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Nazeri A, Dehkharghanian T, Lindsay KE, LaMontagne P, Shimony JS, Benzinger TL, Sotiras A. The Spatial Patterns and Determinants of Cerebrospinal Fluid Circulation in the Human Brain. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.13.553149. [PMID: 37645835 PMCID: PMC10462043 DOI: 10.1101/2023.08.13.553149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
The circulation of cerebrospinal fluid (CSF) is essential for maintaining brain homeostasis and clearance, and impairments in its flow can lead to various brain disorders. Recent studies have shown that CSF circulation can be interrogated using low b-value diffusion magnetic resonance imaging (low-b dMRI). Nevertheless, the spatial organization of intracranial CSF flow dynamics remains largely elusive. Here, we developed a whole-brain voxel-based analysis framework, termed CSF pseudo-diffusion spatial statistics (C Ψ SS ), to examine CSF mean pseudo-diffusivity (M Ψ ), a measure of CSF flow magnitude derived from low-b dMRI. We showed that intracranial CSF M Ψ demonstrates characteristic covariance patterns by employing seed-based correlation analysis. Importantly, we applied non-negative matrix factorization analysis to further elucidate the covariance patterns of CSF M Ψ in a hypothesis-free, data-driven way. We identified distinct CSF spaces that consistently displayed unique pseudo-diffusion characteristics across multiple imaging datasets. Our study revealed that age, sex, brain atrophy, ventricular anatomy, and cerebral perfusion differentially influence M Ψ across these CSF spaces. Notably, individuals with anomalous CSF flow patterns displayed incidental findings on multimodal neuroradiological examinations. Our work sets forth a new paradigm to study CSF flow, with potential applications in clinical settings.
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Affiliation(s)
- Arash Nazeri
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Kevin E. Lindsay
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Pamela LaMontagne
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua S. Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Tammie L.S. Benzinger
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Aristeidis Sotiras
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Institute of Informatics, Washington University School of Medicine, St. Louis, MO, USA
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Kurucz P, Ganslandt O, Buchfelder M, Barany L. Microsurgical anatomy and pathoanatomy of the outer arachnoid membranes in the cerebellopontine angle: cadaveric and intraoperative observations. Acta Neurochir (Wien) 2023:10.1007/s00701-023-05601-x. [PMID: 37133788 DOI: 10.1007/s00701-023-05601-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/17/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE The cerebellopontine angle (CPA) is a frequent region of skull base pathologies and therefore a target for neurosurgical operations. The outer arachnoid is the key structure to approach the here located lesions. The goal of our study was to describe the microsurgical anatomy of the outer arachnoid of the CPA and its pathoanatomy in case of space-occupying lesions. METHODS Our examinations were performed on 35 fresh human cadaveric specimens. Macroscopic dissections and microsurgical and endoscopic examinations were performed. Retrospective analysis of the video documentations of 35 CPA operations was performed to describe the pathoanatomical behavior of the outer arachnoid. RESULTS The outer arachnoid cover is loosely attached to the inner surface of the dura of the CPA. At the petrosal surface of the cerebellum the pia mater is strongly adhered to the outer arachnoid. At the level of the dural penetration of the cranial nerves, the outer arachnoid forms sheath-like structures around the nerves. In the midline, the outer arachnoid became detached from the pial surface and forms the base of the posterior fossa cisterns. In pathological cases, the outer arachnoid became displaced. The way of displacement depends on the origin of the lesion. The most characteristic patterns of changes of the outer arachnoid were described in case of meningiomas, vestibular schwannomas, and epidermoid cysts of the CPA. CONCLUSION The knowledge of the anatomy of the outer arachnoid of the cerebellopontine region is essential to safely perform microsurgical approaches as well as of dissections during resection of pathological lesions.
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Affiliation(s)
- Peter Kurucz
- Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanalage 60, 91054, Erlangen, Germany.
