The interpositional bypass with a parietal branch of superficial temporal artery graft for symptomatic atherosclerotic anterior cerebral artery stenosis or occlusion.

Background: For nonmoyamoya patients with anterior cerebral artery (ACA) stenosis or occlusion, whether direct revascularization of the ACA territory can prevent stroke is still unclear. The objective of this study was to investigate the efficacy and safety of a parietal branch of superficial temporal artery-interposed superficial temporal artery-to-ACA bypass (PISAB) for preventing stroke in patients with symptomatic atherosclerotic ACA stenosis or occlusion (SAASO). Methods: We retrospectively analyzed the data from patients with SAASO who had undergone PISAB in our center between April 2016 and November 2021. The rates of patency, satisfaction (revascularization grades A and B) of bypass, perioperative complications, recurrence of ischemic stroke, changes in bypass flow, and improvements in cerebral blood perfusion were analyzed. Results: A total of 19 SAASO patients were involved in this study. Sixteen out of 19 (84.2%) patients were free from any cerebral ischemic events after surgery. Only 3 patients (15.8%) had recurrent stroke postoperatively. Two (10.5%) surgery-related complications occurred, including hyperperfusion syndrome and minor stroke. No skin ischemic complications occurred. The average follow-up period was 50.6 ± 18.3 months. The flow rate of the bypass was significantly increased half a year after surgery (56.2 ± 8.0 mL/min vs. 44.3 ± 5.3 mL/min, p < 0.001). The ratio of ipsilateral/contralateral mean transit time in the superior frontal gyrus was decreased significantly after bypass (1.08 ± 0.07 vs. 1.23 ± 0.05, p < 0.001) and continued to decrease 6 months after surgery (1.05 ± 0.04 vs. 1.08 ± 0.07, p = 0.002). The patency rate of PISAB was 94.7% (18/19) 2 years after surgery. The satisfaction rate of bypass was 89.5% (17/19). Conclusion: The results of this study indicate that PISAB, as a safe superficial bypass, can effectively reduce the risk of stroke in SAASO patients. More precise conclusions will require randomized control studies.

Nomogram to Predict the Outcome of Ventriculoperitoneal Shunt Among Patients with Non-HIV Cryptococcal Meningitis.

BACKGROUND: The ventriculoperitoneal (VP) shunt is widely acknowledged as a treatment option for managing intracranial hypertension resulting from non-human immunodeficiency virus (HIV) cryptococcal meningitis (CM). Nonetheless, there is currently no consensus on the appropriate surgical indications for this procedure. Therefore, it is crucial to conduct a preoperative evaluation of patient characteristics and predict the outcome of the VP shunt to guide clinical treatment effectively. METHODS: A retrospective analysis was conducted on data from 85 patients with non-HIV CM who underwent VP shunt surgery at our hospital. The analysis involved studying demographic data, preoperative clinical manifestations, cerebrospinal fluid (CSF) characteristics, and surgical outcomes and comparisons between before and after surgery. A nomogram was developed and evaluated. RESULTS: The therapy outcomes of 71 patients improved, whereas 14 cases had worse outcomes. Age, preoperative cryptococcus count, and preoperative CSF protein levels were found to influence the surgical outcome. The nomogram exhibited exceptional predictive performance (area under the curve = 0.896, 95% confidence interval: 0.8292-0.9635). Internal validation confirmed the nomogram's excellent predictive capabilities. Moreover, decision curve analysis demonstrated the nomogram's practical clinical utility. CONCLUSIONS: The surgical outcome of VP shunt procedures patients with non-HIV CM was associated with age, preoperative cryptococcal count, and preoperative CSF protein levels. We developed a nomogram that can be used to predict surgical outcomes in patients with non-HIV CM.

Comparison Between the Efficacy of a Flow Diverter and Interventional Trapping with Bypass in the Treatment of Unruptured Large- or Giant-Sized ICA Aneurysms.

