Anterior Petrosectomy vs. Retrosigmoid Approach-Surgical Anatomy and Navigation-Augmented Morphometric Analysis: A Comparative Study in Cadaveric Laboratory Setting.

Background: Different lateral and postero-lateral cranial approaches to the petroclival region and to the mid-upper brain stem have been described so far, some of which require extensive osseous demolition and possible damage of neurovascular structures. Neuronavigational systems are now extensively available for preoperative planning and intraoperative navigation to assist the surgeons in choosing the optimally invasive approach for each pathology. Herein, we describe a detailed navigation-augmented morphometric analysis to bring insight into the usefulness of an anterior petrosectomy (AP) to handle lesions in the petroclival region.

Complications in Neuroendoscopy.

Neuroendoscopy complications can be divided into three categories: vascular, neural, and technical failures. Moreover, cognitive sequelae can be considered as delayed complications of neuroendoscopic surgery. The purpose of this manuscript is to report the experiences published in the current literature in order to identify the causes of complications in neuroendoscopy and methods to manage and avoid them.

Supraorbital Keyhole Versus Pterional Approach: A Morphometric Anatomical Study.

Objective: Although the supraorbital (SO) keyhole approach has a wide range of indications, its routine usefulness with the advance of current technology has not been fully evaluated. In an attempt to address this issue, a cadaveric morphometric analysis to the supra- and parasellar regions was performed, comparing the standard Pterional craniotomy (PT) with the SO keyhole.

Methods: ETOH-fixed and silicone-injected human cadaveric heads were used.

Anatomical Assessment of the Endoscopic Assisted Lateral Supraorbital Approach and Endoscopic Endonasal Transclival Approach to Basilar Apex Aneurysms.

Aim: To assess the feasibility of using an endoscopic-assisted lateral supraorbital (LSO) approach and an endoscopic endonasal transclival approach (EETA) for basilar apex (BAX) aneurysms.

Material And Methods: Ten cases with LSO approaches, with or without posterior clinoidectomy and endoscopic assistance, and 10 cases with EETA, with or without drilling of the dorsum sellae, were performed on 20 cadaveric heads. Anatomical exposure and surgical freedom at the BAX were evaluated.

Non-Compressive, Disabling, Cervical Radiculopathy and Neck Pain: Cave Osteoid Osteoma.

Cervical radiculopathy is a common clinical condition with an annual incidence of 85/10,000. Refractory cases with positive disco-vertebral imaging findings are routinely referred to the Neurosurgeon for evaluation and treatment. In the absence of a clearcut compressive etiology, other rarer but surgically curable causes must be considered before recommending conservative management.

Common Practice in the Management of Dural Closure: An Italian Questionnaire.

Objective: The optimal management of dural closure is unclear; therefore, we aimed to survey current common practices among Italian practitioners.

Methods: The Delphi method was used to achieve a consensus on dura mater closing techniques in Italy. A steering committee decided 3 major topics to be investigated: pre- and postoperative conditions associated with cerebrospinal fluid (CSF) leak, indications to perform watertight dural closure, and dural closure technique.

Tailoring Endoscopic Approach to Colloid Cysts of the Third Ventricle: A Multicenter Experience.

Background: Endoscopic removal of third ventricular colloid cysts has grown in popularity. The biggest issues concern radicality, cure or at least long-term control of the disease, and endoscopic remnants. Technologic advances in instrumentation and introduction of novel tools have greatly improved endoscopic results.

Secondary coiling after incomplete surgical clipping of cerebral aneurysms: a rescue strategy or a treatment option for complex cases? Institutional series and systematic review.

Residual and recurrent intracranial aneurysms after surgical clipping present a persistent risk of bleeding. Secondary coiling after incomplete clipping represents a strategy to occlude the residual sac: feasibility, bleeding risk and outcome were evaluated through a systematic review of literature along with the series of two tertiary referral neurovascular centres. Demographics, ruptured status, aneurysm morphology, topography, exclusion at surgery, timing of secondary coiling, complications, occlusion rate and outcome were analysed.

Pretreatment with endothelium-derived nitric oxide synthesis modulators on gastrointestinal microcirculation during NOTES: an experimental study.

Background And Study Aims: On-demand endoscopic insufflation during natural orifice transluminal endoscopic surgery (NOTES) adversely affects microcirculatory blood flow (MBF), even with low mean intra-abdominal pressure, suggesting that shear stress caused by time-varying flow fluctuations has a great impact on microcirculation. As shear stress is inversely related to vascular diameter, nitric oxide (NO) production acts as a brake to vasoconstriction.

Objective: To assess whether pretreatment by NO synthesis modulators protects gastrointestinal MBF during transgastric peritoneoscopy.

Position statement from the Italian Society of Neurosurgery on the ARUBA Study.

As the conclusions of the ARUBA Study are strongly oriented towards therapeutic abstention, we think it is appropriate to express the concern of the Italian Society of Neurosurgery for the impact that this study might have on the health of patients, if not properly evaluated. The vast majority of patients (76-81%) included in the study was treated with endovascular or radiotherapy treatments, alone or in combination. Only 18 patients (19%) had surgery.

Intraoperative ultrasound: a review on its role in liver surgery for primitive and metastatic tumors.

