Neurosurgery
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Intraoperative localization of cortical areas for motor and language function has been advocated to minimize postoperative neurological deficits. We report herein the results of a retrospective study of cortical mapping and subsequent clinical outcomes in a large series of patients. ⋯ Negative mapping of eloquent areas provides a safe margin for surgical resection with a low incidence of neurological deficits. However, identification of eloquent areas not only failed to eliminate but rather increased the risk of postoperative deficits, likely indicating close proximity of functional cortex to tumor.
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To determine the clinical value of motor functional magnetic resonance imaging (fMRI) in the presurgical evaluation of a large group of children and adolescents with epilepsy caused by lesions close to the central sulcus. ⋯ Motor fMRI can be performed with a high degree of success and good data quality in this population of patients. It has an important additive role in the discussion of the feasibility of resective surgery contributing to the decision-making process for children with epilepsy caused by brain lesions close to the central sulcus.
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We have developed an interactive virtual model of the temporal bone for the training and teaching of cranial base surgery. ⋯ The Virtual Temporal Bone and its surrounding 3-dimensional workspace provide an effective way to study the essential surgical anatomy of this complex region and to teach and train operative strategies, especially when used as an adjunct to cadaver dissections.
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The vidian canal, the conduit through the sphenoid bone for the vidian nerve and artery, has become an important landmark in surgical approaches to the cranial base. The objective of this study was to examine the anatomic features of the vidian canal, nerve, and artery, as well as the clinical implications of our findings. ⋯ The vidian canal and nerve are important landmarks in accessing the anterior genu of the petrous carotid, anteromedial part of the cavernous sinus, and petrous apex.
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In the past 2 decades, various extracranial approaches to the cavernous sinus (CS), using either microscopic or endoscopic techniques, have been described. The aim of this study was to describe the distinctive anatomic features of these approaches and compare their efficacy in exposing the sella and parasellar areas. ⋯ The sublabial transsphenoidal microscopic approach, with its variations, allows the most versatile extracranial microscopic exposure of the sella and CS. The paraseptal, binostril endoscopic approach allows a very good exposure of the CS; the transethmoid-pterygoid-sphenoidal endoscopic approach achieves the best maneuverability in the lateral compartment of the CS.