World Neurosurg
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Despite recent technological advances, direct approaches to the posterolateral incisural space remain surgical challenges. The choice of the operative route depends on the exact location and extent of the target lesion as well as individual preferences. The extreme lateral infratentorial supracerebellar approach to treat pathologies located in the ambient cistern and posterior incisural space is a technically feasible route in selected cases. In this cadaveric study, we demonstrate the benefits of endoscope-assisted microsurgical maneuvers using the extreme lateral supracerebellar infratentorial approach. ⋯ Direct visualization of the posterior and posterolateral incisural space avoids retraction of the occipital lobe and damage to the deep venous complex. The extreme lateral infratentorial supracerebellar corridor is effective for approaching the posterolateral mesencephalic junction and the posterior incisural space in selected cases. Endoscope-assisted microsurgery can improve visualization and minimize parenchymal retraction, which should enhance surgical control.
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Numerous methods to achieve occipitocervical stabilization have been described, including the use of occipital plate/screw constructs. Bicortical screws may increase the pullout strength, but intracranial injuries to venous sinuses have been reported. This study was performed to analyze the variations in occipital sinuses to prevent sinus injury caused by the bicortical screw. ⋯ The occipital sinus shows several variations, and many morphologic differences can be seen. Preoperative detailed examination by magnetic resonance venography or vertebral angiography may be required for cases in which bicortical occipital screw fixation is necessary to avoid occipital sinus-related complications.
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Recurrent World Health Organization (WHO) grade II and III meningiomas have traditionally been treated by surgery alone, but early literature suggests that adjuvant stereotactic radiosurgery may greatly improve outcomes. We present the long-term tumor control and safety of a hypofractionated stereotactic radiosurgery regimen. ⋯ Stereotactic radiosurgery for adjuvant and salvage treatment of WHO grade II meningioma using a hypofractionated plan is a viable treatment strategy with acceptable long-term tumor control, overall survival, and complication rates. Future studies should focus on radiation-naïve patients and local management of malignant meningioma.
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For the treatment planning of a patient with a middle cerebral artery (MCA) trunk aneurysm, understanding the anatomic relationship among the aneurysm, branching vessels, and lenticulostriate arteries (LSAs) is important. We aimed to demonstrate the branching-vessel anatomy related to an MCA trunk aneurysm using 3-dimensional (3D) angiography. ⋯ We have identified a clinically important anatomic relationship between the MCA trunk aneurysm and branching vessels, including the LSAs. EFCB aneurysms show a close relationship with the LSAs. Pretreatment identification of the origin of the LSAs is important to obviate any perforator injury in EFCB aneurysms.
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The sellar spine is a rare, bony growth that typically arises from the dorsum sellae. Few cases have been described in the literature thus far, and most are asymptomatic and incidentally found. We describe the case of a 19-year-old female in whom a sellar spine was noted to be associated with pituitary glandular deformation and symptomatic optic apparatus compression. ⋯ Recognition of a sellar spine can be elusive, and removal of a symptomatic one may be technically challenging. It is important to consider this entity in the differential diagnosis of a patient with headaches and bitemporal visual deficits.