Microsurgical Resection of a Medulla Oblongata Cavernoma: 3-Dimensional Operative Video.

Cavernous malformations occur in approximately 0.5% of the population. When it comes to the medulla oblongata, the incidence rate is around 5%.1,2 Patients with these conditions face potential risks such as hemorrhaging, substantial mortality, and morbidity. The symptoms experienced by the patient vary depending on the extent of hemorrhaging and the location of the lesion. Surgery stands as the primary and essential form of treatment in these cases.1-4 The aim of this operative video was to present the removal of a medulla oblongata cavernoma. The patient consented to the procedure and to the publication of her images and surgical video. We describe the case of a 53-year-old woman presenting with headaches and with swallowing difficulties, being tracheostomized on hospital admission. Magnetic resonance imaging showed a lesion located at the medulla oblongata. Owing to the patient's symptoms and cavernoma bleeding, surgical resection was determined. There were no adverse outcomes after surgery, and the patient evolved favorably. Postoperative imaging displayed complete removal of the cavernoma. Microsurgical resection of cavernomas in this location with neurophysiological monitoring and selection of the safe entry zone is an effective option.1-4.

Clinical and anatomical analysis of the epileptogenic spread patterns in focal cortical dysplasia patients.

Background: Focal cortical dysplasia (FCD) is one of the main causes of intractable epilepsy, which is amendable by surgery. During the surgical management of FCD, the understanding of its epileptogenic foci, interconnections, and spreading pathways is crucial for attaining a good postoperative seizure free outcome. Methods: We retrospectively evaluated 54 FCD patients operated in Federal Center of Neurosurgery, Tyumen, Russia. The electroencephalogram findings were correlated to the involved brain anatomical areas. Subsequently, we analyzed the main white matter tracts implicated during the epileptogenic spreading in some representative cases. We prepared 10 human hemispheres using Klinger's method and dissected them through the fiber dissection technique. Results: The clinical results were displayed and the main white matter tracts implicated in the seizure spread were described in 10 patients. Respective FCD foci, interconnections, and ectopic epileptogenic areas in each patient were discussed. Conclusion: A strong understanding of the main implicated tracts in epileptogenic spread in FCD patient remains cardinal for neurosurgeons dealing with epilepsy. To achieve meaningful seizure freedom, despite the focal lesion resection, the interconnections and tracts should be understood and somehow disconnected to stop the spreading.

Preoperative tractography algorithm for safe resection of tumors located in the descending motor pathways zone.

Background: Diffusion tensor imaging (DTI) tractography facilitates maximal safe resection and optimizes planning to avoid injury during subcortical dissection along descending motor pathways (DMPs). We provide an affordable, safe, and timely algorithm for preoperative DTI motor reconstruction for gliomas adjacent to DMPs. Methods: Preoperative DTI reconstructions were extracted from a prospectively acquired registry of glioma resections adjacent to DMPs. The surgeries were performed over a 7-year period. Demographic, clinical, and radiographic data were extracted from patients' electronic medical records. Results: Nineteen patients (12 male) underwent preoperative tractography between January 1, 2013, and May 31, 2020. The average age was 44.5 years (range, 19-81 years). A complete radiological resection was achieved in nine patients, a subtotal resection in five, a partial resection in three, and a biopsy in two. Histopathological diagnoses included 10 patients with high-grade glioma and nine with low-grade glioma. A total of 16 perirolandic locations (10 frontal and six frontoparietal) were recorded, as well as two in the insula and one in the basal ganglia. In 9 patients (47.3%), the lesion was in the dominant hemisphere. The median preoperative and postoperative Karnofsky Performance Scores were 78 and 80, respectively. Motor function was unchanged or improved over time in 15 cases (78.9%). Conclusion: This protocol of DTI reconstruction for glioma removal near the DMP shows good results in low-term neurological functional outcomes.

Understanding the molecular profiling of diffuse gliomas classification: A brief overview.

