The superior petrosal sinus: a review of anatomy, embryology, pathology, and neurosurgical relevance.

The superior petrosal sinus is located between the middle and posterior cranial fossae and is important during many neurosurgical approaches to the skull base. Using standard search engines, the anatomical and clinical importance of the superior petrosal sinus was investigated. The superior petrosal sinus is important in many neurosurgical approaches and pathological entities. Therefore, it is important for those who operate at the skull base or interpret imaging here to have a good working knowledge of its anatomy, development, and pathological involvement.

The microanatomy of spinal cord injury: a review.

Spinal cord injury is a highly prevalent condition associated with significant morbidity and mortality. The pathophysiology underlying it is extraordinarily complex and still not completely understood. We performed a comprehensive literature review of the pathophysiologic processes underlying spinal cord injury. The mechanisms underlying primary and secondary spinal cord injury are distinguished based on a number of factors and include the initial mechanical injury force, the vascular supply of the spinal cord which is associated with spinal cord perfusion, spinal cord autoregulation, and post-traumatic ischemia, and a complex inflammatory cascade involving local and infiltrating immunomodulating cells. This review illustrates the current literature regarding the pathophysiology behind spinal cord injury and outlines potential therapeutic options for reversing these mechanisms.

The inferior petrosal sinus: a comprehensive review with emphasis on clinical implications.

INTRODUCTION: The inferior petrosal sinus is an important component of the cerebral venous system with implications in diagnosis and treatment of a variety of diseases such as Cushing's disease, carotid cavernous, and dural arteriovenous fistulas. METHODS: This manuscript will review the anatomy, embryology, and clinical implications of the inferior petrosal sinus. CONCLUSIONS: Knowledge of the inferior petrosal sinus is of great importance for open surgical approaches to the skull base and endovascular access to the cavernous sinus and sellar region.

Non-pharmacological experimental treatments for spinal cord injury: a review.

INTRODUCTION: Spinal cord injury is a complex result of primary mechanical damage and the secondary vascular compromise and inflammatory reactions. Depending on timing, different treatment modalities may have various effects. CONCLUSIONS: We review the latest advances in terms of non-pharmacological experimental treatments.

Sir Charles Bell (1774-1842) and his contributions to early neurosurgery.

The renowned surgeon, neuroanatomist, and artist Sir Charles Bell not only impacted the lives of his peers through his creative endeavors and passion for art, but also sparked noteworthy breakthroughs in the field of neuroscience. His empathetic nature and zest for life enabled him to develop an early proclivity for patient care. As a result of his innovative findings regarding sensory and motor nerves and the anatomical makeup of the brain, he accepted some of the most prestigious awards and received an honorable reputation in society. Bell is recognized for his diligence, perseverance, and his remarkable contributions to surgery. The present review will explore his contributions to the discipline now known as neurosurgery.

James Drake (1667-1707): Anatomist and political activist.

James Drake (1667-1707) was a renowned physician, anatomist, and writer whose name was recognized throughout London. He was highly involved in the politics of his time and was a well-known pamphleteer. He also delved into comedies and plays. Drake became a fellow of the Royal Society and the College of Physicians before his early death at 40 years of age. He authored one of the most deservedly popular medical treatises of his time, Anthropologia Nova, which remained a valuable resource to physicians and anatomists alike for decades. The present article reviews the contributions of this little known name in the history of anatomy.

Early mobilization versus bed rest for incidental durotomy: an institutional cohort study.

OBJECTIVE: The aim of this study was to assess whether flat bed rest for > 24 hours after an incidental durotomy improves patient outcome or is a risk factor for medical and wound complications and longer hospital stay. METHODS: Medical records of consecutive patients undergoing thoracic and lumbar decompression procedures from 2010 to 2020 were reviewed. Operative notes and progress notes were reviewed and searched to identify patients in whom incidental durotomies occurred. The need for revision surgery related to CSF leak or wound infection was recorded. The duration of bed rest, length of hospital stay, and complications (pulmonary, gastrointestinal, urinary, and wound) were recorded. The rates of complications were compared with regard to the duration of bed rest (≤ 24 hours vs > 24 hours). RESULTS: A total of 420 incidental durotomies were identified, indicating a rate of 6.7% in the patient population. Of the 420 patients, 361 underwent primary repair of the dura; 254 patients were prescribed bed rest ≤ 24 hours, and 107 patients were prescribed bed rest > 24 hours. There was no statistically significant difference in the need for revision surgery (7.87% vs 8.41%, p = 0.86) between the two groups, but wound complications were increased in the prolonged bed rest group (8.66% vs 15.89%, p = 0.043). The average length of stay for patients with bed rest ≤ 24 hours was 4.47 ± 3.64 days versus 7.24 ± 4.23 days for patients with bed rest > 24 hours (p < 0.0001). There was a statistically significant increase in the frequency of ileus, urinary retention, urinary tract infections, pulmonary issues, and altered mental status in the group with prolonged bed rest after an incidental durotomy. The relative risk of complications in the group with bed rest ≤ 24 hours was 50% less than the group with > 24 hours of bed rest (RR 0.5, 95% CI 0.39-0.62; p < 0.0001). CONCLUSIONS: In this retrospective study, the rate of revision surgery was not higher in patients with durotomy who underwent immediate mobilization, and medical complications were significantly decreased. Flat bed rest > 24 hours following incidental durotomy was associated with increased length of stay and increased rate of medical complications. After primary repair of an incidental durotomy, flat bed rest may not be necessary and appears to be associated with higher costs and complications.

