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Byline: Arvind. Singh, Biren. Patel, Hirisave. Darshan, Binu. Anand, Ajit. Singh, Harshvardhan. Biradar, Tobin. George, Harihara. Easwer, Prakash. Nair Background: The petroclival area is a technically challenging region to operate [...]

Brain tumor surgery has grown exponentially in the last century, aided by sophistication, globalization, and training initiatives. With progress in cerebral localization, antisepsis, anesthesia, and hemostasis, brain surgery took off in a cautious manner and soon gained momentum. The earliest brain tumor surgery based on cerebral localization dates back to the 19th century and is older than imaging techniques such as X-rays, computed tomography, or magnetic resonance imaging scans. In India, formal neurosurgery started in the post independence era in 1949 at CMC, Vellore and Chennai. With over 2000 practicing neurosurgeons today, India has contributed immensely to global advancements in brain tumor care. The advent of microneurosurgery in the late 60s has been a landmark in the history of brain tumor surgery, advancing safety profiles and elevating outcomes. Further on, advances in brain tumor imaging, surgical gadgetry (neuronavigation and intraoperative imaging), adjuvant therapy, and molecular tumor profiling have improved prognosis and survival. We examine the rich legacy of brain tumor surgery from a global and Indian perspective with five epochs of historical development – premodern (before 1879), incubational (1879–1919), modern (1919–1967), microsurgical (1967–1999), and new millennial (2000 onward). Several path-breaking advancements and an exciting future await brain tumor surgery, translating into superior surgical outcomes and quality of life.

Objectives: This study quantifies hallucal metatarsal (Mt1) and second metatarsal (Mt2) polar second moment of areas (J) in hominoids and cercopithecoids to address three questions. Which catarrhines have more rigid Mt1s versus Mt2s? Is asymmetry in medial metatarsal rigidity (e.g., Mt1 > Mt2) different among taxa? Does asymmetry in medial metatarsal rigidity correlate with relative intrinsic hallucal muscle mass across species. Materials and Methods: J was calculated from CT images in 345 specimens and compared between groups: Pan, Gorilla, Pongo, hylobatids, cercopithecines, and colobines. Differences between the Mt1 and Mt2 within groups were assessed using paired t tests. Log10‐transformed Mt1:Mt2 J ratios were used to assess asymmetry in rigidity and inter‐group comparisons were made. Additionally, correlations were performed between species means of log10‐transformed Mt1:Mt2 J ratios and species means of relative intrinsic hallucal muscle mass. Results: African ape and hylobatid Mt1s are significantly more rigid than their Mt2s. Rigidity in medial metatarsals are more variable in Pongo, but most individuals have stronger Mt2s. Greatest variation is observed in cercopithecoids, with some species having consistently stronger Mt1s or Mt2s, but the majority show no bias for either. Log10‐transformed Mt1:Mt2 J ratios are significantly correlated with relative intrinsic hallucal muscle mass; taxa with more rigid Mt1s have more developed muscle. Discussion: Differences between metatarsals in rigidity do not correlate with previously documented regional differences in peak plantar pressure during weight support. Rather, asymmetry in metatarsal rigidity, specifically Mt1 > Mt2, reflect adaptations of larger intrinsic hallucal musculature capable of producing greater hallucal grasping force. [ABSTRACT FROM AUTHOR]

This article, published in the Journal of Neurological Surgery, introduces a new technique for subtemporal anterior petrosectomy, a complex neurosurgical procedure. The technique involves using microscopic real-time near-infrared indocyanine (NIR-ICG) fluorescence and white light overlay to enhance the visualization of critical vascular structures during surgery. The authors describe their experience integrating this technique and discuss its feasibility and benefits, including improved precision and safety. They suggest that further investigation is needed to determine the widespread adoption of this technique in complex neurosurgical procedures. [Extracted from the article]

