Percutaneous Fully Endoscopic İnterlaminar Approach to the Filum Terminale: A Cadaveric Study

OBJECTIVE

To investigate the utility, safety, and feasibility of a novel endoscopic technique for the visualization and surgical manipulation of the filum terminale in fresh postmortem adult human cadavers.

METHODS

The filums from 18 fresh postmortem adult human cadavers were explored with a percutaneous fully endoscopic interlaminar approach. After the filum was identified and the nerve roots were dissected away from it, the filum was cut. A specimen was sent for histopathologic examination.

RESULTS

In 15 of 18 (83%) cadavers, the filum terminale could be visualized. A specimen for histopathologic examination was obtained from 11 of 15 (73%) visualized filums. Histopathologic examination revealed that 2 of them were fatty filums, 7 were normal filums, and 2 were peripheral nerves.

CONCLUSIONS

We have described a successful and feasible percutaneous fully endoscopic interlaminar approach to the filum terminale. This technique provides a smaller skin incision, narrow durotomy, and minimal tissue damage. Animal studies are necessary to prove the feasibility and safety of our method before clinical use.

Fully endoscopic supraorbital keyhole approach to the anterior cranial base: A cadaveric study

Introduction:

The supraorbital keyhole approach for anterior cranial base lesions has been increasingly used in clinical practice. Anatomical studies focusing on the endoscopic anatomy via this approach are few, although the microscopic anatomy has been well studied. The aim of this study is to describe the anatomical features and surgical exposure provided by the endoscopic supraorbital keyhole approach using quantitative measurements.

Materials and Methods:

Nine formalin-fixed human cadavers from the inventory of the Anatomy department were used. A total of 18 supraorbital keyhole cranitomies were conducted. The distances between the target anatomical structures and the dura mater at the craniotomy site, and the distances between deep anatomical structures were measured with purpose-designed hooks.

Results:

The distance between the dura mater and optic canal was measured as 69.5 ± 6.7 mm (62–83 mm); optic chiasm as 76.2 ± 5.4 mm (67–86 mm); anterior communicating artery as 82.6 ± 6.1 mm (71–93 mm); internal carotid artery (ICA) bifurcation as 74.7 ± 6.0 mm (66–84 mm) and the basilar tip as 94.9 ± 7.0 mm (87–111 mm). The mean diameter of the optic canal was 7.4 ± 1.3 mm (6–11 mm), whereas the mean diameter of diaphragma sellae was measured as 8.4 ± 1.1 mm (7–10 mm).

Conclusions:

The results of this study showed that the anterior and medial aspects of the anterior cranial fossa can be visualized properly. Dissection of the ipsilateral arteries of Circle of Willis can be performed easily using an endoscopic supraorbital keyhole approach.

[Trigeminal neuralgia and treatment options]

Trigeminal neuralgia is a painful condition of the face characterized by paroxysmal lancinating, shock-like pain confined to the somatosensory distribution of the trigeminal nerve. The etiology of most cases of trigeminal neuralgia has been suggested to be vascular compression of the central axons of the trigeminal nerve at the level of pontocerebellar region, so called hyperactive dysfunctional syndrome. Trigeminal neuralgia is the one of the most known pain syndromes. Several neurosurgical procedures have been developed for the treatment of idiopathic trigeminal neuralgia and in this review, idiopathic trigeminal neuralgia was discussed in aspect of different surgical modalities.

Imaging in tuberculosis of the skull and skull-base: case report

We report a 19-year-old girl, who presented with headache and tonic/clonic seizures. Imaging revealed a lytic parietal skull lesion with an adjacent epidural mass, masses in the right parietal lobe and a posterior skull-base mass. The diagnosis of tuberculosis was made after resection of the extradural mass and later verified with culture of Mycobacterium tuberculosis. The parenchymal and skull-base lesions resolved following antituberculous treatment. We present CT, scintigraphic, angiographic and MRI findings.

Reversal of cerebral vasospasm by the nitric oxide donor SNAP in an experimental model of subarachnoid haemorrhage

