World Neurosurg
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Case Reports Comparative Study
Comparative analysis of the transcranial "far lateral" and endoscopic endonasal "far medial" approaches: surgical anatomy and clinical illustration.
The main aim of our study was to analyze and compare the surgical anatomy pertinent to the dorsal transcranial transcondylar (far lateral approach) with that of the ventral endoscopic endonasal transcondylar (far medial approach) route. ⋯ The far medial approach offers a safe, wide exposure of the lower third of the clivus for lesions that expand ventromedial to the hypoglossal nerve. The far lateral approach is most suitable for lesions located dorsolateral to the lower cranial nerves. The vertebral artery and hypoglossal canal are the most important landmarks to guide surgical planning. A combined endonasal-transcranial approach should be considered for resection of extensive lesions involving both ventromedial and dorsolateral compartments. We strive to encourage skull base surgeons to integrate endoscopic and microscopic approaches to the posterior fossa.
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Myelomeningocele is a defect that typically is repaired surgically within the first few days of life in developed countries to minimize the risk of meningitis. If left unrepaired, these children may survive to have their meningocele sac epithelialize. The surgical reduction and closure of an epithelialized myelomeningocele represents a unique challenge for the neurosurgeon because it requires a modification of the typical closure technique. ⋯ Delayed closure of myelomeningoceles is facilitated by lessons learned from our surgical experience during a medical missions to Guatemala.
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Historical Article
Models of functional cerebral localization at the dawning of modern neurosurgery.
The concept of a functional cerebral localization gave the needed support for the development of neurosurgery as a specialty. It should be noted though that the presence of functions on discrete areas of the cortex was a very controversial topic at that time. The objective of this paper is to review models of cortical organization at the end of the 19th century, highlighting beliefs, theories, and controversies behind them. A better understanding of this historical moment is essential to appreciate the debate between holists and localizers that stirred neuroscientists worldwide in the first half of the 20th century.