Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Preoperative Assessment by Navigated Transcranial Magnetic Stimulation

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 8.1 . Key Concepts Navigated transcranial magnetic stimulation (nTMS) is able to identify cortical function, such as motor and language function, but also other higher functions such as arithmetic processing or facial recognition. nTMS is able to assign function to tractography techniques, which allows adding specific information to this otherwise nonspecific…

Neuroanesthesia: Preoperative Evaluation

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 7.1 . Key Concepts Timely preanesthetic evaluation is critical for safety of perioperative care, optimal resource utilization, improved outcomes, and patient satisfaction for the neurosurgical patient. Effective preanesthetic evaluation obviates unnecessary “medical consultations.” The preanesthesia clinic is a key component of the Perioperative Surgical Home model aimed to make surgical care…

Improving Patient Safety

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 6.1 . Key Concepts Medical errors have a large impact on the field of neurosurgery, affecting quality and cost tremendously. Errors in neurosurgery can lead to preventable and nonpreventable adverse events. A systems approach is critical to improving patient safety in neurosurgery in order to identify deficits in the system, rather…

Precision Medicine in Neurosurgery

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 5.1 . Key Concepts Precision medicine in cancer has led to significant advances in cancer research. As we look to the future, improving technologies for molecular analyses, drug delivery, intraoperative guidance, and others will continue to expand the scope of precision medicine. So far, applications in precision medicine have been limited…

Surgical Anatomy of the Spine

Acknowledgments We would like to express our gratitude to the body donors and their families, who, through their altruism, contributed to making this chapter possible. We thank BodyParts3D© The Database Center for Life Science licensed under CC Attribution-Share Alike 2.1 Japan, for sharing their 3D structure database for anatomic concepts used in Figure 4.1A–D , Figure 4.2A–C , Figure 4.5A–D , and Figure 4.5F and H…

Surgical Anatomy of the Skull Base

Acknowledgments The authors thank the staff of Neuroscience Publications at Barrow Neurological Institute for assistance with manuscript and video preparation. This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 3.1 . Key Concepts Neurosurgical approaches to the skull base complement one another. It is important to understand all possible surgical approaches to key anatomic regions (e.g., petrous apex). We believe…

Surgical Anatomy of the Brain

Key Concepts The CNS consists of the brain and spinal cord. The brain is composed of the cerebrum, brainstem, and cerebellum. The cerebrum consists of two cerebral hemispheres. Each hemisphere presents a central core that is composed of basal ganglia and diencephalon. The basal ganglia consist of a group of telencephalic subcortical nuclei (caudate nucleus, putamen, globus pallidus, subthalamic nucleus, and substantia nigra; the putamen and…

Historical Overview of Neurosurgery

Historical Overview of NeurosurgeryJames Tait Goodrich † and Eugene S. Flamm This chapter includes an accompanying lecture presentation that has been prepared by the author: Video 1.1. This chapter includes an accompanying lecture presentation that has been prepared by the author: Video 1.1 . Key Concepts Examples of neurosurgery as a craft that dealt with injuries to the head can be found in the earliest medical…

Foramen Magnum Meningiomas

Preoperative Considerations Meningiomas accounts for 77% of all non-cancerous intradural, extramedullary tumors of the craniocervical junction. The foramen magnum (FM) region is a complex surgical area. Tumors may develop intradurally or extradurally and may represent a surgical challenge. Several classification systems have been designed to define the surgical preoperative strategy. The most frequently used is that from Bruneau and George, where three main criteria are described…

Vestibular Schwannomas

Preoperative Considerations Vestibular schwannomas (VSs) or acoustic neuromas arise from the Schwann cells forming the sheath (covering) of the vestibulocochlear nerve. Most of these tumors arise from the superior division of the vestibular nerve (located in the internal auditory canal), in proximity to the porus acusticus. Bilateral VSs are pathognomonic of neurofibromatosis type 2. These are heterogeneous tumors with a varying extension pattern, usually causing displacement…

Approaches to the Orbit

The orbit is an area that neurosurgeons may approach for orbital tumors with an intracranial component or as a corridor to access the anterior cranial fossa. Approaches to the orbit can be transorbital (within or through the orbit), endonasal, transcranial or combined approaches. A multidisciplinary team is frequently required, working together with an otorhinolaryngologist and/or ophthalmologist. In this chapter approaches to the orbit and periorbital regions…