Cellular and paracellular transplants for spinal cord injury: a review of the literature.

BACKGROUND: Experimental approaches to limit the spinal cord injury and to promote neurite outgrowth and improved function from a spinal cord injury have exploded in recent decades. Due to the cavitation resulting after a spinal cord injury, newer important treatment strategies have consisted of implanting scaffolds with or without cellular transplants. There are various scaffolds, as well as various different cellular transplants including stem cells at different levels of differentiation, Schwann cells and peripheral nerve implants, that have been reviewed. Also, attention has been given to different re-implantation techniques in avulsion injuries. METHODS: Using standard search engines, this literature is reviewed. CONCLUSION: Cellular and paracellular transplantation for application to spinal cord injury offers promising results for those patients with spinal cord pathology.

Pediatric traumatic carotid, vertebral and cerebral artery dissections: a review.

Traumatic cerebral dissections are rare but potentially dangerous conditions that through improved diagnostics have recently gained increased interest. However, there is still a significant lack of knowledge on the natural history, as well as on the best treatment options. Most of the literature on this topic consists of case reports and retrospective studies with no prospective randomized controlled studies. In our review, we highlight the fact that there is no level 1 evidence for the natural history of cerebral dissections or for the best treatment. We present 26 case studies derived from 70 pediatric patients affected by dissections, occlusions, and pseudoaneurysms.

Emanuel Swedenborg (1688-1772): pioneer of neuroanatomy.

Emanuel Swedenborg is widely accredited for his religious fervor and devout dedication to his spirituality. He spearheaded the creation of what is known today as the New Jerusalem Church. However, Swedenborg also served as a prominent figure in the European Enlightenment, making noteworthy strides in the fields of mathematics and science. His acumen for science instilled in the medical world groundbreaking ideas that would forever innovate the practice of medicine. Not only did Swedenborg describe intricacies of the cerebral cortex but he also discovered the perivascular spaces, the foramen of Magendie, and the cerebrospinal fluid. He noted the importance of the pituitary gland or "arch gland" in maintaining normal neurological function. Lastly, in a period where the cortex was given no significant function, Swedenborg developed the idea of somatotopic organization, and this was almost 100 years prior to Fritsch and Hitzig. It is on the shoulders of such great pioneers as Emanuel Swedenborg that we base our current understanding of the nervous system.

China's first surgeon: Hua Tuo (c. 108-208 AD).

Hua Tuo (c. 108-208 AD), the Chinese surgical pioneer and herbal expert, excelled as a physician, making significant strides in anesthesia, surgery, and acupuncture. He is accredited for spearheading the practice of laparotomies and organ transplants, using anesthetics, and he was the first Chinese surgeon to operate on the abdomen including performing splenectomy and colostomy. Neurologically, Hua Tuo is said to have performed procedures to treat headache, paralysis, and suspected a brain tumor in one patient. Tuo's impact on medicine was so profound that the phrases "A Second Hua Tuo" or "Hua Tuo reincarnated" were coined in honor of his diligence and compassion to recognize outstanding physicians who demonstrate an equal caliber of surgical competence. It is the pioneering contributions to medicine and surgery as made by such physicians as Hua Tuo on which we base our current understanding.

Chemical priming for spinal cord injury: a review of the literature part II-potential therapeutics.

INTRODUCTION: Spinal cord injury is a complex cascade of reactions secondary to the initial mechanical trauma that puts into action the innate properties of the injured cells, the circulatory, inflammatory, and chemical status around them, into a non-permissive and destructive environment for neuronal function and regeneration. Priming means putting a cell, in a state of "arousal" towards better function. Priming can be mechanical as trauma is known to enhance activity in cells. MATERIALS AND METHODS: A comprehensive review of the literature was performed to better understand the possible chemical primers used for spinal cord injuries. CONCLUSIONS: Taken together, many studies have shown various promising results using the substances outlined herein for treating SCI.

Cavum velum interpositum, cavum septum pellucidum, and cavum vergae: a review.

