Journal of neurosurgery
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Journal of neurosurgery · Aug 2024
Neglected tracts of the brainstem: transverse peduncular tract of Gudden and taenia pontis.
The anatomy and function of the brainstem have fascinated scientists for centuries; however, the brainstem remains one of the least studied regions of the human brain. As the authors delved into studying this structure, they observed a growing tendency to forget or neglect previously identified structures. The aim of this study was to describe two such structures: the transverse peduncular tract, also known as the Gudden tract, and the taenia pontis. The authors analyzed the potential effects of neglecting these structures during brainstem surgery and the implications for clinical practice. ⋯ Recently, with increasing understanding and expertise in brainstem research, surgical approaches to this area have become more common, emphasizing the importance of a detailed knowledge of the brainstem. The two structures mentioned in this paper are described in history books and were widely studied in the 19th century but have not been mentioned in modern literature. The authors propose that a deeper understanding of these structures may prove valuable in neurosurgical practice and help reduce patient comorbidity.
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Journal of neurosurgery · Aug 2024
Clinical evaluation of a stereotactic system for single-stage deep brain stimulation surgery under general anesthesia: technical note.
Conventional frame-based stereotactic systems have circumferential base frames, often necessitating deep brain stimulation (DBS) surgery in two stages: intracranial electrode insertion followed by surgical re-preparation and pulse generator implantation. Some patients do not tolerate awake surgery, underscoring the need for a safe alternative for asleep DBS surgery. A frame-based stereotactic system with a skull-mounted "key" in lieu of a circumferential base frame received US FDA clearance. The authors describe the system's application for single-stage, asleep DBS surgery in 8 patients at their institution and review its workflow and technical considerations. ⋯ The stereotactic system facilitated safe and effective asleep, single-stage DBS surgery, maintaining traditional lead accuracy standards.
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Journal of neurosurgery · Aug 2024
Ventral amygdalofugal pathway as an integrated surgically important network: microsurgical anatomy and segmentation based on fiber dissection.
The ventral amygdalofugal pathway (VAFP) provides afferent and efferent connections to the amygdala and spans along some of the frequently traversed intra-axial surgical corridors as a dominant fiber bundle. This study aimed to reveal the frequently overlooked VAFP fibers by examining their courses and connections to the basal forebrain, septal region, hypothalamus, thalamus, tegmentum, and brainstem. ⋯ This study supports the concept that interconnected forebrain, diencephalic, mesencephalic, and brainstem connections of the VAFP form an integrated surgically important network. The fiber dissection findings also provide the neuroanatomical basis for VAFP segmentation, which may help neurosurgeons better appreciate the complex microsurgical anatomy of the amygdalar connections. Amygdala-substantia innominata and amygdalotegmental connections are demonstrated for the first time and clarified within the structure of the VAFP.
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Journal of neurosurgery · Aug 2024
Letter Historical ArticleLetter to the Editor. The history of the well-traveled aneurysm clips.