Minimally invasive ultrasound-assisted evacuation of Spontaneous Supratentorial Intracerebral hemorrhages: Retrospective observational single-cohort study.

Objective: To assess safety and efficacy of minimally invasive evacuation of Spontaneous Supratentorial Intracerebral Hemorrhage (SSICH) by means of tailored minicraniotomies and intraoperative ultrasound (iUS) assistance.

Methods: Retrospective analysis of 55 patients who underwent microsurgical evacuation of SSICH using minicraniotomy and iUS assistance, between January 2015 and January 2022. Surgical complications, mortality rate, recurrent bleeding, percentage of hematoma evacuation and reliability of iUS were collected and investigated.

Stealth Autoguide as Robotic Holder for Cranial Endoscopic Surgery: Technical Note and Proof of Concept.

Background: The Stealth Autoguide (Medtronic, Minneapolis, MN) is a robotic auto-targeting device for stereotactic brain biopsy, placement of stereoelectroencephalography electrodes, and laser ablation therapy. This paper evaluates its off-label application as robotic endoscope holder in transnasal and intraventricular neurosurgery. The potential to enhance stability, reduce manual adjustments, and improve surgical precision is discussed, alongside cost-effectiveness and feasibility.

Endoscopic Transpterygoid Approach to Meckel's Cave: Technical Considerations and Retrospective Analysis of a Clinical Series.

Objective: Tumors located within the Meckel's cave (MC) pose a significant surgical challenge. Although several corridors to access this complex region have been described, the endoscopic transpterygoid approach (ETPA) and the endoscopic transorbital superior eyelid approach (ETOA) have emerged in recent years, as viable alternatives to traditional microsurgical transcranial approaches (MTA). To date, there is a limited literature on surgical series considering endoscopic-assisted approaches to the MC.

Single Step Resection-Reconstruction Using Precurved Titanium Mesh of a Giant Intradiploic Meningioma Mimicking Bone Malignancy: Technical Note.

Intradiploic meningiomas are rare neoplasms, often mistaken for metastases or malignant bone tumors. Surgical management can be challenging, considering their diffusive bony invasion. Two main critical decisions need to be taken: the timing for cranial vault reconstruction and the choice of the adequate material for cranioplasty.

360 Degrees Endoscopic Access to and Through the Orbit.

The treatment of pathologies located within and surrounding the orbit poses considerable surgical challenges, due to the intricate presence of critical neurovascular structures in such deep, confined spaces. Historically, transcranial and craniofacial approaches have been widely employed to deal with orbital pathologies. However, recent decades have witnessed the emergence of minimally invasive techniques aimed at reducing morbidity.

Ultrahigh-Definition-3-Dimensional Exoscope-Assisted Clipping of a Right Middle Cerebral Artery Unruptured Aneurysm with Indocyanine Green Video Angiography: Operative Video.

Ultrahigh-definition 3-dimensional exoscopes represent an excellent technologic innovation in contemporary neurosurgery. They combine the advantages of operating microscopes and endoscopes, offering excellent magnification and lighting, maintaining a relatively small footprint and optimal ergonomic features. One of the most interesting employments of exoscopes in neurosurgery is represented by intracranial vascular surgery.

Endoscopic Endonasal Excision of a Cavernous Hemangioma of the Orbital Apex with Cryoprobe Assistance: Two-Dimensional Surgical Video.

Cavernous hemangiomas (CHs) represent the commonest benign orbital lesion in adults, accounting for nearly 6% of overall orbital tumors.The most common presenting symptoms include unilateral visual deficits, diplopia, ocular muscle impairment, and nonpulsatile proptosis. CHs can be asymptomatic until they reach a considerable size, but when lodged deep in the orbital apex, even small masses may cause severe functional deficits.

Endoscopic transventricular approach for the resection of a hemorrhagic cavernous malformation of the tectal plate: Operative video.

Background: Cavernomas of the third ventricle are rare entities that provide significant therapeutic challenges. Because of the better view of the surgical field and the possibility to achieve a gross total resection (GTR), microsurgical approaches are more commonly used to target the third ventricle. Endoscopic transventricular approaches (ETVA), on the other hand, are minimally invasive procedures that can afford a straight corridor trough the lesion, avoiding bigger craniotomies.

Clinical and oncological outcomes in single-stage versus staged surgery for pediatric craniopharyngiomas: a multicenter retrospective study.

Purpose: Craniopharyngiomas (CPGs) are aggressive brain tumors responsible of severe morbidity in children. The best treatment strategies are under debate. Our study evaluates surgical, pituitary, and hypothalamic outcomes of a tailored staged-surgical approach compared to a single-stage radical approach in children with CPGs.

Quantitative Anatomic Comparison of Endoscopic Transnasal and Microsurgical Transcranial Approaches to the Anterior Cranial Fossa.

Background: Several microsurgical transcranial approaches (MTAs) and endoscopic transnasal approaches (EEAs) to the anterior cranial fossa (ACF) have been described.

