World Neurosurg
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Microneurosurgical techniques involve complex manual skills and hand-eye coordination that require substantial training. Many factors affect microneurosurgical skills. The goal of this study was to use a systematic evidence-based approach to analyze the quality of evidence for intrinsic and extrinsic factors that influence microneurosurgical performance and to make weighted practical recommendations. ⋯ Despite the clear value of determining the effects of various factors on surgical performance, the available body of literature is limited, and it is not possible to determine standards for each surgical field. These recommendations may be used by neurosurgical trainees and practicing neurosurgeons to improve microsurgical performance and acquisition of microsurgical skills. Randomized studies assessing the factors that influence microsurgical performance are required.
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To describe the surgical technique of percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) in detail and report the clinical outcomes and radiologic changes in patients with cervical intervertebral disc herniation (CIVDH). ⋯ PEATCD combines the benefits of an anterior transcorporeal approach with endoscopy, preserves the cervical motion segment and causes less damage to the disc, and significantly decreases surgical trauma. Therefore, PEATCD is a safe, effective, minimally invasive, alternative procedure for patients with CIVDH.
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Middle fossa floor access can be challenging. Open skull base approaches have associated morbidity and yield suboptimal working angles around the temporal lobe. Endoscopic endonasal approaches to the middle fossa are poorly described, but provide an improved angle. I hypothesized that the length of the maxillary nerve can be transposed out of the foramen rotundum to provide a path to expose the full width of the middle fossa floor through the anterolateral and anteromedial triangle. ⋯ Endoscopic endonasal transpterygoid approaches with or without transposition of the maxillary nerve provide a reasonable option for sequentially exposing the entire medial to lateral extent of the anterolateral triangle. It provides an advantageous inferior to superior surgical angle and can be considered for treatment of select middle fossa floor pathology.
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Superficial temporal artery (STA)-to-middle cerebral artery (MCA) bypass is an established surgical technique for achieving revascularization. It is important to select the proper recipient artery of the MCA. Three-dimensional computed tomographic angiography (3D-CTA) and conventional angiography are useful in the selection process but need contrast agents. The authors have designed a coloring MRA technique that needs no agents to visualize the recipient artery. Retrospective evaluation of the efficacy and limitation for selection of the recipient artery and decision of the place and size of the craniotomy were carried out. ⋯ The coloring MRA technique was not inferior to 3D-CTA with respect to the size of craniotomy. This novel technique was found to be very helpful not only for the virtual identification of the proper recipient artery but also for preoperative simulation such as decisions about length of donor artery, location, and size of craniotomy.
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Branching and/or replication of the abducens nerve is not an uncommon occurrence. Although numerous variations have been documented, the rarest forms are duplicated or triplicated nerves, where multiple nerve roots originate from the brainstem, travel intracranially, and attach to the lateral rectus as separate entities. ⋯ In this paper, we review the literature on variations found, discuss current hypotheses and clinical relevance, and propose future studies. Neurosurgeons should be aware of such nerve variants when viewing imaging or operating in the regions traversed by the abducens nerve.