This article discusses the use of machine learning and artificial intelligence in predicting the extent of resection in giant pituitary adenomas (GPAs). GPAs are challenging to manage surgically, and achieving gross total resection is crucial for improving patient outcomes. Machine learning algorithms can analyze various factors, such as tumor size, invasiveness, and clinical symptoms, to predict surgical outcomes. The study conducted a retrospective analysis of GPA surgeries and developed a predictive model using machine learning algorithms to accurately determine the extent of resection. The authors believe that this model can be valuable for patient-tailored care and counseling. [Extracted from the article]

This article, titled "Prognostic Considerations and Assessment of Visual Outcomes in a Population-Based Cohort of Macro- and Giant Prolactinomas," explores the visual outcomes in patients with prolactinomas, a type of sellar mass that can compress the optic chiasm. The study retrospectively analyzed 99 prolactinoma patients treated at Emory University between 2000 and 2001, focusing on factors such as serum prolactin levels, tumor dimensions, and visual impairment scores. The preliminary results suggest that there is a significant relationship between prolactinoma features and visual dysfunction before and after treatment. Further analysis will be conducted to assess the utility of visual impairment measures and compare the impact of surgery versus medical therapy on visual impairment scores. [Extracted from the article]

This article, titled "Endoscopic versus Open Surgical Pathway Seeding of Skull Base Chordoma," explores the occurrence of surgical pathway recurrence in patients with skull base chordoma who undergo either endoscopic or open surgical approaches. The study conducted a systematic review of the literature and found that fewer cases of surgical seeding occurred after endoscopic resection compared to open procedures. The most common primary location for seeding was the clivus, and the mean time to seeding was shorter for endoscopic approaches compared to open procedures. The article suggests that clean oncologic technique may help limit tumor seeding, but further research is needed to establish the effectiveness of preventive measures. [Extracted from the article]

This article, titled "Clinical Management of Adult Optic Nerve Glioma: A Systematic Review," explores the management and prognosis of optic nerve glioma in adult patients. Optic nerve glioma is typically found in children and has a good prognosis with timely treatment. However, in adults, these tumors can be aggressive and lead to vision deterioration. The study found that there is a lack of specific guidelines for managing optic nerve glioma in adults. The article includes information on patient and tumor-related factors, such as misdiagnosis and common symptoms, as well as the use of surgical intervention, chemotherapy, and radiotherapy. The authors emphasize the importance of appropriate and timely management to improve patient outcomes. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, explores the palato-sphenoidal canal (PSC) as a potential surgical landmark in endonasal endoscopic procedures. The study describes the anatomical relationship of the PSC with adjacent landmarks, such as the vidian canal, vomer, and foramen rotundum, using stereotactic navigation-guided measurements. The authors also introduce a novel "palatosphenoidal canal-foramen rotundum (PSC-FR) line" that can be used intraoperatively to access the foramen rotundum and the petrous apex region with minimal dissection of surrounding tissue. The study provides measurements and step-by-step endoscopic dissection techniques, supported by high-quality images. [Extracted from the article]

This article discusses a new surgical approach called the biportal endoscopic transorbital and transmaxillary transsphenoidal (bpTONES-EATT) approach, which aims to address lesions in the spheno-orbital and middle cranial fossa regions. The study conducted ex vivo experiments using cadaveric specimens and radiological records to assess the feasibility of this approach compared to the traditional uniportal EATT approach. The results showed that the biportal approach provided adequate exposure of the targeted regions while minimizing tissue injury and morbidity. However, further clinical studies are needed to validate its safety and efficacy. [Extracted from the article]

This article explores the use of endoscopic techniques in the treatment of intracranial tumors that invade the upper parapharyngeal space (PPS). The study compares the additional upper parapharyngeal exposure achieved through biportal endoscopic endonasal transpterygoid and endoscopic transmaxillary approaches to the standard endoscopic transsphenoidal approach. The researchers used cadaveric specimens and radiological records to measure linear trajectories, areas of exposure, angles of attack, and surgical corridor volumes. The results suggest that the biportal approach may provide sufficient surgical exposure without significant additional morbidity, but further clinical investigations are needed to confirm these findings. [Extracted from the article]