OBJECTIVE: Management of large- or giant-sized internal carotid artery aneurysms (LICAAs) remains challenging. Whether a flow diverter device (FDD) or interventional trapping with extracranial-intracranial bypass (ITB) is better, remains unclear. METHODS: We conducted a multicenter retrospective analysis of unruptured LICAA patients treated with FDD or ITB at 3 medical centers. Both the effectiveness and safety results of FDD and ITB were compared. RESULTS: In total, 101 aneurysms in 95 patients treated with FDDs and 36 aneurysms in 36 patients managed with ITBs were included (September 2014-June 2021). There was no significant difference between the groups in the complete obliteration rate 1 year after surgery (P = 0.101). There were 2 relapse cases (2.0%) and 4 retreated cases (4.0%) in the FDD group and 1 relapse case (2.8%) and 2 retreated cases (5.6%) in the ITB group. Neither the relapse rates nor retreat rates between groups were significantly different. The neurological morbidity rates were 4.0% (4/101) and 2.8% (1/36) in the FDD group and ITB group, respectively, and were not significantly different. There was 1 mortality case in each group, and the mortality rates were not significantly different (P = 0.443). Both the perioperative and overall (perioperative plus long-term) complication rates in the FDD group were significantly lower than those in the ITB group (P = 0.033, P = 0.039). CONCLUSIONS: FDD had comparable surgical efficacy and a significantly lower postoperative complication rate to traditional ITB. FDD might be preferable to ITB as a treatment modality for LICAA.

A New Concept for Primary Reconstruction of Skull Defects with 3D-Molded PEEK Patch Assisted by Navigation Based on Animal Study.

AIM: To perform an accurate primary repair of temporal bone defects. MATERIAL AND METHODS: The temporal bone defect models were performed in beagles. Extended estimated patches of the defects were predesigned by 3D reconstruction software and molded from polyether ether ketone (PEEK) using a lathe. The precise trimming of the extended PEEK patches was established via coordinate transformation of the patches between the navigation system and the reconstruction software, and in real-time tracing via intraoperative navigation. Trimmed PEEK patches were embedded onto the defects. Blood tests and image examinations were conducted postoperatively. RESULTS: The extended PEEK patches were prepared precisely according to the predesign. Real-time tracing of the actual skull defect profile was performed quickly and accurately. Trimmed skull patches perfectly matched the shape of the defects. No signs of infection, absorption, or translocation of the patches occurred postoperatively, and little epidural effusion was found. CONCLUSION: With the assistance of navigation and 3D reconstruction technology, customized molded PEEK patches can be used for accurate primary repair of temporal bone defects.

Three-Dimensional Point Cloud Segmentation Algorithm Based on Depth Camera for Large Size Model Point Cloud Unsupervised Class Segmentation.

This paper proposes a 3D point cloud segmentation algorithm based on a depth camera for large-scale model point cloud unsupervised class segmentation. The algorithm utilizes depth information obtained from a depth camera and a voxelization technique to reduce the size of the point cloud, and then uses clustering methods to segment the voxels based on their density and distance to the camera. Experimental results show that the proposed algorithm achieves high segmentation accuracy and fast segmentation speed on various large-scale model point clouds. Compared with recent similar works, the algorithm demonstrates superior performance in terms of accuracy metrics, with an average Intersection over Union (IoU) of 90.2% on our own benchmark dataset.

Hypertriglyceridemia is associated with stroke after non-cardiac, non-neurological surgery in the older patients: A nested case-control study.

