Dural Closure Training With Prototyped Model.

Introduction: The hermetic closure of the dura mater is a critical step in neurosurgical training, often undervalued but crucial to preventing serious complications such as cerebrospinal fluid (CSF) leaks leading to meningitis and death. Inadequate closure, often due to insufficient training, can result in challenging complications, including prolonged hospitalization and reoperation.

Objective: To address the deficiencies in dural closure training, this study aims to describe a 3D prototype for simulating post-craniotomy dura mater suturing.

Adverse Effects of Deep Brain Stimulation for Treatment-Resistant Depression: A Scoping Review.

Deep brain stimulation (DBS) is an emerging therapy for treatment-resistant depression (TRD). Although adverse effects have been reported in early-phase and a few randomized clinical trials, little is known about its overall safety profile, which has been assumed to be similar to that of DBS for movement disorders. The objective of this study was to pool existing safety data on DBS for TRD.

Intracanalicular vestibular schwannomas: facial and hearing outcomes according to the location of the tumor in relation to the nerves of the internal auditory canal.

Objective: The objective was to evaluate whether the position of the nerves within the internal auditory canal (IAC) has any effect on preoperative and postoperative cochlear and facial nerve function in patients with intracanalicular vestibular schwannoma (VS) resected through the retrosigmoid transmeatal approach.

Methods: Forty-four patients with sporadic intracanalicular VS, from a series of 710 patients with VS who underwent operations from January 1993 to April 2022, were retrospectively reviewed. The pattern of displacement of the cranial nerves and tumor within the IAC was recorded.

Elucidating the Mechanisms of Pulsed Radiofrequency for Pain Treatment.

Pulsed radiofrequency is a well-documented treatment option for multiple painful conditions where pulses of energy are delivered close to neural elements. Since its earliest adoption, this technique has gained increasing acceptance as a minimally invasive procedure, and new applications are evolving. Studies have shown microscopic and biochemical changes that reflect beneficial effects; however, the exact mechanism of action is not yet completely understood.

A Rare Case of an Intrasellar Arachnoid Cyst With Middle Cranial Fossa Extension.

Intrasellar arachnoid cysts represent around 1% of all selar lesions. Generally, patients are asymptomatic and when they exhibit visual and/or hormonal disturbances, the indication for surgery is prompted. A 51-year-old woman with a known purely intrasellar arachnoid cyst diagnosed 23 years prior to presentation, evolved with gradual campimetric evaluation.

Randomized Clinical Trials and Observational Tribulations: Providing Clinical Evidence for Personalized Surgical Pain Management Care Models.

Proving clinical superiority of personalized care models in interventional and surgical pain management is challenging. The apparent difficulties may arise from the inability to standardize complex surgical procedures that often involve multiple steps. Ensuring the surgery is performed the same way every time is nearly impossible.

Retrosigmoid Craniotomy and Intradural Variations: Role of Patient-Specific Preoperative Imaging to Identify Landmarks and Relevant Structures.

Objective: There are several landmarks to safely identify the limits of the retrosigmoid approach and its intradural variations; however, there has been little discussion about how those landmarks may vary among patients.

Methods: Patient positions; surface landmarks for the retrosigmoid craniotomy; and structures to recognize for transmeatal, suprameatal, suprajugular, and transtentorial extensions were reviewed.

Results: The position of the dural sinuses in relation to the zygomatic-inion line and digastric notch line is readily identified on magnetic resonance imaging.

The Changing Environment in Postgraduate Education in Orthopedic Surgery and Neurosurgery and Its Impact on Technology-Driven Targeted Interventional and Surgical Pain Management: Perspectives from Europe, Latin America, Asia, and The United States.

Personalized care models are dominating modern medicine. These models are rooted in teaching future physicians the skill set to keep up with innovation. In orthopedic surgery and neurosurgery, education is increasingly influenced by augmented reality, simulation, navigation, robotics, and in some cases, artificial intelligence.

Neuromyelitis optica spectrum disorders with a benign course. Analysis of 544 patients.

Background: Neuromyelitis optica spectrum disorders (NMOSD) most commonly cause severe disability which is related to disease attacks. However, some patients retain good neurological function for a long time after disease onset.

Objectives: To determine the frequency, demographic and the clinical features of good outcome NMOSD, and analyze their predictive factors.

Temporal evolution of new T1-weighted hypo-intense lesions and central brain atrophy in patients with a first clinical demyelinating event treated with subcutaneous interferon β-1a.

Objective: Evaluate the effect of subcutaneous interferon β-1a (sc IFN β-1a) versus placebo on the evolution of T1-weighted MRI lesions and central brain atrophy in in patients with a first clinical demyelinating event (FCDE).

Methods: Post hoc analysis of baseline-to-24 month MRI data from patients with an FCDE who received sc IFN β-1a 44 μg once- (qw) or three-times-weekly (tiw), or placebo, in REFLEX. Patients were grouped according to treatment regimen or conversion to clinically definite MS (CDMS) status.

