Musculoskeletal demands in microsurgery-an explorative study comparing the ergonomics of microscope and 3D exoscope.

To assess neurosurgeons' physical demands and investigate ergonomic aspects when using microsurgical visualization devices. Six neurosurgeons performed micro-surgical procedures on cadaveric specimens using the prototype of a digital 3D exoscope system (Aeos®, Aesculap, Tuttlingen, Germany) and a standard operating microscope (Pentero 900, Zeiss, Oberkochen, Germany) at two different patient positions (semisitting (SS), supine (SP)). The activities of the bilateral upper trapezius (UTM), anterior deltoid (ADM), and lumbar erector spinae (LEM) muscles were recorded using bipolar surface electromyography and neck flexion, arm abduction, and arm anteversion angles by gravimetrical posture sensors.

One-on-one mentoring for final year medical students during the neurosurgery rotation.

Background: Medical students show varying clinical practical skills when entering their final year clinical clerkship, which is the final period to acquire and improve practical skills prior to their residency. We developed a one-on-one mentoring program to allow individually tailored teaching of clinical practical skills to support final year students with varying skill sets during their neurosurgical clinical clerkship.

Methods: Each participating student (n = 23) was paired with a mentor.

Interoptic, Trans-lamina Terminalis, Opticocarotid Triangle, and Caroticosylvian Windows From Mini-Supraorbital, Frontomedial, and Pterional Perspectives: A Comparative Cadaver Study With Artificial Lesions.

The mini-supraorbital (MSO) and pterional (PT) approaches have been compared in a number of studies focusing on the treatment of aneurysms, craniopharyngiomas, and meningiomas. The goal of this study was to analyze the surgical exposure to different artificial lesions through interoptic (IO), trans-lamina terminalis (TLT), opticocarotid triangle (OCT), and caroticosylvian (CS) windows from the MSO, frontomedial (FM), and PT perspectives. The MSO, PT, and FM approaches were performed sequentially in two fixed cadaver heads.

Nerve Ultrasonography as an Additive Tool to Clinical Examination and Electrodiagnostics in Sporadic Mononeuritis - Imaging is the Key.

Purpose:  Sporadic mononeuropathies without trauma or compression are challenging to diagnose. Nerve ultrasound has recently proven its usefulness in the diagnosis of traumatic neuropathies, tumors and polyneuropathies. However, its role in mononeuropathies currently remains unclear.

3D Exoscope System in Neurosurgery-Comparison of a Standard Operating Microscope With a New 3D Exoscope in the Cadaver Lab.

Background: For decades, the operating microscope has been the "gold standard" visualization device in neurosurgery. The development of endoscopy revolutionized different surgical disciplines, whereas in neurosurgery, the endoscope is commonly used as an additional device more than as single visualization tool. Invention of a 3D exoscope system opens new possibilities in visualization and ergonomics in neurosurgery.

The midline suboccipital subtonsillar approach to the cerebellomedullary cistern: how I do it.

Background: Lesions lateral to the lower brainstem in an area extending from the foraminae of Luschka to the foramen magnum are rare and include different pathologies. There is no consensus on an ideal surgical approach.

Method: To gain access to this area, we use the midline suboccipital subtonsillar approach (STA).

Interactive anatomical and surgical live stream lectures improve students' academic performance in applied clinical anatomy.

Tuebingen's Sectio Chirurgica (TSC) is an innovative, interactive, multimedia, and transdisciplinary teaching method designed to complement dissection courses. The Tuebingen's Sectio Chirurgica (TSC) allows clinical anatomy to be taught via interactive live stream surgeries moderated by an anatomist. This method aims to provide an application-oriented approach to teaching anatomy that offers students a deeper learning experience.

Fronto-temporal branch of facial nerve within the interfascial fat pad: is the interfascial dissection really safe?

Background: The study was conducted to clarify the presence or absence of fronto-temporal branches (FTB) of the facial nerve within the interfascial (between the superficial and deep leaflet of the temporalis fascia) fat pad.

Methods: Eight formalin-fixed cadaveric heads (16 sides) were used in the study. The course of the facial nerve and the FTB was dissected in its individual tissue planes and followed from the stylomastoid foramen to the frontal region.

Petrosectomy and Topographical Anatomy in Traditional Kawase and Posterior Intradural Petrous Apicectomy (PIPA) Approach: An Anatomical Study.

Objective: To compare the anatomical exposure and petrosectomy extent in the Kawase and posterior intradural petrous apicectomy (PIPA) approaches.

Methods: Kawase and PIPA approaches were performed on 4 fixed cadaveric heads (3 alcohol-fixed, 1 formaldehyde-fixed silicone-injected; 4 Kawase and 4 PIPA approaches). The microsurgical anatomy was examined by means of Zeiss Opmi CS/NC-4 microscopes.

The midline suboccipital subtonsillar approach to the cerebellomedullary cistern and its structures: anatomical considerations, surgical technique and clinical application.

Objective: Lesions of the cerebellomedullary cistern lateral to the lower brainstem in an area extending from the foraminae of Luschka to the foramen magnum are rare and can be caused by various sources. There is no consensus on an ideal surgical approach. We describe the anatomical features and the surgical technique of the midline suboccipital subtonsillar (STA) approach to the cerebellomedullary cistern and its pathologies.

Focus on the Lateral Incisural Space: Where is the Trochlear Nerve?

Objective To define the entrance point of the trochlear nerve in the free edge of the tentorium, giving a topographical description in relation to supratentorial and infratentorial reference points. Method The study was performed on seven formaldehyde-fixed specimens (14 sides). The distance from supratentorial and infratentorial reference points to the entrance point of the trochlear nerve into the free tentorial edge was measured.

Actual state of EndActive ventricular endoscopy.

Purpose: We assessed usability and applicability of a rigid, multidirectional steerable videoendoscope (EndActive, Karl Storz GmbH, Tuttlingen, Germany) for endoscopic third ventriculostomy and compared our experience with reports about other multidirectional endoscopes.

Methods: The prototype is a 4-mm-diameter rigid videoendoscope with an integrated image sensor comprising an embedded light source, offering a free viewing direction in a range of 160° while the tip itself does not move. In five specimens (ten sides), we introduced the endoscope via precoronal burr holes through the lateral ventricle and foramen of Monro into the third ventricle.

Developments in neuroendoscopy: trial of a miniature rigid endoscope with a multidirectional steerable tip camera in the anatomical lab.

The aim of this study is to assess field of view, usability and applicability of a rigid, multidirectional steerable video endoscope (EndActive) in various intracranial regions relevant to neurosurgical practice. In four cadaveric specimens, frontolateral, pterional, transnasal (to sella and clivus), interhemispheric (transcallosal and retrocallosal) and retrosigmoid approaches as well as precoronal burr holes for ventriculoscopy were performed. Anatomical target structures were defined in each region.