Background: Gliomas represent almost 30% of all primary brain tumors and account for 80% of malignant primary ones. In the last two decades, significant progress has been made in understanding gliomas' molecular origin and development. These advancements have demonstrated a remarkable improvement in classification systems based on mutational markers, which contribute paramount information in addition to traditional histology-based classification. Methods: We performed a narrative review of the literature including each molecular marker described for adult diffuse gliomas used in the World Health Organization (WHO) central nervous system 5. Results: The 2021 WHO classification of diffuse gliomas encompasses many molecular aspects considered in the latest proposed hallmarks of cancer. The outcome of patients with diffuse gliomas relies on their molecular behavior and consequently, to determine clinical outcomes for these patients, molecular profiling should be mandatory. At least, the following molecular markers are necessary for the current most accurate classification of these tumors: (1) isocitrate dehydrogenase (IDH) IDH-1 mutation, (2) 1p/19q codeletion, (3) cyclin-dependent kinase inhibitor 2A/B deletion, (4) telomerase reverse transcriptase promoter mutation, (5) α-thalassemia/ mental retardation syndrome X-linked loss, (6) epidermal growth factor receptor amplification, and (7) tumor protein P53 mutation. These molecular markers have allowed the differentiation of multiple variations of the same disease, including the differentiation of distinct molecular Grade 4 gliomas. This could imply different clinical outcomes and possibly impact targeted therapies in the years to come. Conclusion: Physicians face different challenging scenarios according to the clinical features of patients with gliomas. In addition to the current advances in clinical decision-making, including radiological and surgical techniques, understanding the disease's molecular pathogenesis is paramount to improving the benefits of its clinical treatments. This review aims to describe straightforwardly the most remarkable aspects of the molecular pathogenesis of diffuse gliomas.

Photo-Stacking Technique for Neuroanatomical High-Definition Photography and 3-Dimensional Modeling.

BACKGROUND: Three-dimensional (3D) neuroanatomical knowledge is vital in neurosurgery. Technological advances improved 3D anatomical perception, but they are usually expensive and not widely available. The aim of the present study was to provide a detailed description of the photo-stacking technique for high-resolution neuroanatomical photography and 3D modeling. METHODS: The photo-stacking technique was described in a step-by-step approach. The time for image acquisition, file conversion, processing, and final production was measured using 2 processing methods. The total number and file size of images are presented. Measures of central tendency and dispersion report the measured values. RESULTS: Ten models were used in both methods achieving 20 models with high-definition images. The mean number of acquired images was 40.6 (14-67), image acquisition time 51.50 ± 18.8 s, file conversion time 250 ± 134.6 s, processing time 50.46 ± 21.46 s and 41.97 ± 20.84 s, and 3D reconstruction time was 4.29 ± 0.74 s and 3.89 ± 0.60 s for methods B and C, respectively. The mean file size of RAW files is 1010 ± 452 megabyte (MB) and 101.06 ± 38.09 MB for Joint Photographic Experts Group files after conversion. The mean size of the final image means size is 71.9 ± 0.126 MB, and the mean file size of the 3D model means is 37.4 ± 0.516 MB for both methods. The total equipment used was less expensive than other reported systems. CONCLUSIONS: The photo-stacking technique is a simple and inexpensive method to create 3D models and high-definition images that could prove valuable in neuroanatomy training.

Microneurosurgical anatomy of the basal cisterns: A brief review for cisternostomy.

Background: Cisternostomy is a surgical technique thought of and developed as an option for severe brain trauma treatment. It demands a particular knowledge and skill to microsurgically approach basal cisterns and effectively manipulate their contents. To perform this procedure safely, the anatomy and pathophysiology must be clearly understood. Methods: Detailed microscopic dissection and anatomical review were done, after a detailed reading of facts and recent publications about cisternostomy. Cisternal pathways and landmark planning are described and augmented using a new method to show de arachnoid borders. Finally, a brief discussion is written as a synopsis. Results: Cisternostomy requires thorough microscopic knowledge and microsurgical skills. This paper intends to provide information to understand better the anatomy related, thus, easing the learning curve. The technique used to show arachnoid borders, complementing cadaveric and surgical images, was useful for this purpose. Conclusion: To perform this procedure safely, it is mandatory to handle microscopic details of cistern anatomy. Reaching a core cistern is necessary to assure effectiveness. This procedure needs, as well, surgical step-by-step landmark planning and performing. Cisternostomy could be a life-saving procedure and a new powerful tool for severe brain trauma treatment. Evidence is being collected to support its indications.