Investigation of the Use of Hollow Elastic Biomodels Produced by Additive Manufacturing for Clip Choice and Surgical Simulation in Microsurgery for Intracranial Aneurysms.

Background: Intracranial aneurysms (IAs) are dilatations of the cerebral arteries, whose treatment is commonly based on the implant of a metallic clip on the aneurysm neck. Despite the dissection and understanding of the surgical anatomy of the IA when often only parts of it are visible, the choice of the ideal clip to be used is one of the surgical difficulties. Although current imaging tests guarantee IA visualization, currently there is no planning method that allows for a real three-dimensional (3D) visualization for optimal choice of clip prior to surgery.

Management of jugular bulb injury during retrosigmoid transmeatal resection of vestibular schwannoma.

Inadvertent laceration of the jugular bulb is a potentially serious complication of the retrosigmoid transmeatal approach to vestibular schwannomas. Here, the authors present the case of a 51-year-old woman with a right Hannover T4a vestibular schwannoma and bilateral high-riding jugular bulb, which was opened during drilling of the internal auditory canal (IAC). They highlight the immediate management of this complication, technical nuances for closing the defect without occluding the jugular bulb, and modifications of the standard technique needed to continue surgical resection.

Dorsal displacement of the facial nerve in vestibular schwannoma surgery.

The course of the facial nerve (FN) has been extensively investigated in patients with vestibular schwannomas (VSs). FN running dorsally to the tumor capsule accounts for less than 3% of the cases. Diffusion tensor imaging (DTI)-based fiber tracking helps to preoperatively identify the FN.

5-Aminolevulinic acid fluorescence in brain non-neoplastic lesions: a systematic review and case series.

Fluorescence-guided surgery with 5-aminolevulinic acid (5-ALA) is used to assist brain tumor resection, especially for high-grade gliomas but also for low-grade gliomas, metastasis, and meningiomas. With the increasing use of this technique, even to assist biopsies, high-grade glioma-mimicking lesions had misled diagnosis by showing 5-ALA fluorescence in non-neoplastic lesions such as radiation necrosis and inflammatory or infectious disease. Since only isolated reports have been published, we systematically review papers reporting non-neoplastic lesion cases with 5-ALA according with the PRISMA guidelines, present our series, and discuss its pathophysiology.

Retrosigmoid Infralabyrinthine (Suprajugular) Approach to the Jugular Foramen: Indications, Limitations, and Surgical Nuances.

Background: Among the several approaches described to the jugular foramen (JF), the retrosigmoid infralabyrinthine (suprajugular) approach was one of the most recently described.

Objective: To describe the indications, limitations, and operative nuances of the suprajugular approach.

Methods: We provided a pertinent review of the anatomy, indications, preoperative evaluation, surgical steps and nuances, and postoperative management.

Use of Buspirone in the Treatment of Nonpharmacological Bruxism: About 4 Cases.

Objective: The aim of the study was to describe the efficacy of buspirone in controlling nonpharmacological awake and sleep bruxism.

Methods: Four cases of nonpharmacological awake and sleep bruxism, one of them with a 20-year-long history, in which buspirone succeeded to control bruxism, are described and discussed.

Results: Two of the 4 cases had sleep bruxism, and the other 2 cases had sleep and awake bruxism.

Modified Craniocervical Approach for Resection of the Styloid Process in Patients with Eagle's Syndrome.

 Surgical treatment of Eagle's syndrome remains the mainstay of treatment. Palsy of the marginal mandibular branch of the facial nerve is the most significant complication encountered in transcervical resections, due to direct compression during the approach. We proposed a modification of the craniocervical approach to the jugular foramen to resect the styloid process avoiding the marginal mandibular branch and subsequent palsy.

Correlation of Intraoperative Neurophysiological Parameters and Outcomes in Patients with Intramedullary Tumors.

Introduction: Intramedullary spinal cord tumors (IMSCT) account for about 2%-4% of all central nervous system tumors. Surgical resection is the main treatment step, but might cause damage to functional tissues. Intraoperative neuromonitoring (IONM) is an adopted measure to decrease surgical complications.

Pseudo-Cerebrospinal Fluid Leaks of the Anterior Skull Base: Algorithm for Diagnosis and Management.

 Pseudo-cerebrospinal fluid (CSF) leaks are a rare cause of unilateral, watery rhinorrhea. We proposed a step-wise approach to evaluate these cases.  It involves a single-center retrospective cohort study.

Serial Tap Test of patients with idiopathic normal pressure hydrocephalus: impact on cognitive function and its meaning.

Background: Idiopathic normal pressure hydrocephalus (INPH) is characterized by gait disturbance, urinary incontinence and cognitive decline. Symptoms are potentially reversible and treatment is based on cerebrospinal fluid shunting. The tap test (TT) is used to identify patients that will benefit from surgery.