World Neurosurg
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Review Meta Analysis
Anterior and Posterior Ethmoidal Artery Ligation in Anterior Skull Base Meningiomas: A Review on Microsurgical Approaches.
Anterior skull base neoplastic and vascular lesions can receive significant blood supply from the anterior and posterior ethmoidal artery. Although useful in preoperative embolization of middle meningeal artery branches, endovascular techniques for the occlusion of anterior ethmoidal artery expose the parent vessel, the ophthalmic artery, to possible embolic complications, which can cause loss of vision. When dealing with anterior fossa giant meningiomas, moreover, it is not always possible to gain direct intracranial access to anterior ethmoidal arteries because of dimensions and invasiveness of these neoplasms. The aim of this review is to illustrate the anterior and posterior ethmoidal artery anatomy and the microsurgical approaches for extracranial ligation. ⋯ A combination of different surgical and endovascular techniques before resection of hypervascular giant olfactory groove and planum sphenoidale meningiomas should always be considered. Microsurgical extracranial ligation of anterior and sometimes posterior ethmoidal arteries provides a safe and feasible option to limit blood loss during anterior skull base surgery.
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Review Case Reports
Bilateral Choroid Plexus Metastasis from Papillary Thyroid Carcinoma: Case Report and Review of the Literature.
Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. It has an indolent clinical course and favorable prognosis. Brain metastasis is uncommon and complicates about 0.1%-5% of PTCs. Metastasis to the choroid plexus of the lateral ventricles has been reported in 7 cases of thyroid malignancies, all of which were unilateral. ⋯ Metastases to the choroid plexus from extracranial tumors are very rare, with only a few cases reported thus far. A demographic analysis of these cases suggests there may be a tropism of some extracranial carcinomas, such as renal cell carcinoma, for choroid plexus, especially in the lateral ventricles. We report the eighth case of choroid plexus metastasis, but it is the first bilateral one arising from thyroid cancer.
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Most methods currently used to assess surgical skill are rather subjective or not adequate for microneurosurgery. Objective and quantitative microneurosurgical skill assessment systems that are capable of accurate measurements are necessary for the further development of microneurosurgery. ⋯ These results show the potential contribution of the system to microsurgical skill assessment. Quantitative and detailed analysis of surgical tasks helps surgeons better understand the key features of the required skills.
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Brainstem hemangioblastomas (HBs) are considered one of the most challenging lesions in surgical procedures. We present our institutional experience with 116 patients over a period of 20 years in the treatment of HBs. ⋯ Based on our experience, microsurgery is safe and effective, and excellent outcomes can be obtained for cystic or small tumors. We advocate early surgical intervention for sporadic HBs; giant solid HBs remain a challenge, and meticulous microsurgical technique and perioperative management are vital. Long-term monitoring also is recommended.