Introduction: Geriatric postoperative stroke is a rare but serious complication after surgery. The association between hypertriglyceridemia and postoperative stroke remains controversial, especially in older patients undergoing non-cardiac, non-neurological surgery. The study aims to address this clinical dilemma. Materials and methods: We conducted a nested case-control study among 9601 aged patients undergoing non-cardiac non-neurological surgery from October 2015 to 2021. A total of 22 positive cases were matched for the surgical type and time, to 88 control patients by a ratio of 1:4. The effect of hypertriglyceridemia on the occurrence of postoperative stroke within 30 days after surgery was estimated using conditional logistic regression analysis by adjusting to various potential confounders. Results: A total of 22 cases developed ischemia stroke after surgery, and compared with the non-stroke group, they had more postoperative ICU admission, longer postoperative hospitalization and higher total cost (all p < 0.05), and more patients were presenting with preoperative hypertriglyceridemia [8 (36.4%) vs. 15 (17.0%), p = 0.045]. There was a significant association between hypertriglyceridemia and postoperative stroke, with adjusted odds ratios of 6.618 (95% CI 1.286, 34.064) (p = 0.024). The above results remained robust in the sensitivity analyses. Conclusion: Among older patients undergoing non-cardiac and non-neurological surgery, hypertriglyceridemia was associated with significant increased risk of postoperative stroke.

Multimodal Recanalization for Subacute Symptomatic Internal Carotid Artery Occlusion Due to Atherosclerosis: Outcomes and Notes on Hybrid Techniques.

BACKGROUND: Subacute internal carotid artery occlusion (ICAO) is associated with ipsilateral recurrent stroke, and successful recanalization of ICAO can improve cerebral blood perfusion (CBP) and prevent stroke. However, the optimal treatment remains controversial. METHODS: We conducted a retrospective analysis of patients with subacute symptomatic ICAO due to atherosclerosis treated at our center. The hybrid surgical procedures included carotid endarterectomy, Fogarty balloon catheter embolectomy, aspiration thrombectomy, and percutaneous transluminal angioplasty/stenting. Recanalization rates, CBP improvement, stroke recurrence, and restenosis/reocclusion were investigated. RESULTS: Fourteen symptomatic atherosclerotic ICAO patients (type A, 4; type C, 10; men, 11; women, 3; average age, 68.1 ± 7.9 years) in the subacute phase were treated with a multimodal recanalization technique. Symptoms included mild cerebral infarction, transient ischemic attack (TIA), and amaurosis fugax. The average onset-to-treatment time was 18.1 ± 4.8 days. The successful recanalization (thrombolysis in cerebral ischemia grade 2 or 3) rate was 100%. The ipsilateral-to-contralateral mean transit time ratio was significantly lower at the 1-year follow-up than preoperatively (1.01 ± 0.05 vs. 1.26 ± 0.09, P < 0.0001). There was one case of restenosis detected 1 year after surgery and no cases of reocclusion. During the 28.3 ± 10.0 months of follow-up, only two cases of TIA occurred. The average modified Rankin Scale score and National Institute of Health Stroke Scale score were significantly lower at the most recent follow-up than before recanalization (1.21 ± 0.89 vs. 1.86 ± 0.66, P = 0.0003; 1.36 ± 1.55 vs. 2.00 ± 1.88, P = 0.0066). CONCLUSIONS: Multimodal recanalization techniques performed in a hybrid operation theater can safely achieve high recanalization rates in atherosclerotic ICAO patients in the subacute phase, which can be beneficial for recovering CBP and preventing stroke.

Method for measuring the center of mass and moment of inertia of a model using 3D point clouds.

We propose a method for measuring the center of mass and moment of inertia of a model using 3D point clouds. First, we use point cloud registration and segmentation to obtain point clouds of model parts with different material densities. Then, we correct the point cloud coordinates by principal component analysis, and we perform 2.5D volume calculations in three directions. Finally, we input the material density for each model part, perform point cloud reconstruction, and calculate the center of mass and moment of inertia. In experiments, we measured the center of mass and moment of inertia simultaneously by using multiple time-of-flight cameras. The results demonstrated that the proposed method accurately measured the center of mass and moment of inertia with errors of <1m m and <3%, respectively. This is a promising approach for automatically measuring models of aircraft, cars, etc.

Sinusoidal Phase-Modulated Angle Interferometer for Angular Vibration Measurement.

