgical anatomy of the facial nerve.

The facial nerve connections and pathways from the cortex to the brainstem are intricate and complicated. The extra-axial part of the facial nerve leaves the lateral part of the pontomedullary sulcus and enters the temporal bone through the internal acoustic meatus. In the temporal bone, the facial nerve branches into fibers innervating the glands and tongue.

Technical Description of Minimally Invasive Extradural Anterior Clinoidectomy and Optic Nerve Decompression. Study of Feasibility and Proof of Concept.

Background: Several diseases that involve the optic canal or its contained structures may cause visual impairment. Several techniques have been developed to decompress the optic nerve.

Objective: To describe minimally invasive extradural anterior clinoidectomy (MiniEx) for optic nerve decompression, detail its surgical anatomy, present clinical cases, and established a proof of concept.

Three-Dimensional Endoscopic Photography of Anatomic Specimens.

Background/objective: Three-dimensional images have become an important tool in understanding surgical anatomy. This paper describes a simple method for obtaining endoscopic 3-dimensional anatomic images for teaching purposes.

Methods: This method uses a single endoscope that provides regular, two-dimensional images.

Albert L. Rhoton Jr., MD: His Philosophy and Education of Neurosurgeons.

Dr. Rhoton's key philosophies included "Keep working hard.", "Make surgery more accurate, gentle and safe", "We want perfect anatomical dissections, because we want perfect surgical operations", "Competence without compassion is worthless.

Microsurgical anatomy of the central core of the brain.

OBJECTIVE The purpose of this study was to describe in detail the cortical and subcortical anatomy of the central core of the brain, defining its limits, with particular attention to the topography and relationships of the thalamus, basal ganglia, and related white matter pathways and vessels. METHODS The authors studied 19 cerebral hemispheres. The vascular systems of all of the specimens were injected with colored silicone, and the specimens were then frozen for at least 1 month to facilitate identification of individual fiber tracts.

Prevention of postoperative visual field defect after the occipital transtentorial approach: anatomical study.

OBJECTIVE A postoperative visual field defect resulting from damage to the occipital lobe during surgery is a unique complication of the occipital transtentorial approach. Though the association between patient position and this complication is well investigated, preventing the complication remains a challenge. To define the area of the occipital lobe in which retraction is least harmful, the surface anatomy of the brain, course of the optic radiations, and microsurgical anatomy of the occipital transtentorial approach were examined.

Cavernomas and Arteriovenous Malformations in the Mesial Temporal Region: Microsurgical Anatomy and Approaches.

Background: The mesial temporal region (MTR) is located deep in the temporal lobe and it is surrounded by important vascular and nervous structures that should be preserved during surgery.

Objective: To describe microsurgical anatomy and approaches to the MTR in relation to cavernomas and arteriovenous malformations (AVMs).

Methods: Five formalin-fixed and red silicone-embedded heads of adult cadavers were used for this study.

Operative Management of Distal Anterior Cerebral Artery Aneurysms Through a Mini Anterior Interhemispheric Approach.

Background: Distal anterior cerebral artery (DACA) aneurysms, also known as pericallosal artery aneurysms, are present in 1.5%-9% of all intracranial aneurysms. Here we characterize the important microsurgical anatomy of DACAs; describe the surgical approach to treating these aneurysms with a minimally invasive surgical technique, the mini anterior interhemispheric approach (MAIA); and examine the nuances of aneurysm clipping in this region.

Key Aspects in Foramen Magnum Meningiomas: From Old Neuroanatomical Conceptions to Current Far Lateral Neurosurgical Intervention.

Foramen magnum meningiomas represent a challenge for neurosurgeons. These tumors require careful surgical manipulation as they are often located in proximity to critical neurovascular structures and the cranial nerves. The far lateral approach is considered the safest neurosurgical approach for excising foramen magnum lesions.

Anterior interhemispheric transsplenial approach to pineal region tumors: anatomical study and illustrative case.

Pineal region tumors are challenging to access because they are centrally located within the calvaria and surrounded by critical neurovascular structures. The goal of this work is to describe a new surgical trajectory, the anterior interhemispheric transsplenial approach, to the pineal region and falcotentorial junction area. To demonstrate this approach, the authors examined 7 adult formalin-fixed silicone-injected cadaveric heads and 2 fresh human brain specimens.

Frontal Lobe Decortication (Frontal Lobectomy with Ventricular Preservation) in Epilepsy-Part 1: Anatomic Landmarks and Surgical Technique.

Background: An extensive frontal resection is a frequently performed neurosurgical procedure, especially for treating brain tumor and refractory epilepsy. However, there is a paucity of reports available regarding its surgical anatomy and technique.

Objectives: We sought to present the anatomic landmarks and surgical technique of the frontal lobe decortication (FLD) in epilepsy.

Microsurgical and endoscopic approaches to the pulvinar.

OBJECTIVE Approaches to the pulvinar remain challenging because of the depth of the target, surrounding critical neural structures, and complicated arterial and venous relationships. The purpose of this study was to compare the surgical approaches to different parts of the pulvinar and to examine the efficacy of the endoscope as an adjunct to the operating microscope in this area. METHODS The pulvinar was examined in 6 formalin-fixed human cadaveric heads through 5 approaches: 4 above and 1 below the tentorium.

Translateral Orbital Wall Approach to the Orbit and Cavernous Sinus: Anatomic Study.

