Clinical Pearls Careful clinical diagnosis is key to appropriately selecting patients who will benefit from surgical treatments for trigeminal neuralgia. During microvascular decompression, the entire cisternal segment of cranial nerve V must be inspected from the brainstem to the entrance…
Clinical Pearls Unlike photons, protons deposit a localized peak of dose known as the Bragg peak. In the absence of exit radiation dose, nearby normal organ structures may be spared dose, which may translate to reduced toxicity (eg, neurocognition, endocrine…
Clinical Pearls Randomized controlled and prospective trials have established a survival advantage and high local control rates after stereotactic radiosurgery for metastatic disease to the CNS, including for up to 10 brain metastases. Matched cohort studies comparing Gamma Knife radiosurgery…
Clinical Pearls Radiation therapy relies on delivering energy to tissues, which ultimately disrupts cellular function through DNA damage. The physics of high-energy photons or charged particles determine the delivery profile of energy and its biologic effects. Historically developed by neurosurgeons,…
Clinical Pearls Progressive deficits of cranial nerves IX, X, and XI associated with pulsatile tinnitus and hearing loss are the most common presenting features of jugular foramen tumors. The differential diagnosis of jugular foramen tumors is highly reliant on magnetic…
Clinical Pearls Become knowledgeable about the equipment and practice on a cadaver or under the guidance of an experienced neuroendoscopist. Orientation and anatomy of the cranial skull base are everything. Absolutely know where you are, what you are looking at,…
Clinical Pearls As a general principle, a skull base approach should provide optimal exposure of the lesion in question without retraction or other injury to normal neurologic structures. Planning an operation for individual skull base tumors involves identifying the anatomic…
Clinical Pearls Intraventricular lesions often present with nonspecific symptoms and clinical signs and can affect patients of all ages. They may grow quite large before the diagnosis is secured. Imaging studies, in concert with a detailed knowledge of the surrounding…
Clinical Pearls It is essential to be knowledgeable about the equipment and practice on a cadaver or to be under the guidance of an experienced neuroendoscopist. Orientation and anatomy are everything. Knowledge of the anatomy will ensure that you know…
Clinical Pearls Pituitary tumors present in various ways as a result of excess or deficient secretion of pituitary hormones or extrinsic compression on the pituitary stalk or adjacent structures. Approximately 75% of pituitary adenomas are functioning tumors; of these, half…