Microvascular decompression for primary trigeminal neuralgia with the 3/4 circumferential expanded polytetrafluoroethylene (ePTFE) sleeve technique.

Background: Microvascular decompression (MVD) using Teflon or Ivalon is the surgeon's preference for treating trigeminal neuralgia (Tn). Still, sometimes the prosthetic material is unavailable, or there is some recurrence of pain during the follow-up. In this case series, we report the outcome analysis for MVD using the expanded polytetrafluoroethylene (ePTFE) sleeve technique in classic Tn. Methods: We conducted a retrospective analysis of patients with Tn from January 2017 to March 2022. Classic or primary Tn was considered a direct compression by a cerebrovascular structure in the posterior fossa, detected by magnetic resonance imaging or direct surgical visualization. Pre- and postoperative Barrow Neurological Institute Pain Intensity Scale (BNI-SI) and Barrow Neurological Institute Hypoesthesia Scale (BNI-HS) were used for the clinical results assessment of the ePTFE sleeve circumferential technique. Results: There were nine patients approached with the 3/4 circumferential ePTFE sleeve technique with BNISI IV (n: 11, 58%) and BNI-SI V (n: 8, 42%). In all patients, there was a clinical improvement after the surgical treatment (P < 0.001). All patients obtained BNI-SI ≤ IIIa in an average follow-up of 11.89 (±14.137), with a slight improvement in BNI-HS (P: 0.157). In our revision, this technique has not previously been described for Tn. Conclusion: The circumferential ePTFE sleeve technique is a good option for MVD in Tn. For classic Tn, MVD could remain the first option, and this technique could be applied for multi-vessel compression.

Rosai-Dorfman sphenoorbital histiocytosis with intraparenchymal invasion: Do we have to consider this skull base pathology as a malignant disease?

Background: Rosai-Dorfman disease (RDD) is a rare type of histiocytosis that can manifest with diverse symptoms. It usually presents with systemic involvement, and only a few cases have been reported at the level of the skull base. RDD typically follows a benign course during the progression of the disease. In this particular case reported, after the skull base invasion, the disease started to infiltrate the brain parenchyma. Our objective for this case report was to present this particular progression pattern and the nuances of its surgical treatment. In addition, a revision of the current literature was performed about skull base RDD with intracranial invasion and brain parenchyma infiltration not previously described. Case Description: We are presenting the case study of a 57-year-old male patient who was experiencing severe headaches and an increase in volume in the right fronto-orbital region. On clinical examination, no neurologic clinical symptoms were observed. Contrast computed tomography and magnetic resonance imaging showed a tumor mass that affected the right orbit, frontal paranasal sinus, greater sphenoid wing, and right frontal lobe with moderate adjacent brain edema. The patient underwent surgery using an extended pterional approach with intracranial, orbital decompression, and frontal sinus cranialization, accompanied by frontal lobe tumor resection. Neuropathologic diagnosis revealed a Rosai-Dorfman histiocytosis disease. Conclusion: The etiopathogenesis of RDD is still not completely understood. The current literature considers this disease to have a predominantly benign course. Nevertheless, as we have shown in this case, it may, in some cases, present direct parenchymal invasion. We consider that prompt surgical treatment should be ideal to avoid the local and systemic progression of the disease.

Microsurgical and endoscopic-assisted supraorbital keyhole approach for intra-suprasellar cysticercosis.

Background: Treatment for intra/suprasellar cysticercosis can be challenging and may result in visual disturbances if not managed properly. Despite its limited knowledge, an effective surgical option exists to treat this condition. This article presents three cases of sellar cysticercosis, comprising one female and two male patients, managed with microsurgical supraorbital keyhole approach (mSKA) and endoscopic-assisted supraorbital keyhole approach (eaSKA). Case Description: The first patient is a 35-year-old man with no prior medical history who suffered from memory deficits and visual disturbances due to a sellar cyst pushing the orbitofrontal gyrus treated with mSKA. The second case involved a 52-year-old man who experienced visual deficits caused by a rostral sellar cyst with posterior displacement of the pituitary gland treated with eaSKA. The third case was a 46-year-old woman who experienced decreased visual acuity and memory loss due to multifocal neurocysticercosis (NCC) with sellarsuprasellar cyst extension treated with mSKA. All case diagnoses were confirmed by neuropathology department. Conclusion: The authors confidently suggest that the SKA is an effective surgical option and could be considered for removing sellar cystic lesions with suprasellar extension. With endoscopic assistance, it improves adequate neurovascular structure visualization.