World Neurosurg
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To describe the technical and anatomic nuances related to endoscopic endonasal approaches (EEAs) to the paramedian skull base. ⋯ Approaches to the paramedian skull base are the most challenging and complex of all endoscopic endonasal techniques. Because of their technical complexity, it is recommended that surgeons master endoscopic endonasal anatomic approaches oriented to median structures (sagittal plane) before approaching paramedian (coronal plane) pathologies.
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The current approach for the diagnosis and repair of spontaneous and traumatic anterior skull-base defects is oulined, highlighting the controversies that exist in the field and describing the strategies required to access different segments of the anterior cranial fossa. ⋯ Endoscopic endonasal repair of CSF leaks and encephaloceles has evolved significantly during the past decade. The versatility of different endoscopic approaches through the four endonasal corridors allows for the endoscopic repair of almost all skull-base defects. The use of vascularized pedicled mucosal flaps has evolved to cover these defects as part of multilayered closure strategies.
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To evaluate preliminary outcomes for a cohort of patients who were treated with multisession Gamma Knife radiosurgery (GKRS) using the new noninvasive vacuum-assisted immobilization system. ⋯ Preliminary experience with multisession GKRS appears promising, with reasonable tumor control and complication rates. Multisession stereotactic radiosurgery may expand the treatment envelope for intracranial pathologies, including targets with larger volumes and locations in close proximity to radiosensitive structures.
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Case Reports
The pterional transsylvian transtentorial approach to ventrolateral pontine cavernomas: indications and techniques.
The authors describe a pterional transsylvian transtentorial approach to the ventrolateral pons based on its clinical application to cavernomas. ⋯ Although a comprehensive comparison with other approaches needs a large patient volume and a prospective designed study, the pterional transsylvian transtentorial approach could be an alternative for ventrolateral pontine cavernomas. The principle for this approach to ventrolateral pontine cavernomas is that if the thinnest parenchyma layer over the cavernoma could be defined in the ipsilateral upper ventrolateral pons, facilitated by an oblique multiangled working space, cavernomas in even the entire ventrolateral pons could be removed.