Approaches to the Temporal Bone: Basic Principles

In this chapter we will introduce the anatomy and some key steps for the three most relevant approaches to the temporal bone for the neurosurgeon: the subtemporal or middle fossa approach, the translabyrinthine and the transcochlear approach. Middle Fossa or Subtemporal Approach Good for hearing preservation, as it allows direct access to the IAC without the need for a labyrinthectomy. Also, the risk of CSF leaks…

Invasive Pituitary Adenomas

Preoperative Considerations Pituitary adenomas are benign epithelial neoplasms derived from the pituitary glands. In the absence of a macroscopic capsule, those lesions can infiltrate adjacent structures such as the cavernous and sphenoid sinuses, dura and brain parenchyma. These tumors are considered invasive pituitary adenomas. They are characterized by their mass effect on bordering structures such as the optic nerves and chiasm, as well as for their…

Parasellar Tumors

Preoperative Considerations The parasellar region is an extensive area that includes the structures that surround the sella turcica. It includes laterally the dural walls of the cavernous sinus, which is bordered inferiorly by the sphenoid bone, superiorly with the diaphragma sella and the suprasellar subarachnoid spaces containing the optic nerves and chiasm, the circle of Willis, hypothalamus, tuber cinereum and anterior third ventricle ( Figure 33.1…

Sphenoid Wing Meningiomas

Indications and Preoperative Considerations Meningiomas are one of the most frequently occurring intracranial primary tumors. Sphenoid wing meningiomas (SWMs) represent up to 18% of intracranial meningiomas. Those are anatomically located along the sphenoid ridge, the bony crest formed by the greater and lesser sphenoid wings. Medial SWMs are relatively common tumors associated with significant morbidity and mortality, primarily from their anatomic proximity to many critical neurologic…

Midline Anterior Skull Base Meningiomas

Indications and Preoperative Considerations Meningiomas represent 34% of all primary brain tumors, originate from the arachnoid cells in the brain and spine and are histologically non-cancerous lesions. Anterior midline meningiomas can be classified according to their location ( Figure 31.1 ) into three different groups: Olfactory groove meningiomas Planum sphenoidale meningiomas Tuberculum sellae meningiomas. Olfactory groove meningiomas arise from the cribriform plate of the ethmoid bone…

Combined Transmaxillary and Subfrontal Approach

Indications Subfrontal approaches are mainly used to access the floor of the anterior cranial fossa, anterior midline parasellar structures, like the tuberculum sellae, anterior communicating artery, optic chiasm, posterior orbit and orbital apex. The unilateral subfrontal approach can be adequate for most orbital lesions and midline lesions that are largely eccentric towards one side. The bifrontal approach is preferable to treat large or midline lesions because…

Combined Transconjunctival and Endonasal Approach

Introduction Transconjunctival and endonasal approaches provide direct access to the anterior skull base and can be employed in the surgical treatment of various pathologies. The combined transconjunctival and endonasal approach is a two-surgeon/four-handed technique designed to circumferentially access the anterior cranial fossa from both transcranial and transnasal trajectories in a minimally invasive fashion. The combined approach is associated with enhanced visualization, working area and angles of…

Combined Subfrontal and Endonasal Approach

Indications The major advantages of this approach include broad exposure to the anterior cranial base with minimal brain retraction. The approach can facilitate the access to the anterior skull base, especially at the midline, including orbits, planum sphenoidale, sphenoid sinus, sphenoethmoidal and clival regions, as well as to the nasal and paranasal cavities with direct visualization of the adjacent vital structures. This combined approach is very…

Techniques for Skull Base Reconstruction in Endoscopic Surgery

Indications and Preoperative Considerations Postoperative CSF leak is one of the most important complications secondary to endoscopic skull base surgery. Skull base reconstruction techniques have been instrumental for the development of endoscopic skull base surgery. Continuous research has been done during the past decade on new approaches, techniques and materials to improve its clinical results. Currently, the endoscopic endonasal approach is the preferred method for repair…