Split cord malformations are disorders of gastrulation. Disorders of secondary neurulation occur later and are traditionally considered separate from the former. Complex split cord malformations involving both the cord and the conus and encompassing the epochs of gastrulation, primary neurulation, junctional neurulation, and secondary neurulation have not been described in literature. We present a four-year-old boy with such a malformation and postulate the embryological mechanism involved. The clinical vignette of this unique case has been described. We report a good clinical outcome in this patient with surgical management. [ABSTRACT FROM AUTHOR]

This is a surgical video of an EEA odontoidectomy and pannus resection in a 68-year-old female with of progressive motor deficits and PMH of rheumatoid arthritis. MRI showed severe ventral brainstem compression and spine image showed cranio-cervical instability. She underwent a two-stage surgery, an EEA odontoidectomy, and pannus resection that is depicted on the video followed by a posterior cervical fusion.By Erion J. de Andrade; Kody Bolk; Biren Patel; Leonardo Tariciotti; Arturo Solares; Tomas Garzon-Muvdi and Gustavo PradillaReported by Author; Author; Author; Author; Author; Author; Author [Extracted from the article]

This article, titled "Combined Single- Or Two-Stage Anterolateral Transcranial and Endoscopic Approaches to Address Spheno-Petroclival Tumors: A Systematic Review," discusses the challenges and complications associated with the surgical resection of extensive petroclival lesions. The authors conducted a systematic review of the literature to analyze the rate of complications after the resection of these tumors using combined microscopic and endoscopic approaches. The study found that implementing these combined approaches can increase resection rates and improve overall outcomes, providing survival benefits and potentially delaying adjuvant treatments in certain cases. The article is authored by Leonardo Tariciotti, Justin Maldonado, Biren Patel, Samir Lohana, Alejandra Rodas Calderon, J. Manuel Revuelta Barbero, Erion Jr De Andrade, Youssed M. Zohdy, C. Arturo Solares, Tomas Garzon-Muvdi, and Gustavo Pradilla. [Extracted from the article]

This article, titled "Intracranial Extra-Axial Tumors Invading the Extracranial Parapharyngeal Space (PPS): A Systematic Review," provides a comprehensive review of the clinical presentation, radiological features, operative techniques, and postoperative morbidity of intracranial brain tumors that invade the parapharyngeal space (PPS). The authors conducted a systematic review and meta-analysis of the current literature to gather information on peri-operative complications, such as cranial nerve palsies, vascular injury, CSF leakage, infections, mortality rate, and extent of resection. The article concludes that the involvement of PPS by intracranial neoplasms is rare, and limited data is available on this condition. The authors provide a detailed summary of presenting symptoms and management options, as well as discuss the surgical implications and morbidity burden of addressing neoplasms in the PPS. [Extracted from the article]

This article discusses the extreme lateral infrajugular transcondylar (ELITE) approach, specifically focusing on its dorsolateral variant. The ELITE approach provides a surgical corridor to access complex neurosurgical lesions involving various structures such as the jugular foramen, hypoglossal canal, foramen magnum, vertebral and posteroinferior cerebellar artery, medulla oblongata, brainstem, and cranial nerves V to XII. The study aims to provide a step-by-step dissection of the dorsolateral ELITE approach using cadaveric specimens, with the goal of enhancing understanding and proficiency among future neurosurgeons. The article emphasizes the importance of familiarizing oneself with this approach and its anatomical relationships. [Extracted from the article]

This article compares two variations of the extreme lateral infrajugular transcondylar (ELITE) approach, the anterolateral (Al-ELITE) and dorsolateral (Dl-ELITE) approaches, for surgical access to various pathologies involving the skull base. The study conducted dissections on cadaveric specimens and found that both approaches involve similar steps, but the Al-ELITE approach provides a larger surgical exposure area and is better suited for certain types of lesions. The article emphasizes the importance of understanding the anatomical aspects and differences between these approaches in order to select the appropriate surgical approach for each case. [Extracted from the article]

Byline: Biren. Patel, H. Darshan, Anand. Binu, H. Easwer, Prakash. Nair Background: Complex craniopharyngiomas pose a significant surgical challenge owing to its proximity to critical structures and its intrinsic nature [...]