- Department of Neurosurgery, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany.
| | - Oliver Ganslandt
- Department of Neurosurgery, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanalage 60, 91054, Erlangen, Germany
| | - Laszlo Barany
- Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanalage 60, 91054, Erlangen, Germany
- Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
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Anagnostakou V, Epshtein M, Ughi GJ, King RM, Valavanis A, Puri AS, Gounis MJ. Transvascular in vivo microscopy of the subarachnoid space. J Neurointerv Surg 2022; 14:neurintsurg-2021-018544. [PMID: 35115394 DOI: 10.1136/neurintsurg-2021-018544] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/19/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND The micro-architectonics of the subarachnoid space (SAS) remain partially understood and largely ignored, likely the result of the inability to image these structures in vivo. We explored transvascular imaging with high-frequency optical coherence tomography (HF-OCT) to interrogate the SAS. METHODS In vivo HF-OCT was performed in 10 dogs in both the posterior and anterior cerebral circulations. The conduit vessels used were the basilar, anterior spinal, and middle and anterior cerebral arteries through which the perivascular SAS was imaged. The HF-OCT imaging probe was introduced via a microcatheter and images were acquired using a contrast injection (3.5 mL/s) for blood clearance. Segmentation and three-dimensional rendering of HF-OCT images were performed to study the different configurations and porosity of the subarachnoid trabeculae (SAT) as a function of location. RESULTS Of 13 acquisitions, three were excluded due to suboptimal image quality. Analysis of 15 locations from seven animals was performed showing six distinct configurations of arachnoid structures in the posterior circulation and middle cerebral artery, ranging from minimal presence of SAT to dense networks and membranes. Different locations showed predilection for specific arachnoid morphologies. At the basilar bifurcation, a thick, fenestrated membrane had a unique morphology. SAT average thickness was 100 µm and did not vary significantly based on location. Similarly, the porosity of the SAT averaged 91% and showed low variability. CONCLUSION We have demonstrated the feasibility to image the structures of the SAS with transvascular HF-OCT. Future studies are planned to further map the SAT to increase our understanding of their function and possible impact on neurovascular pathologies.
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Affiliation(s)
- Vania Anagnostakou
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Mark Epshtein
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Giovanni J Ughi
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.,Research and Development, Gentuity LLC, Sudbury, MA, USA
| | - Robert M King
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Antonios Valavanis
- Clinical Neuroscience Center, University Hospital Zurich Department of Neuroradiology, Zurich, ZH, Switzerland
| | - Ajit S Puri
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Matthew J Gounis
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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Lu S, Brusic A, Gaillard F. Arachnoid Membranes: Crawling Back into Radiologic Consciousness. AJNR Am J Neuroradiol 2022; 43:167-175. [PMID: 34711549 PMCID: PMC8985673 DOI: 10.3174/ajnr.a7309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/29/2021] [Indexed: 02/03/2023]
Abstract
The arachnoid membranes are projections of connective tissue in the subarachnoid space that connect the arachnoid mater to the pia mater. These are underappreciated and largely unrecognized by most neuroradiologists despite being found to be increasingly important in the pathogenesis, imaging, and treatment of communicating hydrocephalus. This review aims to provide neuroradiologists with an overview of the history, embryology, histology, anatomy, and normal imaging appearance of these membranes, as well as some examples of their clinical importance.
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Affiliation(s)
- S. Lu
- From the Department of Radiology (S.L., A.B., F.G.), Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - A. Brusic
- From the Department of Radiology (S.L., A.B., F.G.), Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - F. Gaillard
- From the Department of Radiology (S.L., A.B., F.G.), Royal Melbourne Hospital, Parkville, Victoria, Australia,Faculty of Medicine, Dentistry, and Health Sciences (F.G.), University of Melbourne, Parkville, Victoria, Australia
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Arachnoid and dural reflections. HANDBOOK OF CLINICAL NEUROLOGY 2021; 169:17-54. [PMID: 32553288 DOI: 10.1016/b978-0-12-804280-9.00002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The dura mater is the major gateway for accessing most extra-axial lesions and all intra-axial lesions of the central nervous system. It provides a protective barrier against external trauma, infections, and the spread of malignant cells. Knowledge of the anatomical details of dural reflections around various corners of the skull bases provides the neurosurgeon with confidence during transdural approaches. Such knowledge is indispensable for protection of neurovascular structures in the vicinity of these dural reflections. The same concept is applicable to arachnoid folds and reflections during intradural excursions to expose intra- and extra-axial lesions of the brain. Without a detailed understanding of arachnoid membranes and cisterns, the neurosurgeon cannot confidently navigate the deep corridors of the skull base while safely protecting neurovascular structures. This chapter covers the surgical anatomy of dural and arachnoid reflections applicable to microneurosurgical approaches to various regions of the skull base.
