Journal of neurosurgery
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Despite the increased detection of incidental or small meningiomas, the lesion's natural history is largely unknown. ⋯ Although the authors could obtain variable results depending on the measurement method, the data demonstrate patients younger than 60 years of age and those with meningiomas characterized by hyperintensity on T2-weighted MR imaging, no calcification, diameter greater than 25 mm, and edema need to be observed more closely. Volumetry was more sensitive to detecting tumor growth than measuring the linear diameter.
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Journal of neurosurgery · May 2011
Case ReportsPreservation of the superior petrosal sinus during the petrosal approach.
The petrosal approach is based on sectioning the superior petrosal sinus (SPS) and the tentorium. However, the venous anatomy in certain situations forbids this maneuver. The authors have derived a technique that enables the SPS to be spared during the performance of the petrosal approach. They describe the anatomical basis of this technique and report on 2 cases in which the technique was applied. ⋯ This modification of the petrosal approach involving sparing of the SPS or cutting of the tentorium is an effective means for cases in which the venous anatomy mandates preservation of these structures.
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Journal of neurosurgery · May 2011
The neurosurgical anatomy of the sphenoid sinus and sellar floor in endoscopic transsphenoidal surgery.
A considerable degree of variability exists in the anatomy of the sphenoid sinus, sella turcica, and surrounding skull base structures. The authors aimed to characterize neuroimaging and intraoperative variations in the sagittal and coronal surgical anatomy of healthy controls and patients with sellar lesions. ⋯ Preoperative assessment of neuroimaging studies is critical for characterizing the morphological characteristics of the sphenoid sinus, sellar floor, tuberculum sellae, and clivus. The flat sellar type identified in 11% of people) or a complex sphenoid sinus configuration (in 29% of people) may make intraoperative correlation substantially more challenging. An understanding of the regional anatomy and its variability can improve the safety and accuracy of transsphenoidal and extended endoscopic skull base approaches.