World Neurosurg
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The classic anatomic view of the course of the internal carotid artery (ICA) and its segments familiar to neurosurgeons by a 3-dimensional microscopic cranial view may be challenging to understand when seen in the unique 2-dimensional view of transnasal endoscopic surgery. ⋯ Our classification of the segments of the ICA achieves consistency without sacrificing either clinical or anatomic accuracy for either transcranial or endoscopic approaches. Universal application of this established nomenclature can avoid new and misleading terms, respects anatomical landmarks delineating segments, and provides a universal language for clear communication between disciplines.
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Different surgical approaches have been used over the years in order to access skull base. The endoscopic endonasal approach represents a direct and minimally invasive approach to the suprasellar, retrosellar, and retroclival space, with the advantage of avoid brain retraction and visualize safely and effectively the surgical target. The present contribution aims to provide anatomical details of the skull base as seen from below (i.e., via an endoscopic endonasal approach). ⋯ The development of endoscopic techniques has opened different perspectives over the skull base surgery. Endonasal surgery provides access to a wide range of skull base lesions via a natural surgical corridor (i.e., the nasal cavities).
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Craniopharyngiomas represent one of the major challenges of neurosurgery. Surgical management of craniopharyngiomas classically required various transcranial approaches with the transsphenoidal route reserved for very selected cases. With the widespread use of endoscopes in endonasal surgery in the past decade, the extended endoscopic endonasal transtuberculum and transplanum approaches have been proposed as an alternative surgical route for removal of different types of suprasellar tumors, including solid craniopharyngiomas in patients with normal pituitary function and small sella. ⋯ The endoscopic endonasal approach offers advantages in the management of craniopharyngiomas that historically have been approached via the transsphenoidal route (i.e., purely intrasellar or intra-suprasellar infradiaphragmatic, preferably cystic lesions in patients with panhypopituitarism). Use of the "extended" endoscopic endonasal approach overcomes the limits of the transsphenoidal route to the sella enabling the management of different purely suprasellar and retrosellar cystic/solid craniopharyngiomas, regardless of the sellar size or pituitary function.
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To develop an understanding of the availability of the formal clinical neuro-oncology educational opportunities for medical students. ⋯ Formal clinical neuro-oncology elective opportunities for medical students in the United States and Canada are limited. Additional such opportunities may be of value in the education of medical students.
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Comment Letter
Hemicraniectomy for older patients in low-income countries?