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El Refaee E, Elbaroody M. Endoscopic Fenestration of Arachnoid Cysts Through Lateral Pontomesencephalic Membranotomy: Technical Note and Case Series. World Neurosurg 2020; 148:54-64. [PMID: 33385600 DOI: 10.1016/j.wneu.2020.12.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/21/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The ideal treatment method for cranial arachnoid cysts stills controversial, each of endoscopic and microscopic techniques has its pros and cons. METHODS We described cystocisternostomy technique for arachnoid cysts through fenestration medial to the edge of tentorium through lateral pontomesencephalic membrane and illustrated it's outcomes. We performed endoscopic lateral pontomesencephalic membranotomy in nine children with zero angled rigid endoscope (STORZ).The age ranged from eight months up to nine years. The cysts were Galassi type III in eight cases (five of them giant hemispheric) and Galassi type II in one case. Clinical presentations were delay in milestones, seizures, loss of consciousness, unsteady gait, and persistent headache. RESULTS The cysts decreased in size in five cases after three months and nearly disappeared after three and 15 months in two cases, and in 18 months in the other two. Preoperative symptoms improved in all cases. Insignificant subdural hygroma was found in five cases, one case developed hydrocephalus four months later treated with a ventriculoperitoneal shunt; contralateral massive subdural hematoma occurred in one case four months after surgery evacuated with two burr holes with good clinical outcome. There was neither cerebrospinal fluid leakage, cranial nerve palsy nor mortality. CONCLUSIONS The fenestration through the lateral pontomesencephalic membrane created a shortcut of cerebrospinal fluid flow to the basal cisterns especially cerebellopontine cistern and represents a reliable option with an acceptable success rate. It creates a good drainage to the large cysts.
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Affiliation(s)
- Ehab El Refaee
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt; Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Mohammad Elbaroody
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Li X, Zhang S, Song YQ, Tan H, Hui XH. Anti-P0 Antibody-Conjugated Nanoscale Contrast Agent Targeting the Myelin Sheath for Intraoperative Visible Delineation of Cranial Nerves. ACS Biomater Sci Eng 2020; 6:1744-1754. [PMID: 33455377 DOI: 10.1021/acsbiomaterials.9b01444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The preservation of cranial nerves is a major problem that surgeons encounter when resecting a tumor in the posterior cranial fossa. Most cranial nerve injuries occur because the tight adhesion between the tumor capsule and cranial nerves renders the nerves indistinguishable. In this study, a nerve-specific nanoscale contrast agent was developed for visually distinguishing cranial nerves from the tumor surface in real time. To enable the contrast agent to specifically bind peripheral nerves, a previously reported biodegradable multiblock polyurethane nanoparticle (BMPU NP) was conjugated with an antibody against myelin protein zero (MPZ, P0), which is expressed on myelin sheaths in peripheral nerve fibers. Coomassie brilliant blue G (CB) was encapsulated into the BMPU NP for visual contrast. The CB-BMPU NP specifically stained mouse peripheral nerve fibers blue when directly applied to the nerve surface ex vivo and in vivo. The CB-BMPU NP also achieved satisfactory visual contrast of the trigeminal nerve in a mouse nerve-tissue adhesion model. This study offers new insights for the development of intraoperatively applied nerve-specific contrast agents for delineating cranial nerves adhered to tumors.
