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Background and Objectives: This study aims to evaluate the adequacy of the liberal transfusion strategy applied in patients undergoing endoscopy-assisted Metopic, Coronal, or Sagittal craniosynostosis surgery according to the Pre-Transfusion and Post-Transfusion Estimated Red Blood Cell Mass (ERCM) ratios. Materials and Methods: This retrospective cohort study, conducted at the Pamukkale University Faculty of Medicine (2017–2023), utilized anesthesia, surgical records, and hospital electronic data of patients undergoing endoscopic craniosynostosis surgery. The primary endpoints were the rates of Post-Transfusion 1st-hour ERCM/Pre-Transfusion ERCM (%) and Post-Transfusion 24th-hour ERCM/Pre-Transfusion ERCM (%). The secondary endpoints were determined as Hemoglobin (Hb) and Hematocrit (Hct) values at the 1st and 24th hours after surgery, Calculated Blood Loss (CBL) during surgery (%), total 24 h CBL (%), ERCM (%), and Estimated Blood Loss (EBV) during surgery and total 24 h transfusions, Packed Red Blood Cells (PRBCs) (mL/kg) amounts during surgery, and total 24 h transfusions. Results: A total of 86 pediatric craniosynostosis cases were evaluated and categorized into Metopic (n = 38), Sagittal (n = 33), and Coronal (n = 15) groups, with Post-Transfusion evaluation conducted across these groups. Post-Transfusion 1st-hour ERCM/Pre-Transfusion ERCM ratios were found to have median values of 90.70% in the Metopic group, 91.61% in the Sagittal group, and 93.09% in the Coronal group. Post-Transfusion 24th-hour ERCM/Pre-Transfusion ERCM ratios were found to be median values of 94.05% in the Metopic group, 88.3% in the Sagittal group, and 87.08% in the Coronal group. Conclusions: The liberal transfusion strategy provided adequate transfusion, maintaining ERCM ratios within the 85–115% range across all groups. Significant decreases in Hb and Hct levels were observed from preoperative to postoperative measurements at 1 and 24 h. Changes in CBL, ERCM, EBV, and PRBC volumes were noted between the postoperative 1 h and 24 h measurements across all groups.

Most of the primary brain tumours are located in the supratentorial region, and it is uncommon to see tumour growth on deep brain structures such as posterior corpus callosum (PCC). In addition, lesions in PCC are also difficult to recognise, because construction apraxia, visuospatial perception and attentional capacity impairment may be the only presenting symptoms. Here, we represent a rare case of gliobastoma multiforme located in PCC, which solely presents with depressive symptoms and visual memory deficits. Initial manifestations of primary brain tumours with psychiatric symptoms and memory disturbances, in addition to headaches and seizures, should be kept in mind.

Background: In vitro specimens are suitable models for the introduction of bypass surgery training of inexperienced neurosurgeons and residents. This paper aims to provide a guide for the applications of end to side anastomosis in the laboratory. Materials and Methods: The chicken wings were purchased from a local supermarket and used to perform end to side anastomosis. The microscissors, knotting forceps and 10/0 sutures were used, and all stages of the procedure were performed under a desktop microscope. Results: The experience required for bypass surgery, which is a skillful field in neurosurgery practice, can be obtained in the chicken wing model, which is a cheap and easily accessible method. Conclusion: The chicken wing model is a practical and feasible method in training the end to side anastomosis in a microsurgery laboratory.

The technique we describe was developed for cervical foraminal stenosis for cases in which a keyhole foraminotomy would not be effective. Many cervical stenosis cases are so severe that keyhole foraminotomy is not successful. However, the technique outlined in this study provides adequate enlargement of an entire cervical foraminal diameter. This study reports on a novel foraminal expansion technique. Linear drilling was performed in the middle of the facet joint. A small bone graft was placed between the divided lateral masses after distraction. A lateral mass stabilization was performed with screws and rods following the expansion procedure. A cervical foramen was linearly drilled medially to laterally, then expanded with small bone grafts, and a lateral mass instrumentation was added with surgery. The patient was well after the surgery. The novel foraminal expansion is an effective surgical method for severe foraminal stenosis.