A simple technique for generating 3D endoscopic images.

Background: Most neurosurgical photographs are limited to two-dimensional (2D), in this sense, most teaching and learning of neuroanatomical structures occur without an appreciation of depth. The objective of this article is to describe a simple technique for obtaining right and left 2D endoscopic images with manual angulation of the optic. Methods: The implementation of a three-dimensional (3D) endoscopic image technique is reported. We first describe the background and core principles related to the methods employed. Photographs are taken demonstrating the principles and also during an endoscopic endonasal approach, illustrating the technique. Later, we divide our process into two sections containing explanations, illustrations, and descriptions. Results: The results of taking a photograph with an endoscope and its assembly to a 3D image has been divided into two parts: Photo acquisition and image processing. Conclusion: We conclude that the proposed method is successful in producing 3D endoscopic images.

Anatomic variations of the floor of the third ventricle: Surgical implications for endoscopic third ventriculostomy.

Background: Endoscopic third ventriculostomy (ETV) is currently used as a treatment for different types of hydrocephalus. However, the anatomical endoscopic variants of the third ventricle floor (3VF), as well as their surgical implications, have been underrated. The anatomic variations of the 3VF can influence the technique and the success rate of the ETV. The purpose of this article is to describe the anatomical variations of 3VF, assess their incidence, and discuss the implications for ETV. Methods: Intraoperative videos of 216 patients who underwent ETV between January 2012 and February 2020 at Hospital Infantil Universitario de San José, Bogotá, Colombia were reviewed. One hundred and eighty patients who met the criteria to demonstrate the type of 3VF were selected. Results: 3VF types were classified as follows: (1) Thinned, (2) thickened, (3) partially erased, (4) globular or herniated, and (5) narrowed. Conclusion: Knowledge of anatomical variations of the 3VF is paramount for ETV and it influences the success rate of the procedure.

Three-Dimensional Anatomy of the Anterior Commissure: A Tractography and Anatomical Study.

BACKGROUND: The anterior commissure (AC) is one of the main commissural fibers of the brain. The commissural fibers are involved in bilateral integration and coordination of any normal brain activity. The AC is an important interhemispheric structure that forms a bidirectional communication channel between the frontal, temporal, parietal, and occipital lobes bilaterally. METHODS: In the present study, we focused on describing the morphology, relationships, and distribution of the AC using diffusion spectrum imaging-based fiber tracking. The tractograms were compared with the findings from gross anatomical dissection of the AC of adult brains. RESULTS: Our findings suggest that the AC found using tracking methods is larger than that found by dissection. CONCLUSIONS: The use of tractography added extensions to the main AC structure.

Microsurgical Anatomy of the Central Retinal Artery.

BACKGROUND: The central retinal artery (CRA) has been described as one of the first branches of the ophthalmic artery.It arises medial to the ciliary ganglion and after a sinuous path within the orbital cavity it penetrates the lower surface of the dura mater that covers the optic nerve, approximately 1 cm behind the eyeball. However, the numerous anatomic descriptions that were made of the CRA have been insufficient or unclear in relation to certain characteristics that are analyzed in the present study. METHODS: An electronic literature search was made in the PubMed database and a cadaver dissection was performed on 11 orbits fixed in formaldehyde. RESULTS: Results were obtained regarding the source, collateral branches, curves, direction, length of the optic nerve, dural perforation site, distance, path and relations, diameter, and area of the central artery of the retina. CONCLUSIONS: Our anatomic study innovates in 2 aspects of the CRA: area and curves. Not only was there a simple count of the number of curves, but it also analyzed the angle presented by each of the curves based on photos obtained in high definition, with a digital program to reduce the margin of error. These curvatures of the CRA were classified according to their spatial disposition within the orbital cavity based on a pattern that was easy to understand. Data were obtained from the area of the CRA on the penetration of the CRA into the dural sheath of the optic nerve.

