Neurosurgery
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The pretemporal approach has gained popularity for the treatment of basilar apex aneurysms. However, it requires the sacrifice of anterior temporal bridging veins to allow posterior temporal lobe retraction and, for patients with dominant pretemporal venous drainage, has the attendant risk of venous hypertension, hemorrhagic venous infarction, or seizures postoperatively. Alternatively, we have found that splitting the sylvian fissure, resecting the uncus, and applying posterolateral retraction to the medial temporal lobe provides a similar exposure to the basilar apex while preserving the anterior temporal bridging veins. To evaluate the transsylvian, trans-uncal approach to the basilar apex, we report our initial clinical results using this exposure in eight consecutive patients. A morphometric cadaveric analysis comparing this approach with the pretemporal approach was also performed. ⋯ When approaching the basilar bifurcation, the transsylvian, trans-uncal approach provides superior exposure of the ipsilateral superior cerebellar and posterior cerebral arteries compared with the pretemporal approach, while preserving the anterior temporal bridging veins. This approach is most valuable in patients with dominant temporal venous drainage or when additional exposure of the ipsilateral posterior cerebral or superior cerebellar arteries is required.
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To demonstrate the role of intraoperative multichannel electromyographic (EMG) monitoring to reduce postoperative deterioration and achieve full untethering of complex occult dysraphisms. ⋯ Intraoperative multichannel EMG monitoring can be carried out and requires only minimal changes to anesthetic procedures. With this method, it is possible to better identify the neural structures of complex malformations, reducing the risks of surgical damage and incomplete detethering.
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The purpose of this study was to identify biological markers that may be involved in the adhesiveness of craniopharyngiomas to optical chiasms and/or pituitary stalks. ⋯ Our data suggest that at least part of the adhesiveness of craniopharyngiomas to the surrounding tissue, such as optical chiasms and pituitary stalks, could be explained by the interactions between alpha(2beta1) integrin expressed by craniopharyngiomas and collagens on the one hand, and vitronectin expressed by the surrounding tissue on the other hand. In addition, a Cox regression analysis has revealed that the levels of galectin-4 contribute significant information toward the delay in recurrence independently of surgical status.
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To evaluate, regardless of the clinical results, the contribution of combining functional magnetic resonance imaging (fMRI) with intraoperative cortical brain mapping (iCM) as functional targeting methods for epidural chronic motor cortex stimulation (MCS) in refractory neuropathic pain. ⋯ This study confirms the functional accuracy of fMRI guidance in neuropathic pain and illustrates the usefulness of combining fMRI guidance with iCM to improve the functional targeting in MCS. Because appropriate targeting is crucial to obtaining pain relief, this combination may increase the analgesic efficacy of MCS.
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We discuss and evaluate surgical strategies and results in 42 patients with a variety of tumors involving the anterior and anterolateral foramen magnum and present factors affecting the degree of resection and patient outcomes. We describe our surgical techniques for resection of these tumors via the lateral approach, including consideration for occipital condylar resection and vertebral artery management. ⋯ In anterior or anterolaterally located foramen magnum tumors, we think the extreme lateral or far lateral approach affords significant advantages. Vertebral artery mobilization and occipital condyle resection may be needed depending on the extent and location of the foramen magnum tumor and its specific pathological characteristics. Tumor invading the occipital condyle or significant condylar resection may cause occipitocervical instability and require fusion.