World Neurosurg
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The amount of parasellar extension is a known limitation for gross total resection (GTR) of pituitary adenomas. Endoscopic technique seems to improve resection of adenomas extending laterally. Knosp classification is used to evaluate the extent of parasellar invasion: increasing Knosp grades correspond with lower rates of GTR. The 4-quadrant method could help to estimate the risk of partial resection in adenomas with parasellar extension. The objective of this study was to compare the rate of GTR between microsurgical and endoscopic techniques in pituitary adenomas with parasellar extension. The secondary aim was to compare the predictive value of Knosp classification and of the 4-quadrant classification regarding GTR. ⋯ GTR of macroadenomas with parasellar extension is significantly enhanced by the endoscopic approach. The 4-quadrant classification appears as sensitive as the Knosp classification and could be a simple adjunct to predict surgical radicality, in particular in cases of inferolateral quadrant invasion.
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With the introduction into the neurosurgical practice of minimally invasive methods using endoscopic techniques, it became possible to effectively remove hard-to-reach tumors, including central tumors of the anterior region of the posterior cranial fossa. ⋯ The endoscopic endonasal transclival approach can be used to obtain access to centrally located skull base tumors. This approach allows for a radical and low-risk removal of various skull base tumors of central localization that, until recently, were considered to be almost inoperable.
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Langerhans cell histiocytosis (LCH) is a multisystemic dendritic cell proliferation that is relatively uncommon in adults. Central nervous system LCH outside the pituitary gland is even more uncommon. ⋯ The present case is so rare it should not be used as a guide. We probably will never see a single intraparenchymal supratentorial central nervous system LCH lesion. However, we hope our report will help colleagues in the future with the thought process.
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The clivus is a small, central area of the basal cranium with limited surgical access and high morbidity associated with pathologies of its surrounding structures. Therefore thorough knowledge and understanding of the anatomy in this region are crucial for the success of treatments and interpretation of imaging. As to our knowledge, there is no extant cadaveric examination of the transclival veins, so the present study was performed. ⋯ An improved understanding of the skull base and its venous drainage can assist clinicians and surgeons in better understanding normal, pathologic, and variant anatomy in this region.
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To analyze treatment of microvascular decompression using the retrosigmoid approach (RA) in primary trigeminal neuralgia and hemifacial spasm using preoperative images combined with intraoperative microscopic navigation to avoid unnecessarily opening the mastoid air cells (MACs). ⋯ Image processing and intraoperative microscopic navigation can avoid unnecessarily opening MACs and might reduce postoperative cerebrospinal leakage and scalp infection after RA craniotomy.