Background: Surgical approaches to lesions in either the orbit or cavernous sinus have been well documented; however, approaching lesions involving both areas remains challenging.

Objective: To examine the microsurgical and endoscopic anatomy of the orbit and cavernous sinus as seen through the orbitozygomatic and translateral orbital wall approaches.

Methods: Seven orbits and cavernous sinuses of formalin-fixed adult cadaveric heads were dissected and examined with the aid of the surgical microscope and 0° endoscope.

Quantitative anatomical analysis and clinical experience with mini-pterional and mini-orbitozygomatic approaches for intracranial aneurysm surgery.

OBJECTIVE The aim of this investigation was to modify the mini-pterional and mini-orbitozygomatic (mini-OZ) approaches in order to reduce the amount of tissue traumatization caused and to compare the use of the 2 approaches in the removal of circle of Willis aneurysms based on the authors' clinical experience and quantitative analysis. METHODS Three formalin-fixed adult cadaveric heads injected with colored silicone were examined. Surgical freedom and angle of attack of the mini-pterional and mini-OZ approaches were measured at 9 anatomical points, and the measurements were compared.

Comparative anatomical analysis of the transcallosal-transchoroidal and transcallosal-transforniceal-transchoroidal approaches to the third ventricle.

OBJECTIVE Access to the third ventricle is a veritable challenge to neurosurgeons. In this context, anatomical and morphometric studies are useful for establishing the limitations and advantages of a particular surgical approach. The transchoroidal approach is versatile and provides adequate exposure of the middle and posterior regions of the third ventricle.

The cochlea in skull base surgery: an anatomy study.

OBJECTIVE The object of this study was to examine the relationships of the cochlea as a guide for avoiding both cochlear damage with loss of hearing in middle fossa approaches and injury to adjacent structures in approaches directed through the cochlea. METHODS Twenty adult cadaveric middle fossae were examined using magnifications of ×3 to ×40. RESULTS The cochlea sits below the floor of the middle fossa in the area between and below the labyrinthine segment of the facial nerve and greater petrosal nerve (GPN) and adjacent to the lateral genu of the petrous carotid.

Midline and off-midline infratentorial supracerebellar approaches to the pineal gland.

OBJECTIVE A common approach to lesions of the pineal region is along the midline below the torcula. However, reports of how shifting the approach off midline affects the surgical exposure and relationships between the tributaries of the vein of Galen are limited. The purpose of this study is to examine the microsurgical and endoscopic anatomy of the pineal region as seen through the supracerebellar infratentorial approaches, including midline, paramedian, lateral, and far-lateral routes.

The endoscopic anatomy of the middle ear approach to the fundus of the internal acoustic canal.

OBJECTIVE The application of the endoscope in the lateral skull base increases the importance of the middle ear cavity as the corridor to the skull base. The aim of this study was to define the middle ear as a route to the fundus (lateral end) of the internal acoustic canal and to propose feasible landmarks to the fundus. METHODS This was a cadaveric study; 34 adult cadaveric temporal bones and 2 dry bones were dissected with the aid of the endoscope and microscope to show the anatomy of the transcanal approach to the middle ear and fundus of the internal acoustic canal.

Microsurgical and Fiber Tract Anatomy of the Nucleus Accumbens.

Background: The nucleus accumbens (NAc) has been a target for deep brain stimulation (DBS) in the treatment of depression and obsessive-compulsive disorder (OCD).

Objective: To examine the anatomy and connections of the NAc using a fiber dissection technique.

Methods: Ten human brains and 2 whole cadaveric heads were examined by fiber dissection technique and ×6 to ×40 surgical magnification.

The accuracy of an electromagnetic navigation system in lateral skull base approaches.

Objectives/hypothesis: Image-guided optical tracking systems are being used with increased frequency in lateral skull base surgery. Recently, electromagnetic tracking systems have become available for use in this region. However, the clinical accuracy of the electromagnetic tracking system has not been examined in lateral skull base surgery.

The white matter tracts of the cerebrum in ventricular surgery and hydrocephalus.

OBJECTIVE The relationship of the white matter tracts to the lateral ventricles is important when planning surgical approaches to the ventricles and in understanding the symptoms of hydrocephalus. The authors' aim was to explore the relationship of the white matter tracts of the cerebrum to the lateral ventricles using fiber dissection technique and MR tractography and to discuss these findings in relation to approaches to ventricular lesions. METHODS Forty adult human formalin-fixed cadaveric hemispheres (20 brains) and 3 whole heads were examined using fiber dissection technique.

Fiber Tracts of the Medial and Inferior Surfaces of the Cerebrum.

Objective: Fiber dissection studies of the cerebrum have focused on the lateral surface. No comparable detailed studies have been done on the medial and inferior surfaces. The object of this study was to examine the fiber tracts, cortical, and subcortical structures of the medial and inferior aspects of the brain important in planning operative approaches along the interhemispheric fissure, parafalcine area, and basal surfaces of the cerebrum.

[Microvascular decompression in hemifacial spasm: 13 cases report and review of the literature].

Objective: The aim of this study is to describe the results of 13 patients with facial hemispasm, treated with microvascular decompression.

Methods: Between June 2005 and May 2014, 13 patients with facial hemispasm were operated, underwent microvascular decompression. The age, sex, duration of symptoms before surgery, and surgical finds, were all evaluated.