Journal of neurosurgery
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Journal of neurosurgery · Apr 2008
Case ReportsExpanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas: a new classification based on the infundibulum.
Craniopharyngiomas are notoriously difficult to treat. Surgeons must weigh the risks of aggressive resection against the long-term challenges of recurrence. Because of their parasellar location, often extending well beyond the sella, these tumors challenge vision and pituitary and hypothalamic function. New techniques are needed to improve outcomes in patients with these tumors while decreasing treatment morbidity. An endoscopic expanded endonasal approach (EEA) is one such technique that warrants understanding and evaluation. The authors explain the techniques and approach used for the endoscopic endonasal resection of suprasellar craniopharyngiomas and introduce a tumor classification scheme. ⋯ The endoscopic EEA requires a thorough understanding of both sinus and skull base anatomy. Moreover, in its application for craniopharyngiomas, an understanding of tumor growth and extension with respect to the optic chiasm and infundibulum is critical to safely approach the lesion via an endonasal route.
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Journal of neurosurgery · Apr 2008
Biography Historical ArticlePioneering Turkish neurosurgeon Hami Dilek and the traces of Harvey Cushing's legacy in his work.
Hami Dilek trained in neurosurgery under Clovis Vincent and Thierry de Martel, pioneers of French neurosurgery who ranked among Harvey Cushing's most loyal admirers. Taking cues from Cushing and the giants of French neurosurgery, Dilek became the first surgeon to practice neurosurgery regularly in Turkey during the 1930s. In 1949, Dilek founded the first independent Turkish department of neurosurgery in Istanbul, and in 1951 he initiated resident training in neurosurgery. ⋯ Also, they both single-handedly developed a new specialty where one did not exist before. Further similarities between Dilek and Cushing are also revealed in Dilek's delightful surgical and anatomical drawings. Dilek played an important role in the establishment and development of modern Turkish neurosurgery, and his life story highlights the fact that Cushing's legacy strongly influenced Turkish neurosurgery in the first half of the 20th century.
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Journal of neurosurgery · Apr 2008
Intraoperative acquisition of three-dimensional imaging for frameless stereotactic guidance during transsphenoidal pituitary surgery using the Arcadis Orbic System.
Intraoperative fluoroscopy has long been used for anatomical localization in transsphenoidal pituitary surgery. More recently, frameless stereotaxy has been used to supplement 2D sagittal radiographs with 3D multiplanar reconstructions. Use of Arcadis Orbic allows both conventional fluoroscopic views and multiplanar reconstructions to be acquired intraoperatively without need for preoperative planning studies. The authors report their initial experience using Arcadis Orbic during transsphenoidal pituitary surgery. ⋯ Arcadis Orbic provides excellent quality 2- and 3D images during transsphenoidal pituitary surgery, and intraoperative frameless navigation using these images is highly accurate. Arcadis Orbic is easy to use, even in patients with large body habitus, and image acquisition takes no longer than registration during a frameless stereotactic case. Based upon our preliminary experience, Arcadis Orbic precludes the need for preoperative CT studies in patients with pituitary lesions requiring frameless stereotactic navigation.