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Affiliation(s)
- Xiang Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Si Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Yuan-Qing Song
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, People's Republic of China
| | - Hong Tan
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, People's Republic of China
| | - Xu-Hui Hui
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
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Kurucz P, Meszaros C, Ganslandt O, Buchfelder M, Barany L. The "Valva Cerebri": Morphometry, Topographic Anatomy and Histology of the Rhomboid Membrane at the Craniocervical Junction. Clin Anat 2019; 33:56-65. [PMID: 31444925 DOI: 10.1002/ca.23460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 08/19/2019] [Indexed: 11/09/2022]
Abstract
The arachnoid membranes' anatomy is a controversial topic in the literature, and the rhomboid membrane at the craniovertebral junction is an element of this system that has been described poorly. Hence, the objective of our study was to examine this membrane's anatomy and histology. A total of 45 fresh formalin-fixed human cadaveric heads were examined, and anatomic dissections and histologic examinations using standard staining methods were performed. The membrane was found to be a constant structure. It has a rhomboid shape and is located on the medulla oblongata and upper cervical spine's ventral surface within the subarachnoid space. Its average craniocaudal length is 49 mm and the short axis is 26 mm. The cranial apex is attached to the vertebral arteries' junction, and the caudal apex reaches the level of C4. The lateral apices are attached to the dura mater at the level of the denticulate ligament's second insertion. The C1 spinal nerves perforate the membrane, while the C2 roots are located dorsal to it. The membrane is attached strongly to the underlying pia mater. Histologically, it has a typical arachnoid structure, in which its adhesions to the vertebral arteries as well as to the pia mater could be verified histologically. This is the first detailed examination of the rhomboid membrane. Our results suggest that the membrane serves a valve-like function between the spinal and cranial subarachnoid spaces. Based on our findings, further hydrodynamic studies should clarify the membrane's physiological role. Clin. Anat. 32:56-65, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Peter Kurucz
- Department of Neurosurgery, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany.,Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Cintia Meszaros
- Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
| | - Oliver Ganslandt
- Department of Neurosurgery, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Laszlo Barany
- Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
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Kurucz P, Ganslandt O, Buchfelder M, Barany L. Arachnoid Membranes Around the Cisternal Segment of the Trigeminal Nerve: A Cadaveric Anatomic Study and Intraoperative Observations During Minimally Invasive Microvascular Decompression Surgery. World Neurosurg 2019; 125:e262-e272. [DOI: 10.1016/j.wneu.2019.01.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/03/2019] [Accepted: 01/05/2019] [Indexed: 10/27/2022]
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10
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Kurucz P, Barany L, Buchfelder M, Ganslandt O. The Clival Line as an Important Arachnoid Landmark During Endoscopic Third Ventriculostomy: An Anatomic Study. World Neurosurg 2018; 120:e877-e888. [DOI: 10.1016/j.wneu.2018.08.180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 08/22/2018] [Accepted: 08/23/2018] [Indexed: 11/24/2022]
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The trigeminal root: an anatomical study using magnetic resonance imaging. Surg Radiol Anat 2018; 40:1397-1403. [PMID: 30218149 DOI: 10.1007/s00276-018-2106-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
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Kurucz P, Ganslandt O. Letter to the Editor Regarding "Anatomic Dissection of Arachnoid Membranes Encircling the Pituitary Stalk on Fresh Non-Formalin-Fixed Specimens: Anatomoradiologic Correlations and Clinical Applications in Craniopharyngioma Surgery". World Neurosurg 2017; 109:505-506. [PMID: 29232813 DOI: 10.1016/j.wneu.2017.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Peter Kurucz
- Department of Neurosurery, Klinikum Stuttgart, Stuttgart, Germany.
| | - Oliver Ganslandt
- Department of Neurosurery, Klinikum Stuttgart, Stuttgart, Germany
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Pile driving into the skull and suspending the bridging veins? An undescribed role of arachnoid granulations. Surg Radiol Anat 2016; 39:541-545. [DOI: 10.1007/s00276-016-1745-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/08/2016] [Indexed: 10/21/2022]
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Florian IS, Ungureanu G, Florian A. The role of the basal cisterns in the development of posterior fossa skull base meningiomas. ROMANIAN NEUROSURGERY 2016. [DOI: 10.1515/romneu-2016-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Meningiomas account for more than 30% of all intracranial brain tumors, with 25% of them originating somewhere along the skull base and about 20% of these located in the posterior fossa. The intimate relation of these tumors with neural and vascular structures make them difficult to treat, both surgically and nonsurgically. Their treatment is further hampered by the lack of definitive recommendations, which is partially due to the fact that there is no general accepted model of classification. The present report proposes a new concept of classification of posterior fossa skull base meningiomas, one that takes into account the intimate relation of these tumors with arachnoid structures, simplifies the overcrowded landscape of their systematization and can be extended to oher skull base locations.
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Abstract
This brief history of topographical anatomy begins with Egyptian medical papyri and the works known collectively as the Greco-Arabian canon, the time line then moves on to the excitement of discovery that characterised the Renaissance, the increasing regulatory and legislative frameworks introduced in the 18th and 19th centuries, and ends with a consideration of the impact of technology that epitomises the period from the late 19th century to the present day. This paper is based on a lecture I gave at the Winter Meeting of the Anatomical Society in Cambridge in December 2015, when I was awarded the Anatomical Society Medal.
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