World Neurosurg
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Premature infants with severe germinal matrix/intraventricular hemorrhage are at high risk of posthemorrhagic ventricular dilation and hydrocephalus (Video 1). We report a 4-month-old premature infant with grade III intraventricular hemorrhage and compartmentalized hydrocephalus with an unusual craniospinal cyst. The cyst extended anteriorly from the mesencephalon to the posterior wall of C6, causing severe compression of the brainstem and spinal cord. ⋯ At 18-month follow-up, the child demonstrated almost normal neurological and psychomotor development with no cyst recurrence or hydrocephalus. Our report underlines the importance of performing multiple fenestrations of such cysts. We believe that performing a transfixing fenestration through the cyst allows cerebrospinal fluid flow and prevents recurrence, as, for instance, has been shown for suprasellar arachnoid cysts.
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Case Reports
The Use of Augmented Reality to Improve Safety of Anterior Petrosectomy: 2-Dimensional Operative Video.
An anterior petrosectomy (AP) provides access to the upper petroclival region, but approach-related complications include seizures and temporal lobe hematomas.1 Moreover, the floor of the middle fossa contains multiple critical neurovascular structures, and drilling Kawase's quadrilateral must be performed carefully to avoid iatrogenic injury. In particular, the cochlea, carotid artery, and the contents of the internal acoustic canal are vulnerable because there are no locational cues to help the surgeon define their borders.2-4 In this video, we demonstrate the use of an augmented reality (AR) to protect critical structures during drilling of an AP. The illustrative case involves a 70-year-old woman with difficulty walking caused by a petrotentorial meningioma. ⋯ The AP in surgery mimicked the one practiced during rehearsal and provided exposure to our patient's tumor. After surgery, the patient awoke without injury to her hearing, balance, or facial movements. By providing visual locational cues to the surgeon, we believe that AR improves the safety to the critical neurovascular structures during AP.
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Anterior clinoidectomy is an important tool for neurovascular and skull base surgeons. This technique is cardinal for expanding access to the sella, proximal carotid artery, and central skull base. The goal of anterior clinoidectomy is to reveal the more proximal ophthalmic and clinoidal segments of the internal carotid artery while unroofing the optic canal and skeletonizing the proximal optic nerve. This maneuver expands the opticocarotid and carotid-oculomotor access windows and therefore the operative corridor to the interpeduncular cisterns.