1,721,024 research outputs found
Telo-velar approach to fourth-ventricle tumours: how I do it
No full textBackground The telo-velar approach is an alternative to cerebellar splitting to gain access to the fourth ventricle through the so-called cerebello-medullary fissure (CMF). Method In this approach, the CMF is exposed and access to the ventricle is obtained by incising the tela chorioidea and inferior medullary velum. This approach enables the explora- tion of the entire ventricle cavity from the obex to the aqueduct. Conclusions The exposure of the fourth ventricle is satisfac- tory and the floor of the fourth ventricle can be visualised early and protected. The extent of resection and outcome are satis- factory in most patients, including those with large tumours or lesions attached to the lateral or superolateral recesses of the ventricle. The deep rostral tumour attachment is the main lim- itation of the telo-velar approac
Transcallosal approach to third ventricle tumors: how I do it
No full textBackground The transcallosal approach provides a direct corridor to the lesions lying in the third ventricle with distinct advantages over alternative routes, such as the pos- sibility to use multiple corridors for tumor resection. Method Here we present a personal perspective of the sur- gery of tumors of the anterior portion of the third ventricle using this approach.
Conclusions This approach requires the ability to move around many neurovascular, cortical, and white matter structures. Knowledge of regional anatomy and adherence to principles of microsurgery are basic requirements to obtain a favorable outcome
Lamina terminalis fenestration
No full textChohan et al.3 (Chohan MO, Carlson AP,
Hart BL, et al: Lack of functional patency of the lamina
terminalis after fenestration following clipping of anterior
circulation aneurysms. Clinical article. J Neurosurg
119:629–633, September 2013). In their study, the authors
injected, on postoperative Day 1 following clipping of
anterior circulation aneurysms, an iodine-based contrast
agent intraventricularly to assess, with CT imaging, the
flow into the basal cisterns through a fenestrated lamina
terminalis. They concluded that fenestration of the lamina
terminalis (FLT) did not result in functional patency of
the lamina terminalis when performed as part of surgical
clipping for ruptured aneurysms.
We have some remarks and criticisms regarding this
article, which leads to clear-cut conclusions
Book Review: Youmans and Winn Neurological Surgery, Seventh Edition, 4-Volume Set
No full textIn reviewing the seventh edition of the Neurological Surgery by
Youmans and Winn, the first question arising is whether we still
need an all-encompassing textbook, an opera omnia, on Neurosurgery.
Ours is an age of specialization and even of ultraspecialization.
Being early addressed to a subspecialty is a today’s general
trend for young neurosurgeons and this is certainly functional to
the rapid gathering of a wealth of experience to ensure optimal
patient outcome. Nevertheless neurosurgeons, especially those
young doctors who did not live in a time when neurosurgeons
were able to deal with most of the neurosurgical diseases, run
the risk of losing a more comprehensive understanding of our
discipline—its great beauty as well as its pitfalls.
The intent of providing an encyclopedic overview of neurological
surgery is clearly stated by the authors, and we recognize
that this textbook is, in its own right, an essential reference guide
to both the experienced and nascent clinician.
The first edition of Neurological Surgery by Julian Youmans
appeared in 1973. Since then on, and for each generation
of neurosurgeons, the “Youmans” represented a comprehensive
textbook highlighting the state of the art of neurosurgery, the
techniques and technology of that generation’s contribution to
neurosurgery. Almost 5 decades have passed from that first
edition, and the textbook has expanded to 415 chapters and 5000
pages. By looking through all the editions, we can understand the
long journey made by our knowledge and the breadth reached by
our current practice of neurosurgery.
The second question concerns what a textbook, with ambition
to be considered the bible of the craft of neurosurgery of
the present and next generation, should communicate. If great
attention should be paid to the rise of the technological aspects on
which our discipline is increasingly dependent, all these innovations
make sense if able to improve patient safety and postoperative
quality of life. To this purpose, this seventh edition
dedicates a good number of pages to relevant, but elsewhere
overlooked, themes such as “Improving patient safety,” “Complication
avoidance in neurosurgery,” or “Coagulation in neurosurgery.”
Also, more traditional issues are discussed under original
and modern perspectives (ie, chapter 24, “Brain Retraction”).
The description of pitfalls and complications is always very
difficult. Summarizing in few pages all the circumstances in
which minimal variations from what we plan may result in
an unexpected event with serious implications on the patient’s
healing perspectives, is a great challenge. Equally complicated
would be trying to describe the emotional consequences that
these events may have in the immediacy and on the subsequent
choices. Can a textbook explain to young neurosurgeons
that mastering surgical techniques is sometimes insufficient and
that our results depend substantially on our decision-making?
Probably no. Nonetheless, Neurological Surgery by Youmans and
Winn makes an attempt to explain to the reader this fundamental
issue of the discipline with its “complication avoidance” sections
and especially with the foreword of Henry Marsh, a wonderful
declaration of love and an epitome of the essence of neurosurgery.
