Delayed hearing loss after microvascular decompression for hemifacial spasm—an unsolved conspiracy of the cochlear apparatus , ,

How I do it: endoscopic supracerebellar infratentorial approach for torcular meningioma removal Abstract Background Torcular meningioma is a rare type of brain tumor with few reports regarding the appropriate resection approach for this disease. In cases without sinus occlusion, surgeons are advised to spare the sinus; however, the sinus may interfere with the visual field. Method Endoscopic supracerebellar infratentorial approach for removal of torcular meningioma was performed in the prone position. The tumor attachment to sinus or confluence was removed or coagulate safely due to an optimal look-up view with the 0° and 30° endoscope. Conclusion Endoscopic supracerebellar infratentorial approach for infratentorial torcular meningioma is a safe and less invasive technique.

The delicate topic of progress

Telemetric home monitoring of intracranial pressure—where are we now

Clipping of a PICA aneurysm located on the contralateral side of its parent vertebral artery in front of the brainstem: how I do it Abstract Background Vertebro-PICA aneurysms may be challenging because of their relationship with the brainstem and the lower cranial nerves, especially when the vertebral artery is tortuous and the aneurysm is located in front of the brainstem, contralaterally to the parent vertebral artery. We describe the surgical technique for safe approach. Method Cadaveric dissection performed by the authors, provided comprehensive understanding of relevant anatomy. Intraoperative photos and videos show clipping of the aneurysm using a combined midline and far-lateral suboccipital craniotomy with a para-condylar extension. The literature reviews potential complications. Conclusion This combined approach allows safe clipping of such PICA aneurysms.

Long-standing tentorial dural arteriovenous fistula presenting as progressively worsening cervical myelopathy by degenerative cervical intervertebral disc: a case report Abstract We report a rare case of long-standing asymptomatic tentorial dural arteriovenous fistula (DAVF) presenting as symptomatic progressive cervical myelopathy which was caused by the protrusion of degenerative cervical intervertebral discs into the spinal canal and compression of the anterior spinal vein. The cervical spinal canal was narrowed, and the spinal cord was compressed anteriorly by protrusion of cervical intervertebral discs at the C6–7 level. The intervertebral discs compressed the draining vein of the tentorial DAVF (the anterior spinal vein) so venous congestion of the spinal cord resulted in cervical myelopathy only above the C6 level.

Supraorbital keyhole approach for suprasellar arachnoid cyst: how I do it Abstract Background Keyhole approaches have lately sparked strong interest because these approaches address skull base pathologies as reported by Eroglu et al. (World Neurosurg, 2019); Hickmann, Gaida, and Reisch (Acta Neurochir (Wien) 159:881–887, 2017); Jallo and Bognar (Neurosurgery, 2006); and Poblete et al. (J Neurosurg 122:1274–1282, 2015), minimizing brain retraction and improving cosmetic results. We describe the step-by-step surgical technique to drain a suprasellar arachnoid cyst by a supraorbital approach. Method The eyebrow incision is a direct route to expose the supraorbital corridor and even if it is smaller than a pterional approach, it permits to open the cisterns and to visualize neurovascular structures. The arachnoid cyst could be safely drained and a T-tube is placed. Conclusion This technique represents a suitable option for suprasellar arachnoid cyst, avoiding more extended and invasive approaches.

Minimal exposure maximal precision ventriculoperitoneal shunt: how I do it Abstract Background Ventriculoperitoneal shunt is among the most frequent neurosurgical procedures, complicated by infection and obstruction. The first is influenced by number of skin incisions, catheter exposure and manipulation, and the latter by catheter position. Method Presenting our neuronavigated laparoscopic-assisted minimal exposure shunt technique performed on 40 consecutive adults. No patient presented infection or distal catheter migration (mean follow-up 12 months). Ventricular catheter malpositioning associated with electromagnetic neuronavigation inaccuracy occurred in two patients with slit ventricles. Conclusion This technique demonstrates low infection/malfunction rate, postoperative pain, and cosmetic advantages. Limiting factors are availability of laparoscopic surgeons and neuronavigation if not familiar with the approach.

Reply to letter “Pituitary tumors and oculomotor cistern”

Letter to the Editor: Pituitary tumors and oculomotor cistern