Objective: To provide a preclinical, quantitative, anatomic, comparative analysis of surgical approaches to the ACF.

Methods: Five alcohol-fixed specimens underwent high-resolution computed tomography.

Frameless neuronavigation-assisted brain biopsy with electromagnetic tracking: how I do it?

Background: In recent years, thanks to several technological innovations, stereotactic cerebral biopsies have evolved from frame-based to frameless neuronavigation-assisted techniques.

Methods: The authors provide herein a detailed step-by-step description of the technique, shedding light on surgical tips and how to avoid complications. The practical application of the technique is demonstrated with a high-quality video.

Lessons learned during COVID-19 pandemic, a worldwide survey: evolution of global neurosurgical practice.

Background: During the COVID-19 pandemic, a multitude of surveys have analyzed the impact virus spreading on the everyday medical practice, including neurosurgery. However, none have examined the perceptions of neurosurgeons towards the pandemic, their life changes, and the strategies they implemented to be able to deal with their patients in such a difficult time.

Methods: From April 2021 to May 2021 a modified Delphi method was used to construct, pilot, and refine the questionnaire focused on the evolution of global neurosurgical practice during the pandemic.

Preliminary Validation of FoRCaSco: A New Grading System for Cerebral and Cerebellar Cavernomas.

Objective: Surgical indications for cerebral cavernous malformations (CCMs) remain significantly center- and surgeon-dependent; available grading systems are potentially limited, as they do not include epileptologic and radiologic data. Several experienced authors proposed a new grading system for CCM and the first group of patients capable of providing its statistical validation was analyzed.

Methods: A retrospective series of 289 CCMs diagnosed between 2008 and 2021 was collected in a shared anonymous database among 9 centers.

Endoscopic Endonasal Pituitary Hemi-Rotation Approach to the Upper Clivus: Anatomical Study and Clinical Report.

Aim: To report on the endoscopic endonasal pituitary hemi-rotation approach (EPHRA) in a preclinical setting and in a preliminary clinical experience.

Material And Methods: EPHRA was performed in five fresh-frozen head and neck specimens (a total of 10 sides) and in a selected case of a right-sided dorsum sellae chordoma.

Results: The approach described allowed exposure of the lateral part of the upper clivus in all the specimens and in the case reported.

Endoscopic Endonasal Transethmoidal-Transsphenoidal Approach to a Cavernous Sinus Chondrosarcoma.

 We illustrate a cavernous sinus chondrosarcoma treated with an endoscopic endonasal transethmoidal-transsphenoidal approach.  Case report of a 15-year-old girl with diplopia and esotropia due to complete abducens palsy. Preoperative images showed a right cavernous sinus lesion with multiple enhanced septa and intralesional calcified spots ( Fig.

Symptomatic ecchordosis physaliphora of the upper clivus: an exceedingly rare entity.

Objective: This paper highlights the management of 5 patients affected by symptomatic ecchordosis physaliphora (EP), treated via endoscopic endonasal transsphenoidal-transclival approach and contextual multilayer skull base reconstruction. A detailed analysis of each case is provided, along with the review of the current body of literature.

Methods: A retrospective review of patients treated by means of endoscopic endonasal approach for EP from 2010 to 2020 in the Otolaryngology and Neurosurgery Departments of a tertiary-care referral center for endoscopic skull base surgery was analyzed.

Endoscopic Endonasal Odontoidectomy Preserving Atlantoaxial Stability: a Pediatric Case.

 We illustrate endoscopic endonasal odontoidectomy for the Chiari-I malformation respecting craniovertebral junction (CVJ) stability.  Case report of a 12-year-old girl affected by the Chiari-I malformation. Magnetic resonance imaging (MRI) showed tonsillar herniation, basilar invagination, and dental retroversion, causing angulation and compression of the bulbomedullary junction.

Neurosurgeons on the front line: experience from the center of the storm in Italy.

In this tumultuous time, the entire world has been shaken up by the COVID-19 outbreak. Italy has had one of the highest infection-related mortality rates. Bergamo, a city in eastern Lombardy, was among the most affected.

An Uncommon Case of Neuroenteric Cyst Located at the Lateral Cerebellomedullary Cistern.

We present the case of a 42-year-old woman with a 5-week history of headache, progressive dysphagia, dysphonia, and hoarseness. A brain magnetic resonance imaging revealed an extra-axial cyst of the left lateral cerebellomedullary cistern. The subsequent histopathologic examination diagnosed a neuroenteric cyst.

The endoscopic diving technique in endonasal transsphenoidal surgery: how I do it.

Background: The endoscopic diving technique (EDT) is a procedure utilized in endonasal endoscopy, which consists of irrigating the surgical cavity during tumor removal, with a continuous flow of pressurized saline solution.

Methods: The authors provide a detailed step-by-step description of the technique, shedding light on surgical tips and pitfalls. Advantages, disadvantages, and the most useful application of the technique are clarified and showed with a high-quality endoscopic video.