The constant release of nitric oxide (NO) is essential to maintain basal cerebrovascular tone. Oxyhaemoglobin, liberated by lysis of red blood cells after subarachnoid haemorrhage binds NO and prevents its entry into vascular smooth muscle cells. While endothelium-dependent vasoconstriction is preserved, decreased levels of NO inhibit endothelium-dependent relaxation and may cause vasospasm. S-nitrosothiols are potent vasodilators and precursors of NO. The authors' aim was to determine whether S-nitroso-N-acetylpenicillamine (SNAP), a stable S-nitrosothiol compound, could reverse vasospasm in an experimental vasospasm model in rabbit. Experimental subarachnoid haemorrhage (SAH) was induced in 37 New Zealand white rabbits. The animals were divided into four groups. Control (no SAH), SAH only, SAH plus saline and SAH plus SNAP. SNAP (15 micrograms/kg/min) or 0.09% saline (equal volume) was infused 46 hours after induction of SAH. All animals were killed by perfusion fixation 48 hours after SAH occurred. Basilar arteries were removed, sectioned and their cross sectional areas were evaluated in a blind manner, by light microscopy and by using computer assisted morphometry. Experimental SAH elicited vasospasm in all animals of SAH only and SAH plus saline group. In animals treated with SNAP, arterial narrowing was markedly attenuated without producing systemic hypotension. This widening achieved statistical significance when compared to the arteries of the SAH only and SAH plus saline group (p < 0.01). This study indicates that the NO donor SNAP is a potentially useful drug to reverse cerebral vasospasm due to SAH.

[Intracerebral solitary plasmacytoma. Apropos of a case possibly induced by head injury]

We report a rare occurrence of an intraparenchymal plasmocytoma. On the past history of a severe head injury twenty years ago and the presence of a porencephalic area on the computerized tomography scan and magnetic resonance imaging we suspected a possible trauma-tumor relation. Accuracy of the histological diagnosis of plasmocytoma was confirmed. The treatment was a surgical excision only, and after a 4.5 years follow-up period, no clinical nor radiographic recurrence was noted.

Three unusual cases of intracranial hydatid cyst in the pediatric age group

Three unusual cases of hydatid disease with central nervous system involvement are reported in the pediatric age group: a 9-year-old boy with a total number of 12 intracranial secondary hydatid cysts; a 13-year-old girl admitted in areflexia who survived after cyst puncture and successive mass removal, and a 14-year-old boy with a huge intracranial hydatid cyst weighing 770 g which was extracted without rupture. The article discusses the surgical problems, and the related literature is reviewed.

The modification of the new type of end-to-side anastomosis between carotid arteries in rats: a technical and scanning electron microscopic study

Modification of a type of end-to-side anastomosis that has been described before is studied. The recipient artery is occluded for only 3-4 minutes to complete the anastomosis by using only the running suture. The anastomotic site was studied by inspection and Scanning Electron Microscope (SEM) at different times after the operation on 30 rats.

A new ventriculocisternal shunt technique in treatment of noncommunicating hydrocephalus: a technical note with a brief discussion of the literature

Ventriculo-cisternostomy is an established procedure for the treatment of noncommunicating hydrocephalus, if the underlying pathology cannot be removed. In cases in which the foramina of Monro and the proximal part of the third ventricle are obstructed, it is not possible to make a communication between the internal and external CSF-spaces by perforation of the floor of the third ventricle, the so-called third ventriculo-cisternostomy. For such cases the authors describe a new method of drainage of both lateral ventricles to the interpeduncular cistern. This new method has been used successfully in a case with obstructive hydrocephalus of both lateral ventricles, caused by a pilocytic astrocytoma of the optic chiasma and hypothalamus with obstruction of both foramina of Monro.

Bromocriptine-induced cerebrospinal fluid fistula in patients with macroprolactinomas: report of three cases and a review of the literature

Bromocriptine therapy for macroprolactinoma induced cerebrospinal fluid (CSF) rhinorrhea in three patients. The tumor had extended well beyond the sella turcica and caused bony erosion in all the cases. All three patients responded to bromocriptine therapy rapidly. CSF fistula occurred concomitantly with the reduction of tumor size and caused meningitis in two of the patients. Withdrawal of bromocriptine resulted in cessation of the leakage. One of the patients underwent transsphenoidal repair. Two patients refused surgery. This potentially lethal complication encountered in these three cases demonstrates the need for close supervision of macroprolactinoma patients with skull base erosion placed under bromocriptine therapy.

Skull base amyloidoma. Case report

A mass lesion of amyloid involving the central nervous system is a rare finding. A 64-year-old woman presented with a large amyloidoma at the skull base causing neural tissue compression. The only accompanying disease was an asymptomatic renal cyst. The mass had caused destruction of the bone elements and pathological calcification as seen on x-ray films, computerized tomography (CT) scans, and magnetic resonance (MR) images, and was enhanced after injection of contrast medium on both CT scans and MR imaging.

Spinal cord compression due to pagetic spinal stenosis with involvement of extradural soft tissues: a case report

Although Paget's disease of the spine may cause neurological dysfunction by bone hypertrophy or collapse, it is very rare for the disease process to extend into the soft tissues of the spinal canal. We report a case of Paget's disease causing ossification of the ligamentum flavum and extradural fat, thus causing spinal cord compression. Decompressive laminectomy was carried out, resulting in neurological improvement. In such cases surgical decompression should be followed by therapy with calcitonin.