Primary angular vibration calibration devices based on laser interferometers play a crucial role in evaluating the dynamic performance of inertial sensing devices. Here, we propose a sinusoidal phase-modulated angle interferometer (SPMAI) to realize angular vibration measurements over a frequency range of 1-1000 Hz, in which the sinusoidal measurement retro-reflector (SMR) and the phase generation carrier (PGC) demodulation algorithm are adopted to track the dynamic angle variation. A comprehensive theoretical analysis is presented to reveal the relationship between demodulation performance of the SPMAI and several factors, such as phase modulation depth, carrier phase delay and sampling frequency. Both the simulated and experimental results demonstrate that the proposed SPMAI can achieve an angular vibration measurement with amplitude of sub-arcsecond under given parameters. Using the proposed SPMAI, the frequency bandwidth of an interferometric fiber-optic gyroscope (IFOG) is successfully determined to be 848 Hz.

LINC01116 boosts the progression of pituitary adenoma via regulating miR-744-5p/HOXB8 pathway.

Pituitary adenoma (PA) is one of the common intracranial tumors. In order to optimize status quo, seeking out potential biomarkers for pituitary adenoma diagnosis and treatment is urgent and important. Long non-coding RNAs (lncRNAs) have been related with progression of various cancers. Based on this reason and unknown role of long intergenic non-protein coding RNA 1116 (LINC01116) in pituitary adenoma, we aimed to explore the function and molecular mechanism of LINC01116 in pituitary adenoma. The RT-qPCR analysis showed that LINC01116 was abnormally overexpressed in pituitary adenoma cells. Down-regulated LINC01116 effectively suppressed cell proliferation and migration as well as epithelial-mesenchymal transition (EMT) progression in pituitary adenoma. Additionally, LINC01116 could competitively sponge miR-744-5p as shown by RIP, RNA pull down and luciferase reporter assays. Similarly, we also proved that homeobox B8 (HOXB8) was the target gene of miR-744-5p in pituitary adenoma cells. In the end, the rescue assays unmasked that HOXB8 could effectually reverse inhibition effect of LINC016 knockdown on pituitary adenoma cells proliferation, migration and EMT, further suggesting that LINC01116 expedited the pituitary adenoma progression by up-regulating HOXB8. Taken together, LINC01116 boosted the progression of pituitary adenoma cells via regulating miR-744-5p/HOXB8 pathway.

Modified homodyne laser interferometer based on phase modulation for simultaneously measuring displacement and angle.

Many researchers from scientific and industrial fields have devoted their efforts to the laser interferometer, aiming to improve the measurement accuracy and extend the practical applications. Here, we present a modified homodyne laser interferometer based on phase modulation for simultaneously measuring displacement and angle. The active sawtooth wave phase modulation enhances immunity of this interferometer to the environmental fluctuations and laser power drift. Based on polarized optic theory and the sinusoidal measurement retro-reflector, a modified Michelson-type interferometer configuration is designed to simultaneously measure displacement and angle. Phase difference between the reference and measurement interference signals can be obtained using the sawtooth wave phase modulation and zero crossing detection technique, where the real-time displacement and angle values can be derived directly. Experimental results demonstrate our proposed interferometer has good static and dynamic performance.

Targeting integrated stress response regulates microglial M1/M2 polarization and attenuates neuroinflammation following surgical brain injury in rat.

Integrated stress response (ISR) contributes to various neuropathological processes and acting as a therapy target in CNS injuries. However, the fundamental role of ISR in regulating microglial polarization remains largely unknown. Currently no proper pharmacological approaches to reverse microglia-driven neuroinflammation in surgical brain injury (SBI) have been reported. Here we found that inhibition of the crucial ISR effector, activating transcription factor 4 (ATF4), using the RNA interference suppressed the lipopolysaccharide (LPS)-stimulated microglial M1 polarization in vitro. Interestingly, counteracting ISR with a small-molecule ISR inhibitor (ISRIB) resulted in a significant microglial M1 towards M2 phenotype switching after LPS treatment. The potential underlying mechanisms may related to downregulate the intracellular NADPH oxidase 4 (NOX4) expression under the neuroinflammatory microenvironment. Notably, ISRIB ameliorated the infiltration of microglia and improved the neurobehavioral outcomes in the SBI rat model. Overall, our findings suggest that targeting ISR exerts a novel anti-inflammatory effect on microglia via regulating M1/M2 phenotype and may represent a potential therapeutic target to overcome neuroinflammation following SBI.