INTRODUCTION: Anterior midline intracranial cysts may be found most often in three forms: cavum septum pellucidum, cavum vergae, and cavum velum interpositum. A single offering that reviews these entities is difficult to find in the extant literature. Therefore, the present review was performed. MATERIALS AND METHODS: Various search engines and germane texts were reviewed for the terms cavum septum pellucidum, cavum vergae, and cavum velum interpositum. RESULTS: We report the findings of our search of the literature regarding these midline cystic structures. CONCLUSIONS: A better understanding of the associated anatomy, embryology, and pathology of these cysts will assist the clinician who treats such patients.

Charles Prosper Ollivier d'Angers (1796-1845) and his contributions to defining syringomyelia.

INTRODUCTION: Distinguished as an anatomist, pathologist, and clinician, the Frenchman Charles Prosper Ollivier d'Angers dedicated his life to accelerating the forefront of neuroscience. At a young age, he explored the diseases and disorders of the spinal cord during a time when clinical neurological investigation scarcely existed. Ollivier d'Angers coined the term "syringomyelia." CONCLUSION: The coinage of the term syringomyelia by d'Angers shed light on the disorder causing more practitioners to investigate the spinal cord and its defects.

Chemical priming for spinal cord injury: a review of the literature. Part I-factors involved.

INTRODUCTION: There are significant differences between the propensity of neural regeneration between the central and peripheral nervous systems. MATERIALS AND METHODS: Following a review of the literature, we describe the role of growth factors, guiding factors, and neurite outgrowth inhibitors in the physiology and development of the nervous system as well as the pathophysiology of the spinal cord. We also detail their therapeutic role as well as those of other chemical substances that have recently been found to modify regrowth following cord injury. CONCLUSIONS: Multiple factors appear to have promising futures for the possibility of improving spinal cord injury following injury.

Nonvestibular schwannomas: an evaluation of functional outcome after radiosurgical and microsurgical management.

PURPOSE: Nonvestibular cranial nerve schwannomas (NVCNS) are relatively rare tumors. We evaluated our experience with radiosurgical and microsurgical treatment alone and in combination for the management of NVCNS. METHODS: The charts of 62 patients with NVCNS who were treated between 1993 and 2005 at our institution were reviewed. Patients diagnosed with neurofibromatosis type 2 were excluded. The patients underwent microsurgery and/or radiosurgery treatment. RESULTS: Trigeminal and jugular foramen schwannomas were the most common NVCNS tumors (n = 47), and the only two groups with sufficient numbers of patients to allow comparison of the three treatment approaches. In these two groups, the mean tumor volume was significantly higher in those who received combined therapy (8.59 +/- 2.29 cc), compared with radiosurgery (4.94 +/- 3.02 cc; p = 0.05) or microsurgery alone (5.38 +/- 3.23; p = 0.027). Patients who underwent radiosurgery alone were significantly older (67.7 +/- 13.3 years; p = 0.019) than those treated with microsurgery (55.3 +/- 13.7 years) or with both modalities (48.7 +/- 12.8 years). The Karnofsky Performance Scale scores were significantly higher (p < or = 0.05) at follow-up compared with baseline for all three treatment approaches. There was no significant change in the Glasgow Outcome scores before and after treatment. CONCLUSIONS: Microsurgery and radiosurgery can both be used to manage NVCNS tumors with excellent results. When treatment with either modality alone is not reasonable, tumors can be managed effectively with combined micro- and radiosurgery treatment.

Dermoid of the Posterior Fossa in Chiari II Malformation: The First Reported Case.

Dermoid cysts are rare lesions, particularly in children. Chiari II malformations are seen in patients with myelomeningocele. Here, we present a child with Chiari II malformation who, during a Chiari II decompression, was found to have a dermoid cyst. To the best of our knowledge, this is the first such case ever reported.

The relationship between the superior petrosal sinus and the porus trigeminus: an anatomical study.

OBJECT: During intracranial approaches to the skull base, vascular relationships are important. One relationship that has received scant attention in the literature is that between the superior petrosal sinus (SPS) and the opening of the Meckel cave (that is, the porus trigeminus). METHODS: Cadaver dissections were performed in 25 latex-injected adult cadaveric heads (50 sides). Specifically, the relationship between the SPS and the opening of the Meckel cave was observed. The goal was to enhance knowledge of the relationship between the SPS and the opening of the Meckel cave. RESULTS: Of the 50 sides, 68%, 18%, and 16% of SPSs traveled superior to, inferior to, and around the opening to the Meckel cave, respectively. In the latter cases, a venous ring was formed around the proximal trigeminal nerve. No sinus entered the Meckel cave. In general, the porus trigeminus was narrowed on sides found to have an SPS that encircled this region. Sinuses that traveled only inferior to the porus were in general smaller than sinuses that traveled superior or encircled this opening. No statistically significant differences were noted between the various sinus relationships and sex, age, or side of the head. CONCLUSIONS: Knowledge of the relationship between the SPS and the opening of the Meckel cave may be useful to the skull base surgeon. Based on this study, some individuals may retain the early embryonic position of their SPS in relation to the trigeminal nerve.