World Neurosurg
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Pineal tumors are rare but surgically challenging due to their deep location and proximity to major veins and brainstem.1,2 Getting a biopsy along with an endoscopic third ventriculostomy is essential before surgical resection.3,4 The supracerebellar infratentorial approach provides direct symmetrical exposure of the pineal region inferior to the vein of Galen.5,6 3-Dimensional (3D) exoscopes are increasingly used due to better ergonomics, greater depth of field, and equivalent image quality of microscope. The endoscope provides angled optics to visualize hidden areas of tumor adherent to neurovascular structures, avoiding blind dissection. These become especially advantageous during suboccipital keyhole surgery in the sitting position, which averts both cerebellar retraction and frequent soiling of the endoscope. ⋯ Histopathology was a high-grade papillary tumor. Magnetic resonance imaging confirmed gross total resection. This is probably the first report of a supracerebellar infratentorial keyhole approach for gross total resection of a giant pineal tumor, effectively using the better ergonomics and depth of field of a 3D exoscope along with angled optics provided by an endoscope, resulting in an excellent outcome.
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Strong performance in neurosurgical sub-internships is a vital component of a successful residency application and requires adequate familiarity with clinical knowledge and technical skills that may not be covered in standard medical school curricula. Accordingly, a need exists for immersive and comprehensive sub-internship preparation programs that respect time and resource limitations, are optimized based on longitudinal student feedback, provide opportunities for mentorship, and foster enthusiasm for neurosurgery. Therefore, residents at a single institution designed and implemented a comprehensive curriculum for a one-day sub-internship academy. ⋯ Student perceptions of the relevance and utility of the sub-internship academy were positive, and the program fostered enthusiasm for neurosurgery and provided opportunities for mentorship. The participants indicated the academy positively impacted their sub-internship performance, and areas for improvement to guide future iterations of the academy were identified.
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Neurosurgeons may resort to caffeine, alcohol, and various drugs to maintain peak performance as they grapple with work demands and escalated stress. The prevalence of this controversial strategy remains largely unexplored. ⋯ Reflecting on our results on job-associated drug use by neurosurgeons, we propose the judicious use of pharmacological or nonpharmacological adjuncts, alongside the prioritization of neurosurgeons' well-being.
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This study aimed to delineate the clinical and radiological outcomes between two different single-door laminoplasty techniques, the staggered approach and the conventional one-sided approach, in treating cervical spondylotic myelopathy (CSM). ⋯ Patients who underwent staggered single-door laminoplasty experienced more favorable outcomes in some metrics than those who received the conventional technique.
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Trapped temporal horn (TTH) is a subtype of focal obstructive hydrocephalus. Although a ventriculoperitoneal shunt (VPS) is a traditional treatment approach, it poses risks of shunt failure and infection. The emergence of neuroendoscopy has led to an increased interest in ventriculocisternostomy as an alternative. This study aimed to evaluate the efficacy and safety of endoscopic ventriculocisternostomy with stent placement (EVSP) for TTH. ⋯ EVSP is a safe and feasible option for the treatment of TTH and is a viable alternative to VPS.