The trend of indirect anastomosis formation in a 2-vessel occlusion plus encephalo-myo-synangiosis rat model.

BACKGROUND: Basic research on the factors influencing indirect anastomosis formation in a 2-vessel occlusion plus encephalo-myo-synangiosis (2VO + EMS) rat model is conducive to improving the efficacy of indirect revascularization surgery in the clinic. However, the time point at which anastomosis between the rat temporal muscle (TM) and brain naturally has the greatest effect after encephalo-myo-synangiosis (EMS) remains unknown. Therefore, we conducted this study to explore the peak time of indirect anastomosis formation in the 2VO + EMS rat model. METHODS: Forty 2VO + EMS rats were randomly divided into five groups (n=8) according to the length of time (by week) after EMS, and 2VO rats were used as the control group (n=8). The expression of vascular endothelial growth factor (VEGF) and CD31 on the EMS side of the brain, perfusion ratio [improvement of cerebral blood perfusion (CBP) on the EMS side] and Morris water maze (MWM) results were compared between groups. Furthermore, the trends of the above variables were explored over weeks. RESULTS: Overall, the expression of VEGF and CD31, the perfusion ratio and the cognitive improvement in the 2VO + EMS rat model gradually increased over weeks after EMS. The VEGF and CD31 expression (as detected by immunofluorescence), perfusion ratio and number of times crossing the platform area peaked at 4 weeks after EMS. In addition, both the escape latency and the time spent in the target quadrant peaked in the fifth week after EMS. CONCLUSIONS: After establishing the 2VO + EMS rat model, the degree of endothelial cell (EC) proliferation and CBP improvement on the EMS side of the brain peaked at 4 weeks after EMS, whereas the cognitive improvement peaked in the fifth week.

Supraorbital eyebrow keyhole approach for microsurgical management of ruptured anterior communicating artery aneurysm.

The mortality and disability rate of patients with ruptured anterior communicating artery (AComA) aneurysm after bleeding is high. Even with the most advanced treatment methods, the incidence of complications remains high. The purpose of the present study was to determine the efficacy of microsurgery via supraorbital eyebrow keyhole approach (SOEK) in clipping ruptured AComA aneurysms. Between September 2010 and October 2018, 543 patients with intracranial aneurysms were admitted to the Department of Neurosurgery of the Third Affiliated Hospital of Sun Yat-Sen University (Guangzhou, China). Among them, 85 patients with ruptured AComA aneurysm and subarachnoid hemorrhage (SAH) underwent microsurgical clipping via the SOEK approach. In those patients, the clipping rate, complications and clinical efficacy of treatment were evaluated. The average age of the patients was 52.69±9.94 years (range, 28-78 years). The proportions of small, medium and large aneurysms were 83.5, 15.3 and 1.2%, respectively. Procedural complications occurred in 9 cases (10.5%). The occlusion rate of the aneurysms was 98.8%. The average follow-up period was 37.9 (±24.5) months. A total of 81.2% of the patients with SAH had a good clinical prognosisat 1 year (modified Rankin scale score, ≤2). In conclusion, for a skilled and experienced surgeon, SOEK was indicated to be a safe procedure for the treatment of ruptured AComA aneurysms; it provided sufficient intra-operative exposure and a high clipping rate.

Increasing the expression of microRNA-126-5p in the temporal muscle can promote angiogenesis in the chronically ischemic brains of rats subjected to two-vessel occlusion plus encephalo-myo-synangiosis.