A wide section is dedicated to the surgical anatomy as crafted
by Albert Rhoton and his colleagues. The section is combined
with relevant clinical cases and relative videos that make surgical
anatomy much more intelligible. The majority of chapters also
contain related surgical videos, which are all very well prepared
with a suitable length, correct magnification, and appropriate
commentaries. Even though an increasing number of video collections
and multimedia publications are available on the web,
this selected well-prepared electronic material remarkably helps
the understanding of several neurosurgical procedures. Videos
on perioperative techniques such as patient positioning are also
provided, as well as other supplementing basic sciences and
clinical topics. Great attention is paid by the authors to radiological
anatomy, with introductory overviews of brain and spine
imaging and other relevant techniques for diagnosis contained
within each subspecialty section.Other investigational techniques
and, in particular, those that are ancillary to the surgical procedure
such as neurophysiology and functional neuroimaging are also
described in detail.
Controversies in clinical practice, an issue that is really relevant
in this textbook, are presented very clearly in a dedicated section
and at the beginning of all introductory chapters for each of the
12 sections. These introductory chapters, written by each section
editor, review the contents of the section and provide thoughtful
comments while presenting main controversies on the topic.
The textbook contains interesting incursions in the fields of
neuroanesthesia, neurointensive care, and neurourology. All this
material represents an important contribution that can greatly
help the cultural growth of neurosurgeons. Being able to understand
and even handle anesthesiology techniques is crucial to
recognize the risks of surgery and greatly improve surgical performance.
Similarly, a chapter dedicated to the role of the neurosurgeon
in intensive care reminds us that such medical expertise
is a basic and indispensable requirement.
The textbook also tries to dominate the uncountable
knowledge provided by basic science investigations through some
chapters that address themes of obvious interest. Of course, this is
an overwhelming task and well beyond the purpose of the authors
Espressione del Tumor Necrosis Factor Receptor-Associated Factor 1 e 2 (TRAF 1& 2) e regolazione dell'attivazione di NF-kB TNF-indotta e meccanismi anti-apoptotici nei glomi cerebrali
No full textLinear scalp incision in brain tumor surgery: intra-operative and post-operative considerations
No full textBackground: Although the linear scalp incision is commonly used in neurosurgical practice, a systematic study elucidating its pros and cons in a specific surgical setting is lacking. Herein, we analyzed our experience with linear scalp incision in brain tumor surgery and the impact on intra-operative variables and post-operative complications. Methods: Patients undergoing brain tumor surgery (January 2014-December 2021) at two neurosurgical departments were included and divided into two groups: linear or flap scalp incision. Patients' demographics characteristics, surgical variables and wound related complications were analyzed. Results: Over a total of 1036 craniotomies, linear incision (mean length 6cm) was adopted in 282 procedures (27.2 %). Mean maximum diameter of the craniotomy was 5.25 cm, with no statistical difference between the two groups. In emergency surgery (36 cases), the linear and flap incisions were used indifferently. Linear incision was predominant in supratentorial and suboccipital lesions. Flap incision was significantly more frequent among meningiomas (p<0.01). Neuronavigation, operative microscope, and subgaleal drain were more frequently used in the flap scalp incision group (p=0.01). Overall complication rate was comparable to flap scalp opening (p= 0.40). Conclusions: The use of the linear incision was broadly applied for the removal of supratentorial and suboccipital tumors granting adequate surgical exposure with a low rate of post-operative complications. Tumors skull base localization resulted the only factor hindering the use of the linear incision. The choice of one incision over another didn't show to have any impact on intra- and post-operative variables and it remains mainly based on surgeon expertise/preference
Endoscopic transoral-transclival approach to the brainstem and surrounding cisternal space: Anatomic study
No full textOBJECTIVE: The purpose of this study was to review the endoscopic anatomic features
of the anterior brainstem and surrounding cisternal spaces via a transoral-transclival
approach.
METHODS: Fifteen adult human cadaveric heads, obtained from 10 fresh cadavers
and 5 formalin-fixed cadavers, were used to demonstrate both the feasibility of an
endoscopic transoral-transclival intradural approach and its exposure potential. To
analyze the exact extension of a safe entry zone through the clivus, 20 skull bases were
used to obtain anatomic measurements.
RESULTS: The transoral approach was performed without maxillotomy or mandibulotomy
and with a clival opening of 20 by 15 mm. Such a limited clival and dural
opening allowed the insertion of the endoscope and instruments, full visualization of
the anterolateral brainstem and cisternal spaces around it, and reconstruction of all
anatomic layers by means of a paraendoscopic technique.
CONCLUSION: The endoscopic transoral-transclival approach enables full access to
the anterolateral brainstem and to the cisternal space around it. The use of the
endoscope has the potential to reduce the need for a wider cranial base opening and
the danger of postoperative complications
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