Intra-operative ultrasound is an invaluable tool in hepatic surgery, either for restaging either as a guidance during resection of liver neoplasms. Nowadays, intraoperative ultrasound is still considered the most accurate diagnostic technique for detecting focal liver lesions in both hepatocellular carcinoma and colorectal liver metastases, which represent the most frequent indication for liver resection. Moreover, the use of ultrasound guidance is mandatory for planning the surgical strategy, deciding the exact resection plane and during the parenchymal transection, in order to respect the surrounding vessels and biliary structures.

Effect of transgastric natural orifice transluminal endoscopic surgery peritoneoscopy on abdominal organ microcirculation: an experimental controlled study.

Background And Aims: On-demand insufflation during endoscopic peritoneoscopy causes wide variations in intra-abdominal pressure. Its effects on splanchnic microcirculation may differ from those of steady intra-abdominal pressure, because pressure characteristics affect crucial intravascular hemodynamic forces--pressure and shear--adapting flow to local metabolic needs. Our aim was to assess the effect of natural orifice transluminal endoscopic surgery (NOTES) peritoneoscopy on splanchnic microcirculatory blood flow.

Endoscopic Approaches to Intraventricular Lesions.

Background: Endoscopy is becoming increasingly popular for the neurosurgical management of intraventricular lesions and has recently been accepted as an effective alternative approach to open surgery. The deep location of intraventricular lesions makes the microsurgical approach difficult. Moreover, many intraventricular tumors do not require aggressive neurosurgical treatment.

Incidental papillary thyroid carcinoma: diagnostic findings in a series of 287 carcinomas.

The recent increase in the detection of papillary thyroid carcinoma (PTC) has been influenced by the finding of incidental tumours. To this group, carcinomas measuring less than 1 cm (the so-called microcarcinomas) as well as those above 1 cm belong. Analyzing a case series from our own experience, this paper focuses on the current pre-operative diagnostic challenges that can lead to PTC incidental discovery.

Neuroendoscopic options in the treatment of mesencephalic expanding cysts: report of four cases and review of the literature.

Objective: Mesencephalic expanding cysts, also called lacunae, are rare intraparenchymal, multilobulated cavities of variable diameter mostly localized in the thalamo-mesencephalic region. In symptomatic cases, usually presenting with hydrocephalus or midbrain syndrome, surgical treatment is required and, considering their position, a minimally invasive approach should be preferred.

Methods: Four cases of expanding mesencephalic cysts endoscopically treated in three different Italian centers are described.

Evaluation of helical tomotherapy in the treatment of high-grade gliomas near critical structures.

Background: Our purpose was to investigate the role of helical tomotherapy using a simultaneous integrated boost technique for the treatment of high-grade gliomas near intracranial critical structures.

Methods And Materials: Of 27 patients treated with helical tomotherapy, 11 were eligible. Only patients whose tumors were within 0.

Supraorbital endoscopic approach to colloid cysts.

Background: Surgical approaches to colloid cysts of the third ventricle have evolved over time. In recent years, endoscopy has been recognized as an effective alternative to open surgery. The disadvantage of endoscopic treatment is the difficulty in controlling the adhesion of the cyst to the roof of the third ventricle and in obtaining complete removal of the cyst.

Bleeding from duodenal ulcer in a patient with bilio-pancreatic diversion.

Scopinaro's bilio-pancreatic diversion is considered as an acceptable malabsorptive surgical approach for the treatment of morbid obesity. We describe a case of acute recurrent gastro-intestinal bleeding in a patient with a previous Scopinaro's bilio-pancreatic diversion. At the first admission in our department, gastroscopy, colonoscopy, contrast-enhanced computerized tomography and angiography resulted negative for active bleeding.

Revisional surgery after sleeve gastrectomy.

Introduction: Worldwide, morbid obesity incidence has increased dramatically in the last decade and surgery is at this moment recognized as the only effective treatment with long-term sustained weight loss and resolution or significant improvement in comorbidities. Laparoscopic sleeve gastrectomy (LSG) was successfully carried out by several groups as a bridge to future laparoscopic bariatric procedures with acceptable weight loss and reduction in comorbidities. LSG is considered a safe procedure with sporadically reported complications, such as bleeding or leakage from the staple line, strictures, delayed gastric emptying, gastric dilatation and vomiting.

Energy-based hemostatic devices in laparoscopic adrenalectomy.

Purpose: In literature, few papers compare different hemostatic devices in laparoscopic adrenalectomy. This sequential cohort study analyzes the outcomes of laparoscopic adrenalectomy performed by different hemostatic instruments, to evaluate if any of them has any advantage over the other and as secondary endpoints, the impact of body mass index (BMI) and tumor size on the indication, and the outcome of laparoscopic adrenalectomy.

Methods: Forty-six patients, aged 54.

Application of neuroendoscopy to intraventricular lesions.

We present an overview of the history, development, technological advancements, current application, and future trends of cranial endoscopy. Neuroendoscopy provides a safe and effective management modality for the treatment of a variety of intracranial disorders, either tumoral or non-tumoral, congenital, developmental, and degenerative, and its knowledge, indications, and limits are fundamental for the armamentarium of the modern neurosurgeon.

Purely neuroendoscopic transventricular management of cystic craniopharyngiomas.

Introduction: This paper reports our series of cystic craniopharyngiomas treated using a purely neuroendoscopic approach.

Methods: Drainage and wide marsupialization into CSF spaces (cysto-ventriculo-cisternostomy) were achieved to ensure mass effect control, continuous dilution, and reabsorption of the cyst's fluid. A steerable, flexible neuroendoscope and a pre-coronal approach were used in 7 patients harboring intra/paraventricular cysts (4 primary and 3 recurrent).