BACKGROUND: miR-126-5p plays an important role in promoting endothelial cell (EC) proliferation. We thus explored whether miR-126-5p can promote EC proliferation and angiogenesis in chronically ischemic brains (CIBs). RESULTS: Improved revascularization in moyamoya patients was correlated with upregulated miR-126-5p expression in the TM and DM. In vitro experiments showed that miR-126-5p promoted EC proliferation through the PI3K/Akt pathway. CIBs from the agomir group exhibited significantly higher p-Akt, VEGF, CD31 and eNOS expression compared with the control CIBs. The ICBP and the RCF were significantly better in the agomir compared with the control group. CONCLUSION: Increasing miR-126-5p expression in the TM can promote EC proliferation and angiogenesis in CIBs of 2VO+EMS rats through the PI3K/Akt pathway. METHODS: We assessed the correlation between revascularization and miR-126-5p expression in the temporal muscle (TM) and dura mater (DM) of moyamoya patients. The effect of miR-126-5p on EC proliferation and downstream signaling pathways was explored in vitro. We established an animal model of two-vessel occlusion plus encephalo-myo-synangiosis (2VO+EMS), transfected the TM with miR-126-5p agomir/antagomir, compared the expression of miR-126-5p and relevant downstream cytokines in brain tissue among different groups, and investigated the improvement in cerebral blood perfusion (ICBP) and the recovery of cognitive function (RCF).

Factors determining the side of approach for clipping ruptured anterior communicating artery aneurysm via supraorbital eyebrow keyhole approach.

PURPOSE: The purpose of this study was to review the microsurgical anatomy and clipping of ruptured anterior communicating artery (AComA) aneurysms and to plan and avoid complications before operation. METHODS: A total of 523 cases of cerebral aneurysms admitted to the neurosurgery department of the Third Affiliated Hospital of Sun Yat-Sen University from September 2010 to October 2018 were analyzed retrospectively. Among them, 85 patients had ruptured AComA aneurysms. This study was limited to 85 of these cases, whose satisfactory preoperative angiographic diagnostic films can be retrieved from the hospital database system because of the need for detailed review. RESULTS: We performed supraorbital eyebrow keyhole approach (SOEK) craniotomy in 85 patients to clip 85 AComA aneurysms, in the setting of subarachnoid hemorrhage (SAH). Patients' mean age was (52.69 ± 9.94) years (range, 28-78 years). The proportions of small, medium and large aneurysms were 83.5%, 15.3%, and 1.2%, respectively. The average size of the aneurysms was (5.07 ± 2.36) mm. There were 77.8% of patients with inferior aneurysms and 81.3% of patients with superior aneurysms achieved good results. There was a significant correlation between A1 dominance and operation method (p < 0.001). There was no significant relationship between surgical approach and aneurysm projection or A2 plane (p = 0.157 &p = 0.318). CONCLUSION: Regardless of whether the A2 plane is open or closed, the A1 dominant side is still a better choice for accessing AComA aneurysms to avoid dangerous premature bleeding.

Research on the Frequency-Dependent Halfwave Voltage of a Multifunction Integrated Optical Chip in an Interferometric Fiber Optic Gyroscope.

The multifunction integrated optical chip (MIOC) is one of the most critical parts of the interferometric fiber optic gyroscope (IFOG), and research on the halfwave voltage of the MIOC is meaningful for a high-precision IFOG. In this paper, the correlation between the frequency and halfwave voltage, which affects the interference light intensity of IFOG, is presented theoretically. A widespread measurement method for frequency dependence of the halfwave voltage, based on lock-in amplification and sinusoidal modulation, is proposed. Further, the measurement result and the oscillation of interference light intensity in the Sagnac interferometer are presented, which are in great agreement with the theory. This paper proposes the frequency dependence of the halfwave voltage and provides a new error research direction for the improvement of the MIOC in a high-precision IFOG.

Outcomes After Pterional and Supraorbital Eyebrow Approach for Cranio-Orbital Lesions Communicated via the Supraorbital Fissure-A Retrospective Comparison.

