World Neurosurg
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The horizontal fissure of the cerebellum, which is the largest and most prominent fissure, has received less interest from anatomists and neurosurgeons. Hence, the current study aims to provide comprehensive detail about the horizontal fissure and its anatomic and surgical relationship with deeper structures such as the dentate nucleus and middle cerebellar peduncle for the benefit of the neurosurgeon. ⋯ The anatomic measurements and relationships provided in this description of the horizontal fissure will serve as a tool for surgery selection and planning, as well as an aid to improve microneurosurgical techniques, with the final goal being better patient outcomes.
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Case Reports
Endoscopic-Assisted Microsurgical Resection of a Recurrent Conus Medullaris Dermoid Tumor.
Surgery for intramedullary spinal cord tumors presents multiple unique challenges, including the need to operate through a very narrow myelotomy window. In this operative video, we demonstrate the use of the surgical endoscope in an operation performed on a 35-year-old woman. ⋯ After consenting to surgery, she underwent reoperative posterior lumbar approach to resection of her tumor. In our video we demonstrate our use of a surgical endoscope, which allowed us to minimize the extent of our myelotomy and resect tumor rostral and caudal to our myelotomy, thus minimizing the risk of damage to normal spinal cord that is displaced by tumor (Video 1).
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Tension pneumosella has been recognized as a very rare complication of pituitary transsphenoidal surgery. To the best of our knowledge, we report the second case of a pituitary adenoma "pneumo-apoplexy", which is characterized by findings consistent with tension pneumosella in the context of apoplexy of a pituitary adenoma; although it is an extremely rare diagnosis, it should be considered in patients with compatible clinical and radiological findings, particularly with a previous history of transsphenoidal pituitary surgery.
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Surgical approaches to the sellar and parasellar regions are highly challenging due to the densely packed nature of the traversing neurovasculature. The frontotemporal-orbitozygomatic approach offers a wide angle of exposure for the management of lesions involving the cavernous sinus, parasellar region, upper clivus, and adjacent neurovascular structures. ⋯ We provide a stepwise description of how we perform the fronto-orbitozygomatic approach and an associated series of surgical maneuvers and techniques that can be utilized in a variety of anterior and anterolateral approaches, either alone or in combination, to tailor exposure to a given lesion. These techniques are not limited to traditional skull base approaches and represent a valuable addition to every neurosurgeon's armamentarium as enhancements to common surgical approaches.
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"Reverse cortical sign" is a rare entity described in lumbar burst fracture that corresponds to the fracture fragment of the posterior wall of vertebral body, which has rotated 180 degrees with the cortical surface facing anteriorly and the cancellous surface facing posteriorly in the canal. Identifying this sign is crucial in deciding the line of management as it is a contraindication for ligamentotaxis. The advent of computed tomography scans with axial and sagittal reconstruction has allowed us to better describe these rare entities. We present a lumbar burst fracture with a reverse cortical sign describing its appearance in axial computed tomography scans, sagittal reconstruction, and magnetic resonance imaging.