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Letter to the Editor Regarding “Exposure of the Cavernous Sinus via the Endoscopic Transorbital and Endoscopic Endonasal Approaches: A Comparative Study”
No full textAnatomy of the Trochlear Nerve
No full textKnowledge of detailed anatomy of the skull base has allowed considerable progress and advances in surgical techniques. Knowledge of dural, bony, and neurovascular spatial relationships of the trochlear nerve has played a critical role in preventing complications during complex microsurgical and endoscope-assisted transcranial and endoscopic endonasal approaches to the supracerebellar region and middle cranial fossae, and to cavernous sinus, parasellar, and orbital regions. The trochlear nerve is long and thin, and the diplopia caused by its lesion due to imprudent surgical maneuvers can have tremendous effects on the patient. The anatomy of the trochlear nerve has been assessed and examined along its entire course from the midbrain to the orbit, in order to perform a classification, anatomically and clinically oriented, of its segments. The nerve has been divided into five segments according to the areas where it is located: cisternal, tentorial, cavernous, fissural, and orbital
Contralateral transmaxillary approaches: the Caldwell-Luc approach revival for ventral skull base surgery
No full textSurgical risk of CSF leakage following endoscopic transorbital approach for anterior and middle skull base pathologies: a systematic review and meta-analysis
No full textThe endoscopic superior eyelid transorbital approach (SETOA) has demonstrated considerable versatility and effectiveness in managing various paramedian anterior and middle skull base pathologies. However, as with any relatively new technique, potential complications remain. We conducted an extensive literature search in MEDLINE and Embase in accordance with PRISMA guidelines including case reports and surgical series reporting cerebrospinal fluid (CSF) leak rate following SETOA for intracranial pathologies. Factors analyzed included lesion location (extra- or intra-axial), reconstruction techniques, and complication management. ROBINS-I tool was employed to assess the risk of bias. Twenty-five studies including 240 cases were eligible. The majority of lesions were intradural extra-axial (68.3%), while trigeminal schwannomas comprised all extradural cases (25.0%). Sixteen patients (6.6%) presented intradural intra-axial tumors. Osteodural reconstruction involved dural substitutes in one third of the cases (32.5%) either alone (14.2%) or combined with fat free graft (18.3%). CSF leak occurred in 6 patients (2.50%), mostly resolving via conservative management (66.6%). The risk of postoperative CSF leak was found to be significantly higher in patients undergoing resection for intra-axial tumors (OR 0.13, 95% CI: 0.04-0.49) compared to those undergoing resection for extra-axial (OR 0.01, 95% CI: 0.00-0.02; I2 = 0%; p < 0.001). Key limitations include the retrospective nature and small sample sizes among included studies as well as data heterogeneity and lack of standardized protocols for reconstruction across studies. SETOA appears safe for addressing selected extradural and intradural skull base pathologies with a low postoperative CSF leak rate. The natural repositioning of the orbital content to its original position may be instrumental in preventing its postoperative occurrence. The investigation followed a prespecified protocol registered on PROSPERO (PROSPERO 2024 CRD42024614111)
Endoscopic Transorbital Resection of Temporal Pole Cavernoma: 2-Dimensional Operative Video
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Endoscopic endonasal control of the paraclival internal carotid artery by Fogarty balloon catheter inflation: An anatomical study
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Neuroanatomical photogrammetric models using smartphones: a comparison of apps
No full textObjectives: A deep knowledge of the surgical anatomy of the target area is mandatory for a successful operative procedure. For this purpose, over the years, many teaching and learning methods have been described, from the most ancient cadaveric dissection to the most recent virtual reality, each with their respective pros and cons. Photogrammetry, an emergent technique, allows for the creation of three-dimensional (3D) models and reconstructions. Thanks to the spreading of photogrammetry nowadays it is possible to generate these models using professional software or even smartphone apps. This study aims to compare the neuroanatomical photogrammetric models generated by the two most utilized smartphone applications in this domain, Metascan and 3D-Scanner, through quantitative analysis. Methods: Two human head specimens (four sides) were examined. Anatomical dissection was segmented into five stages to systematically expose well-defined structures. After each stage, a photogrammetric model was generated using two prominent smartphone applications. These models were then subjected to both quantitative and qualitative analysis, with a specific focus on comparing the mesh density as a measure of model resolution and accuracy. Appropriate consent was obtained for the publication of the cadaver's image. Results: The quantitative analysis revealed that the models generated by Metascan app consistently demonstrated superior mesh density compared to those from 3D-Scanner, indicating a higher level of detail and potential for precise anatomical representation. Conclusion: Enabling depth perception, capturing high-quality images, offering flexibility in viewpoints: photogrammetry provides researchers with unprecedented opportunities to explore and understand the intricate and magnificent structure of the brain. However, it is of paramount importance to develop and apply rigorous quality control systems to ensure data integrity and reliability of findings in neurological research. This study has demonstrated the superiority of Metascan in processing photogrammetric models for neuroanatomical studies
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