Terminología anatómica internacional de la región pelvina / International anatomical terminology of the pelvic region

Introducción: La identificación de los elementos anatómicos, ha sido influenciada por autores franceses con tendencia al uso de epónimos. En la enseñanza de pregrado de la Anatomía, como en publicaciones internacionales se prefiere el uso de la Terminología Internacional (TAI). En esta situación genera problemas de comunicación a la hora de considerar la Pelvis, su patología, diagnóstico y tratamiento, por lo cual es necesario conciliar las Nomenclaturas Anatómicas Internacionales, en lo referente a la región pelviana, remarcando el uso de TAI en el contexto de la creciente globalización de la información médica. Objetivos: Conciliar las Nomenclaturas Anatómicas, remarcando el uso de la TAI en el contexto de la creciente globalización de la información médica. Material y método: Se realizó una encuesta anónima a 104 médicos especialistas en Urología y Ginecología, el conocimiento de las nomenclaturas anatómicas y la actualización bibliográfica sobre dicha región, en el período de marzo /2009-2010. Resultados: De 104 médicos (39 urólogos y 65 ginecólogos) encuestados, el 31.7% (33), de los que el 66.70% (22) eran urólogos y el 33.33% (11) ginecólogos, desconocían la existencia de un listado oficial de nombres de estructuras anatómicas. 6.73 % (7) del total identificaron las estructuras anatómicas de la región según la Terminología Anatómica Internacional, de los cuales el 28.57 % (2) eran urólogos y el 71.43 % (5) ginecólogos. Conclusiones: La TAI preconiza el uso de términos descriptivos, desaconsejando la utilización de epónimos, haciendo uniforme el lenguaje anatómico. Teniendo en cuenta que la comunidad fluida, efectiva y universal es un tópico de gran trascendencia en el seno de procesos de enseñanza – aprendizaje de la anatomía quirúrgica, hace que la Terminología Anatómica Internacional, juegue un rol importante en la consecución de dicho objetivo.

Introduction: The identification of anatomical elements has been influenced by French authors with tendency to the use of eponyms. In undergraduate anatomy teaching, as well as in international publications, the use of International Terminology (IAT) is preferred. This situation creates communication problems when considering the pelvis, its pathology, diagnosis and treatment. This is why it is necessary to reconcile the International Anatomical Nomenclature in relation to the pelvic region, emphasizing the use of IAT in the increasing globalization of medical information context. Objectives: To reconcile the Anatomical Nomenclature, highlighting IAT use in the increasing globalization of medical information context. Material and Methods: An anonymous survey was carried out, between March 2009 and March 2010, among 104 physicians specialized in Urology and Gynecology, about the knowledge of anatomical nomenclature and literature update of said region. Results: From 104 respondents (39 urologists and 65 gynecologists), 33 (31.7%) were unaware of the existence of an official anatomical structure name list [22 urologists (66.70%) and 11 (33.33%) gynecologists]. From the total, 7 (6.73%) identified the anatomical structures of the region according to the International Anatomical Terminology [2 urologists (28.57%) and 5 gynecologists (71.43%)].Conclusions: The IAT advocates the use of descriptive terms, discouraging the use of eponyms, standardizing the anatomical language. Given that fluid, effective and universal communication is a topic of great importance within surgical anatomy teaching – learning process; IAT plays an important role in the achievement of said objective.

Aplicación de las nomenclaturas en región inguino femoral / Nomenclature aplication in inguinofemoral region

Introducción: En la enseñanza de la anatomía humana como en publicaciones de alcance mundial, se utiliza la Terminología Anatómica Internacional (TAI), en vigencia desde 1998; esto generó problemas de comunicación al emplear la terminología oficial en la región inguinofemoral. Objetivo: Conciliar las nomenclaturas anatómicas, remarcando el uso de la TAI en el contexto de la creciente globalización de la información médica. Diseño: Observacional, retrospectivo con encuesta. Material y método: Encuesta anónima a 92 médicos especialistas en Cirugía General, considerando años de graduado y especialista, conocimiento de nomenclaturas anatómicas, actualización bibliográfica, actividad quirúrgica programada o de urgencia en la región y la identificación de estructuras anatómicas en cortes esquemáticos, entre julio/2009-julio/2010. Resultados: De los 92 médicos, 9(9.78%) desconocía la existencia de un listado oficial de nombres de estructuras anatómicas y 83(90.22%) lo conocía. De los 83, 32(38.55%) presentó dificultades para la denominación de dicho listado y 51(61.45%) enunciaron correctamente a la T.A.I. Del total (92), 51 (55.43%) identificaron correctamente las estructuras anatómicas de la región, según la T.A.I., sobre gráficos de la región inguinofemoral. Desempeñaban actividad quirúrgica en patología de la región en forma urgente y programada 73 (79.35%) y 19 (20.65%) solo programada. La última actualización sobre anatomía de la región correspondió, dentro de los 1-5 años en 51 (55.43%), 6-10 años en 20 (21.74%), 11-15 años en 11 (11.96%) y mas de 16 años en 10 (10.87%)...

