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Background The aim of our study was a pictorial documentation of the anatomical structures of the orbit. Methods We performed a transmaxillary endoscopic approach in nine formalin-fixed human heads. We identified and documented the anatomy of the inferior part of the orbit. Results The first intraorbital anatomical landmark was the inferior rectus muscle, from which important structures medially and laterally could be identified. Anatomical structures and their relation to each other were documented and presented as illustrative figures. Conclusion Knowledge of the topographic anatomy of the inferior part of the orbit could be sufficiently imparted by our illustrations. The presented transmaxillary approach allowed a wide overview of the anatomical structures located in the inferior part of the orbit. Our pictorial documentation may provide neurosurgeons more safety and the opportunity to become familiar with the endoscopic anatomy.

Background Olfactory groove meningiomas remain surgically challenging. The common microsurgical approaches suffer from late exposure of the neurovascular structures. Conversely, the pterional approach has the advantage of early dissection of the posterior neurovascular complex. Methods We reviewed the records of patients treated for olfactory groove meningioma in our department between 1991 and 2010. A total of 61 patients underwent removal of olfactory groove meningiomas via the pterional approach. These included 58 primary and 3 recurrent tumors. Mean overall follow-up time was 122 months. Results Early exposure and dissection of the internal carotid artery, middle cerebral artery, anterior cerebral artery, and optic nerve was feasible in all cases. Complete tumor removal was achieved in 60 patients. Morbidity and mortality rates were 26% and 1.6% respectively. Postoperative complications included epileptic seizures (five patients) and cerebrospinal fluid (CSF) leak (two patients). During follow-up, we recorded three tumor recurrences. Conclusions The pterional approach appears to be an excellent solution for the treatment of olfactory groove meningiomas. Its foremost advantage is early visualization of the posterior neurovascular complex. Moreover, it allows frontal sinus preservation and timely tumor devascularization and avoids excessive brain retraction. The pterional view is familiar to most neurosurgeons and therefore the transition to this technique is fairly straightforward.

α-Hederin, a natural triterpene saponin and its derivative kalopanaxsaponin I (ksI) exhibit cytotoxicity against various cancer cell lines and IN VIVO tumors. We studied the genetic variants contributing to the activity of these two anticancer compounds. Cell lines derived from 30 trios of European descent (Centre d'Etude du Polymorphisme Human, CEPH; CEU) and 30 trios of African descent (Yoruban, YRI) were used. Cytotoxicity was determined as inhibition of cell growth at increasing concentrations of α-hederin or ksI for 24 h. In comparison to the European, the Yoruban populations revealed a higher sensitivity to α-hederin and to ksI that can be attributed to several unique SNPs. These SNPs are located near 111 and 130 genes in the European and the Yoruban populations, respectively, raising the possibility that some of these genes contribute to the differential sensitivity to these compounds.

Background: In patients after anterior cervical discectomy (ACD) with fusion newly developed retrospondylophytes or incomplete decompression of the nerve root can cause recurrent radicular pain. Anterior cervical uncoforaminotomy (uncoforaminotomy) is an operative method which removes the causative degenerative pathology at the level of the neural foramen leaving untouched the inserted graft at this level. Method: Between February 2004 and April 2005, 7 patients underwent uncoforaminotomy after ACD with fusion for the treatment of recurrent cervical radiculopathy in our neurosurgical department. Prior to treatment patients received a computed tomography (CT) and a neurological examination. Anterior uncoforaminotomy was performed thereafter (for technical details see publication by Jho, 1996). A postoperative CT scan was done before discharge. Follow-up examination was performed eight weeks after surgery. Findings: Five patients underwent the operation at C5/6, one patient was operated at C6/7 and one patient had the operation at two levels (C5/6 and C6/7). At discharge six patients had excellent or good results. Conclusion: Uncoforaminotomy is a good method for the treatment of newly acquired spondylotic spurs in the foramen or incomplete osseous decompression after ACD with fusion and recurrent radicular pain.

Lumbar synovial cysts represent a rare condition, they are believed to arise from defects of the joint capsule due to degeneration, trauma, rheumatoid arthritis or spondylosis. The symptom spectrum ranges from neural claudication to neurological deficits. We report the case of a contralateral asynchronous facet joint cyst after surgical resection and review the literature.

BACKGROUND There is evidence that the infection with human cytomegalovirus is clinically associated with enhanced metastasis and progression of neuroblastoma disease. An in vitro model with HCMV-infected neuroblastoma cells (NB) was used to investigate whether HCMV modulates the metastatic potential of NB. METHODS The neuroblastoma cell line UKF-NB-4 and its productively and persistently HCMV-infected variant UKF-NB-4AD169 were cocultured with human endothelial cells (EC). The rate of NB adherent to the endothelial monolayer and the rate of transmigrating NB was determined by means of combined reflexion interference contrast/phase contrast microscopy. RESULTS UKF-NB-4AD169 adhered to and transmigrated through cocultured EC monolayer to a significantly higher extent compared with the non-infected cell line UKF-NB-4. At the cell-to-cell contact sites between UKF-NB-4AD169 and EC the intercellular endothelial contacts loosened resulting in the formation of reversible focal openings in the monolayer. This phenomenon was not observed with UKF-NB-4. The transendothelial migration rate of UKF-NB-4AD169 was therefore significantly higher than that of UKF-NB-4. The formation of focal openings in the endothelial monolayer and the enhanced transmigration rate of UKF-NB-4AD169 was suppressed in the presence of phenantroline, suggesting that HCMV-induced proteinases might be responsible for this phenomenon. CONCLUSION The results confirm our assumption that HCMV has the ability to modulate functional properties of NB which are essential for the interactions with endothelial cells and thus for metastasation. The clinical relevance of these findings has to be further defined yet by means of prospective studies with HCMV-infected neuroblastoma patients. Proteinase inhibitors could be valuable in the therapeutic treatment of these patients.

In this retrospective investigation 7 patients operated on for recurrent trigeminal neuralgia via a suboccipital enlarged burr hole trepanation were evaluated. The intraoperative findings indicate that neo-compressive effects due to foreign material used during prior surgery are more important than adhesions around the nerve. Furthermore, the results of recurrent operations are encouraging as 6 of the 7 patients were painfree without additional neurological deficits.

Occult sacral meningoceles are a rare causative factor for neural claudication or radiculopathy. Facet joint cysts in the lumbar spine causing similar symptoms are much more frequent. We report the case of a patient with the radiological diagnosis of a facet joint cyst causing neural claudication. During surgery an occult sacral meningocele was diagnosed. In the literature there are only few cases reported. Hence, the findings and important differential diagnoses of cystic epidural lesions in the lumbar spine are discussed.

For neuronavigation in neuroendoscopy conventional navigation systems cannot exclude tissue movements caused by loss of cerebrospinal fluid (CSF). Open MRI can serve as a real-time navigation system if special conditions of endoscopic instruments and equipment are followed. We adapted an endoscopic system to the MRI and installed a miniaturized laser guidance system to project the central transaxial and coronal planes onto the phantom. A human cadaveric model was examined with a flexible microendoscope marked with a titanium wire inside the open magnet. The procedures were guided by gradient echo sequences refreshing the image every 4.5 seconds to control position of the endoscope. Endoscopic and corresponding MRI-findings are presented. Results and technical conditions are discussed.