The angular gyrus (AG) wraps the posterior end of the superior temporal sulcus (STS), so it is considered a continuation of the superior temporal gyrus (STG)/ middle temporal gyrus (MTG) and forms the inferior parietal lobule (IPL) with the supramarginal gyrus (SMG). The AG was functionally divided in the literature, but there is no fiber dissection study in this context. This study divided AG into superior (sAG) and inferior (iAG) parts by focusing on STS. Red, blue silicone-injected eight and four non-silicone-injected human cadaveric cerebrums were dissected via the Klingler method focusing on the AG. White matter (WM) tracts identified during dissection were then reconstructed on the Human Connectome Project 1065 individual template for validation. According to this study, superior longitudinal fasciculus (SLF) II and middle longitudinal fasciculus (MdLF) are associated with sAG; the anterior commissure (AC), optic radiation (OR) with iAG; the arcuate fasciculus (AF), inferior frontooccipital fasciculus (IFOF), and tapetum (Tp) with both parts. In cortical parcellation of AG based on STS, sAG and iAG were associated with different fiber tracts. Although it has been shown in previous studies that there are functionally different subunits with AG parcellation, here, for the first time, other functions of the subunits have been revealed with cadaveric dissection and tractography images.

This study aims to demonstrate the effect of gamma knife radiosurgery (GKRS) on symptoms, hemorrhage rates, and histopathological changes in patients with cavernous malformations (CMs), regardless of whether the symptomatic lesions are hemorrhagic. This single-center retrospective study evaluated symptomatic patients with single CMs treated with GKRS between 2016 and 2023. The patients’ demographic data, presenting symptoms, GKRS radiation dose, complications developed during follow-up (hemorrhage, radiotoxicity), the rate of symptom improvement, and histopathological changes of surgically removed CMs were recorded. Our study included 134 symptomatic patients, of whom 55 were male (41%) and 79 were female (59%). Among the patients, 80 (59.7%) had CMs in the lobar region, 23 (17.1%) in the cerebellum, 16 (12%) in the brainstem, and 15 (11.2%) in the basal nuclei/thalamus. The mean target volume was 0.64 ± 1.23 cm 3 , and the mean tumor margin dose was 14.89 ± 1.90 Gy. Symptoms were completely recovered in 95 patients (70.9%), while 18 (13.4%) experienced partial recovery. The annual hemorrhage rate (AHR) reduced from 6.26 to 1.01 following GKRS. Adverse radiation effects (ARE) were encountered in ten patients (7.46%) of cases, with only three patients (2.2%) being permanent. The mean follow-up period was 35.57 ± 23.54 months (2–83 months). Two patients without hemorrhage underwent surgical removal of CM due to symptomatic deterioration after GKRS. Histopathological examination demonstrated numerous vascular structures with luminal narrowing due to hyalinization and fibrinoid necrosis caused after GKRS. Our findings suggest that GKRS may help reduce hemorrhage rates and potentially relieve symptoms in patients with symptomatic CMs, although further long-term studies are necessary to confirm these observations and to fully assess potential risks. Since there is no radiological method to evaluate the impact of GKRS on CMs, our study examines the histopathological changes that occurred following the GKRS. The histopathological changes prove that GKRS alters the morphology of the CMs and thus can relieve symptoms and reduce hemorrhage rates associated with CMs.