Introduction: the International Anatomical Terminology (IAT), in force since 1998, is use in human anatomy teaching and in publications worldwide. This led to communication problems when using the official terminology on inguinofemoral region. Objective: Reconciling anatomical nomenclature, emphasizing IAT use on the context of increasing globalization of medical information. Design: Observational, retrospective survey. Methods: Anonymous survey to 92 doctors specializing in General Surgery, considering years of graduation and specialization, knowledge of anatomical nomenclature, updated bibliography, scheduled or emergency surgical activity on the region and anatomical structures identification in schematic cuts between July/2009-july/2010. Results: Of the 92 doctors, 9 (9.78%) were not aware of an official list of names of anatomical structures and 83 (90.22%) knew it. Of the 83, 32 (38.55%) had difficulties in the name of the list and 51 (61.45%) correctly enunciated the IAT. Of the total (92), 51 (55.43%) correctly identified the anatomical structures, according to IAT on graphics of the inguinofemoral region. Scheduled and emergency surgical activity was performed by 73 doctors (79.35%) and 19 (20.65%) only performed scheduled surgery. The latest update of the anatomical literature corresponded, within 1-5 years to 51 doctors (55.43%), 6-10 years in 20 of them (21.74%), 11-15 years in 11 (11.96%) and more than 16 years in 10 (10.87%)...

Terminología anatómica internacional de la región pelvina / International anatomical terminology of the pelvic region

Introducción: La identificación de los elementos anatómicos, ha sido influenciada por autores franceses con tendencia al uso de epónimos. En la enseñanza de pregrado de la Anatomía, como en publicaciones internacionales se prefiere el uso de la Terminología Internacional (TAI). En esta situación genera problemas de comunicación a la hora de considerar la Pelvis, su patología, diagnóstico y tratamiento, por lo cual es necesario conciliar las Nomenclaturas Anatómicas Internacionales, en lo referente a la región pelviana, remarcando el uso de TAI en el contexto de la creciente globalización de la información médica. Objetivos: Conciliar las Nomenclaturas Anatómicas, remarcando el uso de la TAI en el contexto de la creciente globalización de la información médica. Material y método: Se realizó una encuesta anónima a 104 médicos especialistas en Urología y Ginecología, el conocimiento de las nomenclaturas anatómicas y la actualización bibliográfica sobre dicha región, en el período de marzo /2009-2010. Resultados: De 104 médicos (39 urólogos y 65 ginecólogos) encuestados, el 31.7% (33), de los que el 66.70% (22) eran urólogos y el 33.33% (11) ginecólogos, desconocían la existencia de un listado oficial de nombres de estructuras anatómicas. 6.73 % (7) del total identificaron las estructuras anatómicas de la región según la Terminología Anatómica Internacional, de los cuales el 28.57 % (2) eran urólogos y el 71.43 % (5) ginecólogos. Conclusiones: La TAI preconiza el uso de términos descriptivos, desaconsejando la utilización de epónimos, haciendo uniforme el lenguaje anatómico. Teniendo en cuenta que la comunidad fluida, efectiva y universal es un tópico de gran trascendencia en el seno de procesos de enseñanza û aprendizaje de la anatomía quirúrgica, hace que la Terminología Anatómica Internacional, juegue un rol importante en la consecución de dicho objetivo. (AU)

