Search

Objective: The endoscopic endonasal approach (EEA), has become the preferred alternative to traditional open and transoral approaches to the ventral craniovertebral junction (CVJ) region. However, preoperative prediction of the limitations of caudal reach remains challenging. This cadaveric study aimed to quantify the CVJ area of exposure and access afforded by the EEA, evaluate the accuracy of previously described radiographic anthropometric lines, and identify the lowest limit of the EEA corridor. Methods: Endoscopic endonasal dissections of the CVJ were completed in 35 cadaveric specimens. The area of exposure (AoE) and caudal-most reach were measured using a navigation system. Radiographic measurements included the distance of the odontoid process from the hard palate, length of the hard palate, distance of the lowest point reached from the hard palate level, and angles such as the nasopalatine line (NPL) angle, nasoaxial line (NAxL) angle, nostril-hard palate line (NTL) angle, and rhinopalatine line (RPL) angle. Results: The mean CVJ AoE was 931.22 ± 79.36 mm2. The NPL, NAxL, and RPL angles showed significant negative correlations with the distance of the odontoid process from the hard palate line (r = -0.521, p = 0.001; r = -0.538, p = 0.001; r = -0.500, p = 0.002, respectively), while the NTL angle did not (r = -0.241, p = 0.162). No significant correlation was found between achieved AoE via EEA and NPL, NAxL, NTL, or RPL (p > 0.05). Importantly, hard palate length was the sole predictor of CVJ AoE variability (r = -0.416, p = 0.013), with shorter lengths associated with increased exposure. The mean distance of the lowest point reached in the AoE from the hard palate level was 9.47 ± 1.24 mm. Conclusions: This anatomic study highlights the variability in CVJ anatomy and the limitations of using previously defined radiographic anthropometric lines for predicting the caudal limits of the EEA. Hard palate length emerged as the only reliable predictor of the surgical area of exposure via the endonasal corridor. Clinical studies are warranted to validate these findings and define the potential need for adjunctive surgical routes in managing complex CVJ pathologies. [ABSTRACT FROM AUTHOR]

Introduction: Craniopharyngiomas (CPs) are benign and rare tumors found in adults. Their location close to vital neurovascular structures makes traditional treatment modalities (surgery and radiation) challenging and potentially fraught with morbidity. The 2021 WHO classification has divided what was previously considered two subtypes of craniopharyngioma into separate entities. Identification of specific molecular driver mutations in each type- BRAF V600E in papillary craniopharyngiomas (PCP) and CTNNB1 in adamantinomatous craniopharyngiomas (ACP) has resulted in a paradigm shift in the management of adult CPs. Methods: In this study, we describe our experience in treating PCPs with targeted therapy and highlight nuances in management accounting for current evidence. This review also explores the current scope and application of precision oncology in adult CPs including the experience with ongoing trials and prospects for future research. Results: The high prevalence of targetable mutation in cases of PCP and the efficacy of BRAF inhibitors alone or in combination with MEK inhibitors has improved the disease control in these patients. In the current scenario, while surgery is warranted to obtain histopathological diagnosis, radical resection and its associated risks can be avoided. In case of ACPs, dysregulation of multiple pathways has been implicated. This has prompted the use of a variety of targeted therapies with inconsistent outcomes. The results of ongoing and future trials may define its role in management. Conclusion: Precision oncology is a promising addition to the treatment armamentarium of adult CPs. [ABSTRACT FROM AUTHOR]

Byline: Atul. Goel, Sagar. Bhambere, Abhidha. Shah, Hardik. Darji, Chandrima. Biswas, Akshay. Hawaldar Background: A number of complications following surgery aimed at atlantoaxial fixation have been reported. However, there is [...]

This article describes a rare case of trigeminal neuralgia (TN) caused by compression on the trigeminal sensory nucleus and tract by an aberrant dual anastomotic artery loop. The patient, a 74-year-old male, experienced progressive episodic pain in the left forehead, eyelid, cheek, and jaw. Brain MRI revealed compression on the pons near the fourth ventricle caused by the left posterior inferior cerebellar artery (PICA) and an anastomotic loop connecting the anterior inferior cerebellar artery (AICA) and PICA. The patient underwent endoscopic-assisted microvascular decompression (MVD), which successfully relieved the pain. The article discusses the vulnerability of the trigeminal nerve to vascular forces and the effectiveness of MVD in reversing microstructural changes. It also highlights the need for further research on the mechanism and treatment of TN caused by vascular compression. [Extracted from the article]

This article discusses a surgical approach called the Bernard George anterolateral transcervical approach for the treatment of upper anterior cervical spine tumors. The case study presented involves a 67-year-old man with a recurrent C2-3 chordoma. The surgical procedure involved making incisions and dissecting various muscles to access the tumor, which was subsequently resected. An expandable cage was then placed in the tumor cavity. The patient experienced improvement in quadriparesis with no new neurological deficits. The anterolateral transcervical approach provides unique and comprehensive access to the challenging ventral upper cervical region. [Extracted from the article]

Background: Meningiomas are the most frequently diagnosed benign intracranial tumors. However, meningioma en plaque (MEP) is a rare subset accounting for 2.5% of all meningiomas and is characterized by flat, carpetlike proliferation along the dura, typically arising in the spheno-orbital region, and, therefore, causes proptosis, decreased visual acuity, and orbital pain. We present a unique case of a patient with MEP presenting with cerebrospinal fluid (CSF) rhinorrhea and conduct a systematic review of the literature., Methods: Following PRISMA guidelines, a systematic search was conducted in PubMed and Embase databases. Keywords and standardized index terms related to MEP were used. The search was performed without restriction on the publication date. Screening, data extraction, and quality assessment were carried out. Data on demographics, clinical presentations, management modalities, and treatment outcomes were analyzed., Results: The search yielded 487 titles, with 36 studies eligible for inclusion. A total of 530 patients with MEP were reported, with a mean age of 50.1 ± 11.62 years. Proptosis was the most common symptom (95%), followed by visual impairment (57.3%), orbital pain (38.3%), ophthalmoplegia (28.6%), and headache (23%). Our patient represented the only case of a patient with a spontaneous CSF leak. Surgical resection was performed in 85%, adjuvant radiotherapy in 15.7%, and 1 patient received primary radiotherapy, and 8 patients were closely followed up with no intervention., Conclusions: MEP associated with spontaneous CSF rhinorrhea is extremely rare and poses diagnostic and therapeutic challenges. Conservative management for select cases of MEP can be a good choice, sparing the patient from surgical complications, especially for skull base areas that are difficult to access., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)