World Neurosurg
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Stereoscopy has been demonstrated to be a useful method of education in the field of anatomy because it allows users to see, in a simulation, the anatomical structures in their actual volume and depth. ⋯ The teaching of basic, academic, and clinical neuroanatomy through the projection of stereoscopic photographs can be useful. The methods of image capture and stereoscopic projection in neuroanatomy, once combined with the necessary theoretical and practical knowledge, can be reproduced at other centers of neuroanatomy teaching.
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Interest groups for medical students (MSs) facilitate interest and engagement in neurosurgery. Students without interest groups are at a disadvantage as a result of greater barriers to exposure. We aimed to compare the usefulness of a virtual neurosurgery training camp for MSs with and without interest groups. ⋯ Distance learning increases both general and subspecialty-specific interest in neurosurgery among MSs without neurosurgery interest groups to a greater degree than among those with interest groups. Future initiatives seeking to benefit students without home programs should address the specific concerns of these students.
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Although rare, intramedullary spinal cavernous malformations have a 1.4%-6.8% annual hemorrhage risk and can cause significant morbidity.1 Prior hemorrhage and size >1 cm are risk factors for future hemorrhage that, in addition to notable or progressive symptoms, may justify early surgical intervention.1,2 In this video, we present key steps in surgical management of a large, symptomatic thoracic cavernous malformation. A 56-year-old woman presented with worsening lower extremity weakness, imbalance, and difficulty ambulating. Strength was 3/5 in her right lower extremity and 4/5 in her left lower extremity. ⋯ Postoperatively, the patient had improved left lower extremity strength and stable right lower extremity strength but worsened dorsiflexion (1/5), which improved with rehabilitation. At 1-year follow-up, she had full strength in her left lower extremity and 4/5 in her right lower extremity, with mild paresthesias below T10. Consistent with prior series demonstrating low complication rates and good long-term neurological outcomes,2 microsurgical resection of selected symptomatic intramedullary spinal cavernous malformations can halt neurological decline and potentially improve neurological function.
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Case Reports
Role of Extradural Clinoidectomy and Trapping in Giant Superior Hypophyseal Artery Aneurysm.
Giant paraclinoid internal carotid artery (ICA) aneurysms are surgically challenging, mainly owing to lack of adequate working space and distortion of the regional anatomy. Anterior clinoidectomy is a vital surgical technique in such cases, allowing optic nerve decompression and exposure of the proximal ICA outside the confines of the arachnoid. While clinoidectomy is generally conducted intradurally, some aneurysms, particularly unruptured and directed medially paraclinoid ICA aneurysms, can allow a completely extradural clinoidectomy. ⋯ The patient made an uneventful recovery with improvement in vision and normal visual fields. This video demonstrates the feasibility and utility of extradural clinoidectomy in adequate exposure of giant paraclinoid aneurysms and the role of aneurysm trapping for definitive aneurysm obliteration when the distal dural ring is involved. Trapping, in contrast to direct clipping, avoids manipulation of the compressed optic nerves, which is necessary for an optimal environment for postoperative visual recovery.
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Approaches to the jugular foramen can be challenging. Adding to this difficulty is the potential for a bony septation to occur in the foramen thus subdividing its contents. Although such bony septations in the jugular foramen are known, the anatomic details of these structures have not been studied well. Therefore, the present anatomic study was performed. ⋯ Our study found significant variations regarding the bony septa of the jugular foramen. Knowledge of this anatomy can be useful for preoperative planning and intraoperative navigation with approaches to the skull base that target pathology of the jugular foramen.