OBJECTIVE: The pterional approach (PA) has been used to remove cranio-orbital lesions that have communicated via the supraorbital fissure (SOF). The supraorbital eyebrow approach (SEA) has become increasingly popular as a minimally invasive approach. However, few reports have examined the SEA for cranio-orbital lesions. We assessed the relative advantages, disadvantages, and selection criteria for these 2 approaches. METHODS: The data from all consecutive patients who had undergone removal of a cranio-orbital lesion that communicated via the SOF using the PA or SEA were analyzed. RESULTS: Of the 25 patients, 13 had undergone surgical resection using the SEA and 12 had undergone resection using the PA. The SEA provided better cosmetic satisfaction, resulted in a shorter surgical time, and required a shorter incision (P < 0.05). Proptosis had improved significantly in all the patients. No significant differences were found in the total resection rates, visual outcomes, recovery of ptosis, or other new surgically related complications between the 2 groups (P > 0.05). All the patients were followed up for an average of 21.9 months. One patient in each group had developed recurrence or progression that required radiotherapy. The disease of the other patients with subtotal resection was stable or atrophic. CONCLUSION: The SEA provided better cosmetic satisfaction, resulted in a shorter surgical time, and required a shorter incision. The SEA might be a more minimally invasive option for lesions communicating via the SOF without obvious hyperostosis. The PA might be more reasonable for lesions with obvious hyperostosis and more extensive lesions in the cavernous sinus.

An Ectopic Recurrent Craniopharyngioma of the Temporal Lobe: Case Report and Review of the Literature.

BACKGROUND: Ectopic recurrent craniopharyngioma is rare. We present a case of a temporal ectopic recurrent tumor after a trans-eyebrow supraorbital keyhole approach and provide a review of the reported data with basic statistics. METHODS: We retrospectively reviewed 57 cases of craniopharyngiomas surgically treated at our institution. A temporal ectopic recurrent tumor with 10% high Ki-67 proliferation index expression was identified. The lesion underwent gross total resection without any complications. We also reviewed the related data and performed a basic statistical analysis. RESULTS: Our review found 64 cases of ectopic recurrent craniopharyngioma that had been reported (including the present case). The median interval until ectopic recurrence was 4.0 years (interquartile range, 2.0-10.0). Of the 64 lesions, 48 (75%) were adamantinous, 6 (9%) were papillary, and 10 (16%) were unknown. Also, 34 tumors (53%) were located in the previous surgical tract, and 30 (47%) had disseminated along the cerebrospinal fluid pathway. Of the 64 ectopic tumors, 50 (78%) could be resected in total without complications. CONCLUSIONS: Ectopic recurrent craniopharyngioma is a rare phenomenon. Meticulous protection of the entire surgical field and careful manipulation of the tumor during resection are required to prevent possible ectopic recurrence. Regular follow-up examinations are strongly recommended to detect any further recurrences. Gross total resection is the treatment of choice for ectopic recurrence.

Endoscopic Transvestibular Transmandibular Approach for Trigeminal Schwannoma in Infratemporal Fossa and Parapharyngeal Space.

BACKGROUND: Schwannomas that involve the mandibular division of the trigeminal nerve and localize exclusively in the parapharyngeal space (PPS) and infratemporal fossa (ITF) are extremely rare, and a surgical approach to treat such tumors has not been well established. CASE DESCRIPTION: We present our experience in the treatment of a giant trigeminal schwannoma with wide extension in the ITF and PPS using an endoscopic transvestibular transmandibular approach. The clinical and radiologic findings, preoperative planning, advantages of the surgical approach, and clinical outcome are discussed. CONCLUSIONS: Schwannomas located in the ITF and PPS are rare benign neoplasms. They are usually detected late after considerable signs and symptoms appear. Preoperative planning is beneficial to individual surgical approach selection. Total surgical excision following careful evaluation of preoperative computed tomography and magnetic resonance images is the treatment of choice. Recurrence is rare after complete excision.