World Neurosurg
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Case Reports
The combined interhemispheric subcommissural translaminaterminalis approach for large craniopharyngiomas.
We describe a variant of the interhemispheric translaminaterminalis approach for the resection of large suprasellar craniopharyngiomas. The approach is a translaminaterminalis route performed below and above the anterior communicating artery (ACoA). A cadaveric microanatomic study was conducted to describe the surgical technique. ⋯ The approach with preservation of the ACoA may represent a possible route to manage large suprasellar lesions. Combination of the unilateral interhemispheric corridor with the subfrontal and the trans-sylvian routes allows for a safe and radical resection of large suprasellar craniopharyngiomas.
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The microsurgical anatomy of the temporal region has been well described. However, there is a paucity of information about the transventricular endoscopic anatomy of the mesial temporal lobe, and little is known about endoscopic approaches to this region. In this report, we describe the technique of endoscopic amygdalohippocampectomy (AH). The endoscopic anatomy of the mesial temporal region both before and after AH is shown. ⋯ We studied the transventricular endoscopic anatomy of the mesial temporal region and described a technique for safe endoscopic AH. The advantages and potential risks of endoscopic AH are discussed, along with suggestions for minimizing complications. We believe that knowledge of the endoscopic anatomy of the mesial temporal lobe will be useful for endoscopic AH and the removal of other lesions in this region.
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To provide an anatomic basis of the occipital transtentorial keyhole approach (OTKA), then explore its feasibility and surgical indication. ⋯ Compared with the conventional approach, the OTKA is a more minimally invasive surgical procedure for treatment of the lesions in the pineal region and the middle and posterior parts of the medial and inferior temporal lobe. However, the working angles are relatively narrow.
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Case Reports Biography Historical Article
Harvey Cushing's early treatment of meningiomas: the untold story.
In his 1938 monograph, Cushing tabulated 313 meningioma cases treated throughout his career at the Johns Hopkins and the Peter Bent Brigham Hospitals. Of these, 18 patients were treated at the Johns Hopkins Hospital. Cushing provided basic demographic, perioperative, and outcomes data in his tables, but the operative details for many of his early meningioma cases have not been previously described. ⋯ The operative details demonstrate Cushing's early attention to hemostasis, and use of staged resections in patients with large, highly vascular meningiomas. Cushing's first 18 cases of meningiomas, treated while a young attending physician at the Johns Hopkins Hospital, are not the most elegant operations in his lengthy series, but serve as an illustration of his ability to transform clinical challenges into opportunities for improvement.
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To investigate recent trends in surgical volume and associated patient outcomes in the treatment of acoustic neuromas. ⋯ A 41%, or 178 cases per year, reduction in surgical excision of acoustic neuroma cases was observed during the period 2001-2007. A possible explanation for this trend includes increased use of stereotactic radiosurgery. Nonroutine discharge and complications after surgical excision have increased perhaps because of surgery being used for larger tumors.