查看更多>>摘要：? 2022 Elsevier Inc.Arteriovenous malformations (AVMs) are congenital neurovascular disorders frequently manifested in young adults. The clinical presentation is variable and depends on its location, size, and ability to steal flow from adjacent areas, but it depends mainly on the occurrence of bleeding.1 The treatment of these lesions when located in eloquent areas, especially around the central sulcus, is controversial. Surgical resection of an AVM in the central lobe may cause postoperative sensorimotor deficits because this anatomic region includes the precentral and postcentral gyri on the lateral surface and paracentral lobule on the medial surface.2 AVMs can be successfully treated by surgery, but this treatment may pose unacceptable risks to the patient if the AVM involves an eloquent cortex. We consider that surgical removal of many of these lesions is feasible when preoperative planning is performed,3 when it is based on deep anatomic knowledge, and particularly when using a refined microsurgical technique.1 In this 3-dimensional Video 1, we present a case of a cerebral AVM of the central sulcus in which we achieved complete resection with microsurgical treatment without any neurologic sequelae for the patient. The patient consented to publication of images.
查看更多>>摘要：? 2021 Elsevier Inc.A 16-year-old male presented with solitary occipital plexiform neurofibroma, which had grown slowly over several years to reach giant size, thereby mimicking a “double head.” There were no features of neurofibromatosis type 1. Total excision of the neurofibroma was done by infiltrating adrenaline circumferentially around the tumor before scalp incision. The feeding arteries were identified in the dense connective tissue above the aponeurosis and ligated or cauterized. Dissection was then carried out in the loose areolar tissue preserving the periosteal layer. There was no evidence of malignant transformation on histopathology, and 5-year follow-up showed no tumor recurrence.
查看更多>>摘要：? 2021 Elsevier Inc.Malformations of cortical development (MCDs) are structural anomalies that disrupt the normal process of cortical development. These include microcephaly with simplified gyral pattern/microlissencephaly, hemimegalencephaly, focal cortical dysplasia, lissencephaly, heterotopia, polymicrogyria, and schizencephaly. They can present with intractable epilepsy, developmental delay, neurologic deficits, or cognitive impairment. Though the definitive diagnosis of MCD depends on histopathology, the pathologic tissue is rarely available; hence diagnosis begins with neuroimaging. This article shall briefly review the embryology, followed by specific magnetic resonance imaging features of MCD in an attempt to simplify the process of diagnosing these disorders with clinical and genetic correlation. A table has been included to highlight the embryologic, clinical, and genetic findings associated with various MCDs.
查看更多>>摘要：? 2021Background: Iatrogenic vascular injury is an uncommon complication of anterior and/or posterior surgical approaches to the cervical spine. Although the results of this injury may be life-threatening, mortality/morbidity can be reduced by an understanding of its mechanism and proper management. Methods: We conducted a literature review to provide an update of this devastating complication in spine surgery. A total of 72 articles including 194 cases of vascular lesions following cervical spine surgery between 1962 and 2021 were analyzed. Results: There were 53 female and 41 male cases (in addition to 100 cases with unreported sex) with ages ranging from 3 to 86 years. The vascular injuries were classified according to the spinal procedures, such as anterior or posterior cervical spine surgery. The interval between the symptom of the vascular injury and the surgical procedure ranged from 0 to 10 years. Only two-thirds of patients underwent intra- or postoperative imaging and the most frequently injured vessel was the vertebral artery (86.60%). Laceration was the most common lesion (41.24%), followed by pseudoaneurysm (16.49%) and dissection (5.67%). Vascular repair was performed in 114 patients. The mortality rate was 7.22%, and 18.04% of patients had 1 or more other complications. Most presumed causes of vascular lesions were by instrumentation/screw placement (31.44%) or drilling (20.61%). Sixteen patients had an anomalous artery. Direct microsurgical repair was achieved in only 15 cases. Conclusions: Despite increased anatomical knowledge and advanced imaging techniques, we need to consider the risk of vascular injury as a surgical complication in patients with cervical spine pathologies.
查看更多>>摘要：? 2021 Elsevier Inc.Degenerative lumbar spinal stenosis involves an acquired reduction in the spinal canal diameter due to osteoarthritic changes on the disk, facet joints, and ligaments and may result in spinal cord or cauda equina compression.1 This process may lead to pain radiating to the legs, neurogenic claudication, and neurologic deficit. First-line treatment includes conservative care such as physical therapy, spinal injections, and lifestyle changes. If this strategy is insufficient to achieve symptom relief, surgical management is recommended.1,2 Surgery generally encompasses a decompression procedure through a posterior approach. There are several techniques to accomplish this in the context of severe bilateral stenosis including standard open laminectomy, unilateral laminectomy with bilateral decompression, and a tubular approach with bilateral decompression (e.g., “over-the-top technique”).2 Among these, the spinous process splitting laminectomy has emerged as a strategy that allows decompressing the spinal canal through a familiar anatomy to the surgeon while respecting paravertebral muscles.3,4 This technique involves exposure of the laminae by cutting through the spinous process and then separating both halves and muscles attached at the sides. The main advantage is that the insertion of these paravertebral soft tissues is preserved, the required retraction is reduced and postoperative pain is decreased.4 Moreover, the learning curve to achieve a successful decompression employing the splitting laminectomy is substantially shorter than with other minimally invasive approaches, such as tubular. This video aims to show the steps to perform this technique (Video 1). We report the case of a 74-year-old male who presented with left sciatica and neurogenic claudication. The images showed multilevel degenerative lumbar spinal stenosis, with severe bilateral compression at L4-5, without signs of instability. Surgical alternatives were discussed with the patient, and it was decided to perform an L4-5 spinous process splitting laminectomy. The patient had a good evolution with an unremarkable postoperative course.
