Acta neurochirurgica
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Acta neurochirurgica · Apr 2012
ReviewThe subdiaphragmatic cistern: historic and radioanatomic findings.
In the past, sporadic demonstrations of the existence of a subarachnoid subdiaphragmatic cistern have been published. The aim of this study was to evaluate the anatomical characteristics of the subdiaphragmatic cistern of the pituitary gland. ⋯ We confirmed the existence of the subdiaphragmatic cistern. The overused term "suprasellar cistern" refers more to a complex of cisterns, formed by the subdiaphragmatic cistern, below the diaphragma sella, and by the chiasmatic cistern, above it, in direct communication with the lamina terminalis and carotid cisterns.
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Acta neurochirurgica · Apr 2012
ReviewThe challenge to remove diffuse low-grade gliomas while preserving brain functions.
WHO grade II glioma, i.e. diffuse low-grade glioma, is a pre-malignant tumour, usually revealed by seizures in young patients with a normal life. This tumour has a constant growth, and will inescapably become anaplastic. Surgical resection significantly increases the overall survival by delaying the malignant transformation. ⋯ These recent technical and conceptual advances in the hodotopical and plastic view of brain processing have allowed a dramatic improvement of the benefit-to-risk ratio of surgery, concerning both oncological and functional outcomes. In summary, it is time to move towards "functional neurooncology" and "preventive neurosurgery" in low-grade gliomas. Stronger interactions with fundamental neurosciences should be developed, in order (1) to build updated models of cognition and brain plasticity; (2) to elaborate biomathematical models of low-grade glioma growth and migration; (3) to study in silico the dynamic interactions between the natural course of this disease and the adaptative behaviour of its host (the brain), with the goal to adapt the best individualised therapeutic strategy.
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Acta neurochirurgica · Dec 2011
ReviewInfundibulo-tuberal or not strictly intraventricular craniopharyngioma: evidence for a major topographical category.
This study investigates retrospectively the clinical, neuroradiological, pathological and surgical evidence verifying the infundibulo-tuberal topography for craniopharyngiomas (CPs). Infundibulo-tuberal CPs represent a surgical challenge due to their close anatomical relationships with the hypothalamus. An accurate definition of this topographical category is essential in order to prevent any undue injury to vital diencephalic centres. ⋯ Infundibulo-tuberal CPs represent a major topographical category of lesions with a primary subpial development at the floor of the third ventricle. These lesions expand within the hypothalamus itself and subsequently occupy the third ventricle; consequently, they can be classified as not strictly intraventricular CPs. A tight attachment to the hypothalamus and remnants of the third ventricle floor is the pathological landmark of infundibulo-tuberal CPs.
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Acta neurochirurgica · Dec 2011
ReviewExpanding applications of deep brain stimulation: a potential therapeutic role in obesity and addiction management.
The indications for deep brain stimulation (DBS) are expanding, and the feasibility and efficacy of this surgical procedure in various neurologic and neuropsychiatric disorders continue to be tested. This review attempts to provide background and rationale for applying this therapeutic option to obesity and addiction. We review neural targets currently under clinical investigation for DBS—the hypothalamus and nucleus accumbens—in conditions such as cluster headache and obsessive-compulsive disorder. These brain regions have also been strongly implicated in obesity and addiction. These disorders are frequently refractory, with very high rates of weight regain or relapse, respectively, despite the best available treatments. ⋯ Well-designed pilot studies and clinical trials enrolling carefully selected patients with obesity or addiction should be initiated.
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Acta neurochirurgica · Oct 2011
ReviewThe fully endoscopic supraorbital trans-eyebrow keyhole approach to the anterior and middle skull base.
The purely endoscopic eyebrow supraorbital approach is an alternative to both the endoscopic endonasal and eyebrow microsurgical routes to the anterior and middle cranial base. It combines an enhanced visualization provided by the endoscope and the absence of cerebrospinal fluid (CSF) leaks and nasal complications. ⋯ The purely endoscopic eyebrow supraorbital keyhole approach is a valuable and alternative minimally invasive route to anterior and middle skull base lesions.