Introduction: The identification of anatomical elements has been influenced by French authors with tendency to the use of eponyms. In undergraduate anatomy teaching, as well as in international publications, the use of International Terminology (IAT) is preferred. This situation creates communication problems when considering the pelvis, its pathology, diagnosis and treatment. This is why it is necessary to reconcile the International Anatomical Nomenclature in relation to the pelvic region, emphasizing the use of IAT in the increasing globalization of medical information context. Objectives: To reconcile the Anatomical Nomenclature, highlighting IAT use in the increasing globalization of medical information context. Material and Methods: An anonymous survey was carried out, between March 2009 and March 2010, among 104 physicians specialized in Urology and Gynecology, about the knowledge of anatomical nomenclature and literature update of said region. Results: From 104 respondents (39 urologists and 65 gynecologists), 33 (31.7%) were unaware of the existence of an official anatomical structure name list [22 urologists (66.70%) and 11 (33.33%) gynecologists]. From the total, 7 (6.73%) identified the anatomical structures of the region according to the International Anatomical Terminology [2 urologists (28.57%) and 5 gynecologists (71.43%)].Conclusions: The IAT advocates the use of descriptive terms, discouraging the use of eponyms, standardizing the anatomical language. Given that fluid, effective and universal communication is a topic of great importance within surgical anatomy teaching û learning process; IAT plays an important role in the achievement of said objective. (AU)

Aplicación de las nomenclaturas en región inguino femoral / Nomenclature aplication in inguinofemoral region

Introducción: En la enseñanza de la anatomía humana como en publicaciones de alcance mundial, se utiliza la Terminología Anatómica Internacional (TAI), en vigencia desde 1998; esto generó problemas de comunicación al emplear la terminología oficial en la región inguinofemoral. Objetivo: Conciliar las nomenclaturas anatómicas, remarcando el uso de la TAI en el contexto de la creciente globalización de la información médica. Diseño: Observacional, retrospectivo con encuesta. Material y método: Encuesta anónima a 92 médicos especialistas en Cirugía General, considerando años de graduado y especialista, conocimiento de nomenclaturas anatómicas, actualización bibliográfica, actividad quirúrgica programada o de urgencia en la región y la identificación de estructuras anatómicas en cortes esquemáticos, entre julio/2009-julio/2010. Resultados: De los 92 médicos, 9(9.78%) desconocía la existencia de un listado oficial de nombres de estructuras anatómicas y 83(90.22%) lo conocía. De los 83, 32(38.55%) presentó dificultades para la denominación de dicho listado y 51(61.45%) enunciaron correctamente a la T.A.I. Del total (92), 51 (55.43%) identificaron correctamente las estructuras anatómicas de la región, según la T.A.I., sobre gráficos de la región inguinofemoral. Desempeñaban actividad quirúrgica en patología de la región en forma urgente y programada 73 (79.35%) y 19 (20.65%) solo programada. La última actualización sobre anatomía de la región correspondió, dentro de los 1-5 años en 51 (55.43%), 6-10 años en 20 (21.74%), 11-15 años en 11 (11.96%) y mas de 16 años en 10 (10.87%)...(AU)

Introduction: the International Anatomical Terminology (IAT), in force since 1998, is use in human anatomy teaching and in publications worldwide. This led to communication problems when using the official terminology on inguinofemoral region. Objective: Reconciling anatomical nomenclature, emphasizing IAT use on the context of increasing globalization of medical information. Design: Observational, retrospective survey. Methods: Anonymous survey to 92 doctors specializing in General Surgery, considering years of graduation and specialization, knowledge of anatomical nomenclature, updated bibliography, scheduled or emergency surgical activity on the region and anatomical structures identification in schematic cuts between July/2009-july/2010. Results: Of the 92 doctors, 9 (9.78%) were not aware of an official list of names of anatomical structures and 83 (90.22%) knew it. Of the 83, 32 (38.55%) had difficulties in the name of the list and 51 (61.45%) correctly enunciated the IAT. Of the total (92), 51 (55.43%) correctly identified the anatomical structures, according to IAT on graphics of the inguinofemoral region. Scheduled and emergency surgical activity was performed by 73 doctors (79.35%) and 19 (20.65%) only performed scheduled surgery. The latest update of the anatomical literature corresponded, within 1-5 years to 51 doctors (55.43%), 6-10 years in 20 of them (21.74%), 11-15 years in 11 (11.96%) and more than 16 years in 10 (10.87%)...(AU)