Neurosurgical focus: Video最新文献

Atypical skull base meningiomas are characterized by aggressive growth and neurovascular invasion, which complicate resection and predispose to high recurrence rates. Lesions encasing major vessels and cranial nerves or refractory to surgery and radiation therapy are associated with significant morbidity, while systemic therapies remain largely ineffective despite ongoing trials. Their management, therefore, necessitates advanced microsurgical strategies. We describe a radiation-induced WHO grade II atypical meningioma extensively involving the cavernous sinus, supra-/parasellar, and petroclival regions in a patient with 6 prior surgeries, 2 Gamma Knife treatments, and multiple systemic therapies, presenting with ophthalmoplegia and right-eye blindness, treated using a three-stage surgical approach. The video can be found here: https://stream.cadmore.media/r10.3171/2025.10.FOCVID25163.

Anterior clinoid meningiomas are challenging lesions due to their proximity to critical neurovascular structures. Traditional surgical approaches often require extensive bone removal and brain retraction, increasing the risk of complications. The transorbital endoscopic approach has emerged as a novel, minimally invasive alternative, offering direct access to the anterior cranial base and parasellar region through the orbital cavity, minimizing manipulation of brain tissue while maintaining effective tumor resection. Current evidence supports its feasibility and safety in selected skull base cases. The authors present the case of a 66-year-old woman with a recurrent atypical anterior clinoidal meningioma previously treated with a frontotemporal craniotomy. The video can be found here: https://stream.cadmore.media/r10.3171/2025.10.FOCVID25171.

Large anterior skull base meningiomas with sinonasal invasion pose a challenge not only for safe resection but also for tackling reconstruction of the anterior skull base. Here, in this video, the authors present the case of a 35-year-old female with a biopsy-proven WHO grade II meningioma who required a combined transcranial and endoscopic endonasal approach. This combined approach allowed for excellent tumor exposure, complete safe resection, and, importantly, durable and appropriate skull base reconstruction. The video can be found here: https://stream.cadmore.media/r10.3171/2025.10.FOCVID25157.

Anterior skull base meningiomas often cause visual decline by compressing the optic apparatus. The authors present a tuberculum sellae meningioma with optic canal involvement treated via an endoscopic endonasal approach (EEA). Early devascularization, stepwise detachment, and sharp dissection preserved surrounding neurovascular structures and perforating arteries. Optic canal drilling enabled complete removal, and multilayer reconstruction ensured watertight closure. Gross-total resection was achieved without complications. Visual acuity improved from 0.7 to 1.2, with resolution of visual field defect. This case highlights the EEA as a standard technique for optimal visual outcomes in anterior skull base meningiomas with optic canal involvement. The video can be found here: https://stream.cadmore.media/r10.3171/2025.10.FOCVID25176.

Olfactory groove meningiomas represent a surgical challenge due to their intimate relationship with the anterior cranial fossa, olfactory tracts, and critical neurovascular structures. In this video, the authors present a microsurgical resection of an olfactory groove meningioma through a right frontolateral approach. This technique provides a wide operative corridor with minimal frontal lobe retraction, early devascularization of the tumor, and anatomical preservation of the contralateral olfactory tract. Stepwise dissection, relevant microsurgical anatomy, and surgical pearls are demonstrated. The video highlights the safety and rationale of this approach for selected anterior skull base meningiomas with emphasis on olfactory function preservation. The video can be found here: https://stream.cadmore.media/r10.3171/2025.10.FOCVID25173.

The standard treatment for planum sphenoidale meningiomas (PSMs) and olfactory groove meningiomas (OGMs) is resection. Traditional transcranial approaches and a variety of minimally invasive techniques, such as endoscopic endonasal and endoscope-assisted subfrontal approaches, have risen in popularity. The authors describe a surgical technique for PSMs and OGMs using a purely endoscopic subfrontal keyhole approach (PESKA). Gross-total resection was achieved in all patients using PESKA. There were no new neurological symptoms postoperatively. PESKA for PSMs and OGMs is a useful surgical technique that allows for a smaller craniotomy and faster surgery, resulting in less invasiveness for patients. The video can be found here: https://stream.cadmore.media/r10.3171/2025.10.FOCVID25145.

Meningiomas invading the ventromedial optic canal are uncommon anterior cranial fossa tumors that present with progressive visual decline. Their close relationship with the optic nerve and ophthalmic artery makes surgical intervention highly complex. This video presents two illustrative cases-an optic nerve sheath meningioma and an optic canal meningioma-both treated using an endoscopic endonasal approach (EEA). This direct ventral corridor provides early optic canal decompression and panoramic visualization of critical neurovascular structures, avoiding optic nerve manipulation. The same technique was employed in both cases, but was tailored to the distinct surgical challenges of optic nerve sheath and optic canal meningiomas. The video can be found here: https://stream.cadmore.media/r10.3171/2025.10.FOCVID25196.

Olfactory groove meningiomas are slow-growing tumors arising from the dura of the cribriform plate and adjacent to the crista galli in the anterior cranial fossa. These tumors are frequently diagnosed late and may reach a very large size. Several surgical approaches have been described for olfactory groove meningiomas. The pterional transsylvian approach facilitates preservation of the olfactory nerves in most cases, allows for gross-total resection, and provides early access to vital structures. This video presents the successful treatment of a patient with an olfactory groove meningioma, with preservation of the bilateral olfactory nerves via the pterional transsylvian approach. The video can be found here: https://stream.cadmore.media/r10.3171/2025.10.FOCVID25181.

Anterior clinoidal meningiomas are among the most complex skull base tumors because of their proximity to the optic apparatus, internal carotid artery (ICA), and its branches. When vessels are engulfed or encased, the difficulty of resection and the risk to the vasculature increase significantly. Surgical management requires balancing maximal resection with neurovascular preservation. The authors present 2 cases with ICA engulfment. The first involved anterior choroidal artery injury managed using collateral assessment, neurophysiological monitoring, and indocyanine green angiography as a surrogate intraoperative balloon test occlusion. The second emphasizes meticulous dissection and progressive debulking to achieve gross-total resection while preserving neurological function. The video can be found here: https://stream.cadmore.media/r10.3171/2025.10.FOCVID25169.

The endoscopic endonasal approach has emerged as an effective and minimally invasive technique for the management of tuberculum sellae meningiomas. A 53-year-old woman with progressive visual deterioration due to a tuberculum sellae meningioma extending into the optic canal underwent endoscopic endonasal resection with optic canal decompression. Gross-total removal was achieved using a "French-door" dural opening and angled dissection, resulting in Simpson grade II resection with the preservation of neurovascular structures. Optic canal opening enabled safe tumor removal and significant visual improvement. Reconstruction employed sutured fascia lata grafts and a sphenoid sinus mucosal flap resulted in no postoperative cerebrospinal fluid leakage. The video can be found here: https://stream.cadmore.media/r10.3171/2025.10.FOCVID25151.