World Neurosurg
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Dural arteriovenous fistulas represent a distinct direct pathological connection between dural arterial feeders of the meninges to cortical veins or sinuses. Vascular supply of the meninges is provided by a series of named arteries-anterior, middle, and posterior meningeal arteries, with the tentorium provided by the artery of Bernasconi and Cassinari (anterior-medial) and the artery of Davidoff and Schechter (posterior-medial). This case is the first report in the literature of a lateral distal posterior cerebral artery supplying the meninges and contributing dural feeders to a Cognard type III/Borden type III dural arteriovenous fistula.
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Esthesioneuroblastoma (ENB) is a rare malignancy of the sinonasal tract and its infrequency has confounded efforts at clearly describing the survival trends associated with this neoplasm over the years. In this study, we reviewed survival trends in ENB and investigated the impact of treatment extent and modality on patient outcomes. ⋯ Despite advanced diagnostic studies and modernized treatment approaches, ENB survival has remained unchanged over the years, calling for improved efforts to develop appropriate individualized interventions for this rare tumor entity. Our results also confirmed that surgery and adjuvant radiotherapy is associated with improved patient survival whereas the use of chemotherapy should be considered carefully.
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The white fiber and gross anatomy relevant for performing amygdalohippocampectomy through the middle temporal gyrus approach for mesial temporal sclerosis has been depicted by white fiber dissection. ⋯ The middle temporal gyrus is a commonly used approach to perform temporal lobectomy and amygdalohippocampectomy for patients with mesial temporal sclerosis. The anatomy relevant to the approach as presented will aid while performing epilepsy surgery.
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Occipital artery (OA)-posterior inferior cerebellar artery (PICA) bypass is a challenging procedure and is not frequently performed owing to the difficulty of OA harvest. To facilitate harvest, the intersection between the sternocleidomastoid and splenius capitis (the OA triangle) is used as the anatomical landmark to identify the OA segment that carries the highest risk of damage. This clinical study aimed to demonstrate efficacy and safety of OA harvest using this landmark. ⋯ The OA triangle, which is the anatomical landmark of the proximal end of the transitional segment of the OA, facilitated OA harvest using the distal-to-proximal harvest technique with safety and good patency. To the best of our knowledge, this is the first study of OA harvest in clinical cases.
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Case Reports
Microsurgical Resection of Trigeminal Schwannoma via Anterior Petrosal Approach: 2-Dimensional Operative Video.
Trigeminal schwannomas are complex lesions that may be related to many critical neurovascular structures. We present the case of a 59-year-old male presenting a history of left-sided trigeminal neuralgia. Preoperative imaging demonstrated a mass highly suggestive of a trigeminal schwannoma, and microsurgical resection was indicated considering the progressive symptomatology and important mass effect (Video 1). ⋯ The patient's symptoms improved, and there were no neurologic deficits on follow-up. Extensive laboratory training is fundamental to be familiarized with the normal anatomic nuances and prepared to face the anatomy distorted by lesion. Informed consent was obtained from the patient for the procedure and publication of this operative video.