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This article discusses the use of brainstem mapping in conjunction with the one-point method for the resection of brainstem cavernomas. Brainstem cavernomas are challenging due to their proximity to critical cranial nerve nuclei and tracts, as well as high re-hemorrhage rates. The study reviewed 36 patients who underwent resection using the one-point method and intraoperative brainstem mapping. The results showed that brainstem mapping reliably identified the location of relevant cranial nerve nuclei and modified the entrance to the lesion in most patients. The use of brainstem mapping, along with the one-point method, resulted in good functional outcomes and complete resection in the majority of patients. [Extracted from the article]

This article discusses the use of hologram-based craniectomy for the resection of an extensive en plaque meningioma compared to 3D-printed resection templates. The traditional method of cranial vault reconstruction after bone removal during skull base approaches is often suboptimal and costly. Patient-specific skull implants offer a solution, but precise preoperative determination of craniotomy dimensions and removed bone is necessary. The article presents a case study where hologram-based mixed reality resection was compared to template-guided resection, and the hologram was found to be accurate in patient positioning, incision planning, and craniectomy. The use of holograms can offer clearer positioning guidance compared to challenging-to-position templates and can assist in surgical planning, patient education, and more. [Extracted from the article]

This article discusses the use of stereotactic radiosurgery (SRS) as a treatment option for intracranial solitary fibrous tumors (SFTs). SFTs are rare tumors that are difficult to completely remove through surgery and have high recurrence rates. SRS, which delivers targeted radiation to the tumor, has shown promise in improving local tumor control without significant adverse effects. The study found that increasing the margin dose of SRS may lead to better tumor control. However, more research is needed to develop an optimal dosing strategy for SRS in the treatment of SFTs. [Extracted from the article]

This article compares the use of two different embolic agents, Onyx and n-BCA, for preoperative direct puncture embolization (DPE) of juvenile nasopharyngeal angiofibroma (JNA). The study found that both agents were effective in devascularizing JNA and facilitating safe resection with less intraoperative blood loss. However, there are important considerations for each technique, such as the special material properties, injection technique, cost, timing of injection, and consistency of the tumor post-injection. Surgeons should be aware of these differences to make informed decisions for patients with JNA. [Extracted from the article]

Background Surgical treatment of ventral and ventrolateral lesions of the craniocervical junction are among the most challenging neurosurgical pathologies to treat. Three surgical techniques, the far lateral approach (and its variations), the anterolateral approach, and the endoscopic far medial approach can be used to approach and resect lesions in this area. Objective The aim of the study is to examine the surgical anatomy of three skull base approaches to the craniocervical junction and review surgical cases to better understand the indications and possible complications for each of these approaches. Methods Cadaveric dissections with standard microsurgical and endoscopic instruments were performed for each of the three surgical approaches, and key steps and surgically relevant anatomy were documented. Six patients with appropriate pre-, post-, and intraoperative imaging and video documentation are presented and discussed accordingly. Results Based on our institutional experience, all three approaches can be utilized to safely and effectively approach a wide variety of neoplastic and vascular pathology. Unique anatomical characteristics, lesion morphology and size, and tumor biology should all be considered when determining the optimal approach. Conclusion Preoperative assessment of surgical corridors with 3D illustrations helps to define the best surgical corridor. 360 degree knowledge of the anatomy of craniovertebral junction allows safe surgical approach and treatment of ventral and ventrolateral located lesions using one of the three approaches. [ABSTRACT FROM AUTHOR]

Background Endoscopic endonasal skull base reconstructions have been associated with postoperative cerebrospinal fluid (CSF) leaks. Objective A repair protocol for endoscopic endonasal skull base reconstruction is presented with the objective of decreasing the overall leak rate. Methods A total of 180 endoscopic endonasal skull base reconstructions were reviewed. Reconstructions were classified I to IV according to the reconstruction method, determined by severity of intraoperatively encountered CSF leaks for types I to III, and planned preoperatively for type IVs, which required nasoseptal flap. Results A total of 11 patients(6%) had postoperative leaks: 0 in type I (0%), 2 in type II (5%), 7 in type III (18%), and 2 (4%) in type IV reconstruction. Type III leak rate was higher than all other reconstructions. Total 31 intraoperative and 16 postoperative lumbar drains were placed. More patients had lumbar drains placed postoperatively for type III and intraoperatively for type IV than all other groups. There were significant overall differences in postoperative CSF leaks and lumbar drain placement between the four reconstruction types. No patient with type III reconstruction and intraoperative lumbar drain had postoperative CSF leak. Conclusions A repair protocol for endoscopic endonasal reconstructions determined by intraoperative CSF leak and preoperative planning minimizes unnecessary repair materials and additional morbidity. Our experience leads to a routine prophylactic lumbar drain placement in all type III leak and reconstructions. We also favor the type III reconstruction for minor intraoperative leaks, and a more generous use of type IV reconstructions in expectation of significant intraoperative CSF leak. The option of rescue flap technique in type III leaks should be strongly considered. [ABSTRACT FROM AUTHOR]

A 61-year-old male patient presented with recurrent malignant meningioma involving the left optic canal and decreased vision from the left eye. The patient had undergone orbital exenteration on the right 2 years ago. The decision to treat the patient was made based on the significant vision deterioration and rapid tumor growth. Endoscopic transsphenoidal approach considered the most suitable route due to the inferomedial invasion of the optic canal. Gross total removal was achieved and the patient's vision improved postoperatively. The patient developed hydrocephalus 4 weeks postoperatively and cerebrospinal fluid (CSF) leak. Ventriculoperitoneal shunt placement corrected both hydrocephalus and CSF leak. [ABSTRACT FROM AUTHOR]

Tuberculum sella meningioma can be approached by either open or endoscopic approaches. The aim of this video case presentation is to highlight the nuances of the lateral supraorbital craniotomy for tuberculum sella meningioma resection. The authors present a 34-year-old female patient who presented with decreased right eye visual acuity (20/60), afferent pupillary defect, and nasal field cut due to a tuberculum sella meningioma. The tumor was partially encasing the left A1 artery, severely displacing the optic apparatus, and minimally invading the right optic canal. The lateral supraorbital craniotomy was considered the most suitable approach to this tumor. The operative nuances and pitfalls of this approach are detailed in the video. Gross total resection of the tumor was achieved and confirmed with postoperativeMRI. The patient's vision gradually improved and she was discharged on the fourth postoperative day. The minimally invasive lateral supraorbital craniotomy for tuberculum sella meningioma is a suitable approach in selected cases. [ABSTRACT FROM AUTHOR]