Abstract BACKGROUND Approaching ambient cistern lesions is still a challenge because of deep location and related white matter tracts (WMTs) and neural structures. OBJECTIVE To investigate the white matter anatomy in the course of 3 types of transtemporal-transchoroidal fissure approaches (TTcFA) to ambient cistern by using fiber dissection technique with translumination and magnetic resonance imaging fiber tractography. METHODS Eight formalin-fixed cerebral hemispheres were dissected on surgical corridor from the temporal cortex to the ambient cistern by using Klingler's method. The trans-middle temporal gyrus, trans-inferior temporal sulcus (TITS), and trans-inferior temporal gyrus (TITG) approaches were evaluated. WMTs that were identified during dissection were then reconstructed on the Human Connectome Project 1021 individual template for validation. RESULTS The trans-middle gyrus approach interrupted the U fibers, arcuate fasciculus (AF), the ventral segment of inferior frontoocipital fasciculus (IFOF), the temporal extensions of the anterior commissure (AC) posterior crura, the tapetum (Tp) fibers, and the anterior loop of the optic radiation (OR). The TITS approach interrupted U fibers, inferior longitudinal fasciculus (ILF), IFOF, and OR. The TITG approach interrupted the U fibers, ILF, and OR. The middle longitudinal fasciculus, ILF, and uncinate fasciculus (UF) were not interrupted in the trans-middle gyrus approach and the AF, UF, AC, and Tp fibers were not interrupted in the TITS/gyrus approaches. CONCLUSION Surgical planning of the ambient cistern lesions requires detailed knowledge about WMTs. Fiber dissection and tractography techniques improve the orientation during surgery and may help decrease surgical complications.

Cerebellopontine angle lipomas are rare and more rarely associated with trigeminal neuralgia especially in childhood. Medical treatment provides relief from the pain; however, the effect may not be permanent. Surgical treatment is associated with a high morbidity rate; therefore, surgery should be considered only in intractable cases. In this article we describe the clinical course and radiological features of a 6-year-old girl with a cerebellopontine angle lipoma who presented with a 4-year history of left-side trigeminal neuralgia, especially in the mandibular area. Magnetic resonance imaging revealed an extra-axial fatty mass at the level of the ‘dorsal-entry zone' of the trigeminal nerve. The pain improved with carbamazepine therapy.

Dysembryoplastic neuroepithelial tumour (DNT) is located in the cerebral cortex with very few exceptions. In this article, an extremely rare case of intraventricular DNT originating from the septum pellucidum is reported. A 25-year-old woman presented with 5-month history of headache. Cranial magnetic resonance imaging (MRI) scans revealed a mass in the right lateral and third ventricle which was hypointense on T1-weighted image, and hyperintense on T2-weighted images. No contrast enhancement was detected. The lesion was excised totally using a transcallosal-transventricular approach. Immunohistochemical examination revealed DNT. The patient was discharged without any neurological deficits. Intraventricular DNT presents with symptoms of increased intracranial pressure rather than seizures. Distinguishing DNT from other intraventricular tumours is essential as DNT is characterized by benign clinical course and does not require adjuvant therapy. Dysembrioplastyczne guzy neuroepitelialne (DNT) są umiejscowione, z nielicznymi wyjątkami, w korze mózgowej. W bieżącej pracy autorzy przedstawiają wyjątkowo rzadki przypadek chorej z DNT położonym wewnątrzkomorowo, wychodzącym z przegrody przezroczystej. Chora, 25 lat, zgłosiła się z powodu utrzymującego się od 5 miesięcy bólu głowy. W badaniu za pomocą rezonansu magnetycznego uwidoczniono guz położony w komorze bocznej prawej i w komorze trzeciej, hipointensywny w obrazach T1-zależnych, hiperintensywny w obrazach T2-zależnych i niewzmacniający się po podaniu środka kontrastowego. Guz wycięto w całości z dojścia przez ciało modzelowate i przez komorę. W badaniu immunohistochemicznym stwierdzono DNT. Chora została wypisana do domu bez ubytkowych objawów neurologicznych. Wewnątrzkomorowe DNT przejawiają się raczej wystąpieniem objawów wzmożonego ciśnienia śródczaszkowego niż napadów padaczkowych. Odróżnianie DNT od innych guzów wewnątrzkomorowych jest nieodzowne ze względu na fakt, że guz przebiega łagodnie i nie wymaga leczenia wspomagającego.