查看更多>>摘要：? 2021 Elsevier Inc.Intraaxial tumors of the central lobe are challenging lesions to deal with because of the high eloquence of this anatomic area.1,2 Diffusion tensor imaging magnetic resonance imaging and fluorescein (F) have proven to be useful in the planning and execution, respectively of glioma surgery.3-9 Nevertheless, the advantages of intraoperative use of augmented reality (AR) with diffusion tensor imaging?based high-definition fiber tractography (HDFT) are still underestimated. In the AR HDFT-F technique reported by our group, the integration of AR into the microscope comes through the BrainLAB Curve navigation platform (BrainLAB AG, Munich Germany), Smartbrush software (BrainLAB AG), KINEVO 900 surgical microscope (Carl Zeiss, Oberkochen, Germany), and YELLOW 560 filter (Carl Zeiss).9 The microscope establishes a wired autodetection of the navigation platform, and the eyepiece functions as a “see-through display” of the AR images, which are overlapped onto the surgical field. Video 1 shows the technical key aspects of the intraoperative use of the AR HDFT-F technique in the maximal safe anatomic resection of a postcentral gyrus high-grade glioma.
查看更多>>摘要：? 2021 Elsevier Inc.The temporomesial region is a frequent site of neurosurgical lesions such as tumors, cavernomas, or arteriovenous malformations. This region has been divided into 3 regions: anterior, middle, and posterior.1-4 The objective of Video 1 is to present the case of a posterior temporomesial cavernoma resection through a supracerebellar transtentorial approach, highlighting the surgical technique. The case is a 50-year-old female with history of temporomesial bleeding, headaches, and seizures refractory to medical treatment. In the neuroimaging studies a posterior temporomesial image was diagnosed. We selected a paramedian supracerebellar transtentorial approach in semisitting position for the surgery. With the use of neuronavigation guidance, the cavernoma was located and removed in 1 piece. The patient evolved favorably, without neurologic deficit, improving the symptoms after surgery. The approach is an excellent alternative for exposing the temporomesial region, and the semisitting position facilitates the retraction by gravity of the cerebellum, maintaining a clean surgical field during the microsurgical procedure.3-5
查看更多>>摘要：? 2021 Elsevier Inc.Background: Posterior cerebral artery (PCA) aneurysms are rare, and most are giant, dissecting, or fusiform in morphology. Proximal occlusion of the PCA without revascularization causes high risk of ischemic complications. This study aimed to evaluate the safety and validity of using superficial temporal artery (STA)–PCA bypass through zygomatic anterior temporal approach in complex PCA aneurysms. Methods: Trapping or resecting of aneurysms and reconstruction of distal PCA through a zygomatic anterior temporal approach were performed in 6 patients from June 2017 to August 2020. Postoperative angiography confirmed obliteration of aneurysms and patency of bypass artery. Neurological function was assessed by the modified Rankin Scale (mRS). Results: Patients were 4 men and 2 women with a mean age of 43.8 years (range, 21–58 years). Subarachnoid hemorrhage occurred in 5 patients. Hunt and Hess grade was IV in 3 patients, III in 2 patients, and I in 1 patient. All PCA aneurysms were treated with trapping or resection of the aneurysms and revascularization of distal PCA. Postoperatively, all aneurysms were eliminated, and no new permanent neurological deficit was found. During follow-up, mRS score of all patients improved: 2 patients had mRS score 0, 1 patient had mRS score 1, 1 patient had mRS score 3, and 2 patients had mRS score 4. Long-term graft patency rate was 100%. Conclusions: STA-PCA bypass appears to be safe and effective for the treatment of complex PCA aneurysms requiring supplementation of blood flow in the area of the PCA. We established a surgical route, allowing the procedure to be done through the zygomatic anterior temporal approach. This approach provides adequate operative field exposure and reduces retraction of temporal lobe.
查看更多>>摘要：? 2022 Elsevier Inc.The eponymous term torcular Herophili has been used for the confluence of sinuses. Although no original writings of Herophilus are extant, his accomplishments and descriptions live on in the writings of such authors as Galen. However, in regard to the torcular Herophili, there are some inconsistencies in the secondary sources and their translations regarding what was actually originally described by Herophilus. Herein, we review the history of the term torcular Herophili, which is so often used in clinical medicine.
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