Neurosurgical focus: Video最新文献

A 51-year-old female presented with an olfactory groove meningioma causing seizures, confusion, and anosmia. Large tumor size and frontal lobe edema can complicate resection in a single-stage craniotomy and lead to brain injury secondary to intraoperative retraction. Moreover, complete resection by the endoscopic endonasal approach (EEA) alone is not feasible given the lateral extent of the tumor. A two-stage resection with a transcribriform transplanum EEA, followed by a fronto-temporo-parietal craniotomy 4.5 months later, was performed. The EEA allows for initial decompression, devascularization, and reduction of edema, which may decrease the morbidity of craniotomy by reducing the significance of frontal lobe retraction. The video can be found here: https://stream.cadmore.media/r10.3171/2025.10.FOCVID25185.

Anterior skull base meningiomas can be approached via frontotemporal, interhemispheric, lateral supraorbital (LSO), transeyebrow supraorbital, or endonasal transsphenoidal approaches. The LSO approach, with extensive orbital roof drilling, provides a sufficient corridor to reach tumors located most anteriorly while achieving a favorable cosmetic outcome. This video demonstrates the utility of the LSO approach for resection of a large olfactory groove meningioma infiltrating the pia mater and clipping of a large anterior communicating artery (Acom) aneurysm. Even for a superiorly projecting Acom aneurysm, the space created after tumor resection allowed wide interhemispheric dissection and adequate exposure of the aneurysm. The video can be found here: https://stream.cadmore.media/r10.3171/2025.10.FOCVID25165.

Suprasellar meningiomas present operative challenges because of their involvement with cranial nerves and neurovascular structures. The optimal approach for suprasellar meningiomas encasing the optic nerve remains debated. This video presents a patient with profound vision loss limited to hand motion, arising from a calcified suprasellar meningioma with 360° optic nerve encasement, which was resected via an anterolateral approach with extradural anterior clinoidectomy followed by an endoscopic endonasal approach. Postoperatively, vision improved to 20/30 at 2 months with no recurrence at 2 years. This case highlights the complementary roles of transcranial and endonasal strategies in safely resecting an intraosseous suprasellar meningioma encasing the optic nerve. The video can be found here: https://stream.cadmore.media/r10.3171/2025.10.FOCVID25187.

Tuberculum sellae meningiomas often compress the optic apparatus and encase the ACA-ACom complex, making approach selection challenging. This video demonstrates endoscopic endonasal resection of a large, recurrent, tuberculum sellae meningioma with severe adherence to the ACA-ACom complex. A transplanum-transtuberculum corridor provided direct access to the dural base, enabling early tumor devascularization and meticulous dissection of microvasculature to the optic nerves, pituitary stalk, and hypothalamus. Unroofing the optic canal facilitated early optic nerve decompression, reducing the risk of neural injury during tumor manipulation. Multilayer skull base reconstruction achieved watertight closure. Gross-total resection was achieved without ischemic sequelae, and postoperative visual function improved significantly. The video can be found here: https://stream.cadmore.media/r10.3171/2025.10.FOCVID25148.

Large meningiomas of the midline anterior skull base do not respect anatomical boundaries. Therefore, a giant planum sphenoidale meningioma has the unique risk of simultaneously endangering the olfactory and visual functions. A pterional approach to such cases has several advantages, and the Dolenc's modification allows a complete extradural anterior clinoidectomy, early release of compressed optic nerve, and exposure of basal portions of the internal carotid artery with a possible operative corridor expansion. This enhances tumor resection ergonomics with a more basal angle of attack while visualizing the anterior-to-posterior expanse of the entire anterior skull base. The video can be found here: https://stream.cadmore.media/r10.3171/2025.10.FOCVID25172.

The authors present the resection of an anterior skull base parasellar meningioma causing vasogenic edema due to compression of the frontopolar vein. A contralateral orbitopterional craniotomy was chosen to provide a minimally invasive approach while avoiding morbidity from a bifrontal approach. Extradural removal of the orbital roof minimized frontal lobe retraction. The infrafrontal corridor enabled identification and preservation of the olfactory and optic nerves, the carotid artery, and the frontopolar vein. Circumferential microsurgical dissection with low-power bipolar coagulation enabled en bloc tumor removal. Postoperative MRI confirmed gross-total resection, resolution of the edema, and preservation of the vein. The patient had an uneventful recovery and intact neurological function at the 5-week follow-up. The video can be found here: https://stream.cadmore.media/r10.3171/2025.10.FOCVID25189.

This video demonstrates endoscopic transnasal "microsurgery" for a suprasellar meningioma involving the anterior communicating artery complex. A 44-year-old woman presented with visual loss due to a suprasellar tumor. Preoperative three-dimensional simulation aided in planning the expanded skull base exposure. Using bimanual dissection and meticulous vascular handling, the tumor was resected while preserving critical structures. Skull base reconstruction employed multilayered techniques with dural suturing. This case illustrates how endoscopic microsurgical strategies enable safe resection of anatomically challenging tumors, combining the benefits of endoscopic visualization and microsurgical precision for optimal outcomes. The video can be found here: https://stream.cadmore.media/r10.3171/2025.10.FOCVID25131.

Meningiomas may enlarge during pregnancy. This video presents a case of an anterior clinoidal meningioma that showed rapid growth during a patient's second trimester of pregnancy, leading to marked stenosis of the internal carotid artery (ICA). In clinoidal meningiomas, early identification of the proximal ICA and middle cerebral artery is essential for safe orientation and efficient resection. However, a narrowed ICA increases the risk of dissection and, in young patients with large tumors, securing distal control can be challenging. This video highlights technical nuances for safe dissection in such cases. The video can be found here: https://stream.cadmore.media/r10.3171/2025.10.FOCVID25130.

Tuberculum sellae meningioma (TSM) causes disproportionate vision loss due often to an associated bony hypertrophy or an intradural tumor invasion into the optic canals. Several surgical approaches are available for resecting the TSMs. A contralateral transcranial approach from the side of better/normal vision may be beneficial in asymmetrical TSMs. It allows a favorable angle of attack and access to the medial wall of the affected optic canal. Here, the authors demonstrate the technique of a contralateral supraorbital eyebrow approach (c-SOA) that could be useful in a specific subset of TSMs with good oncological and cosmetic outcome. The video can be found here: https://stream.cadmore.media/r10.3171/2025.10.FOCVID25166.

Scalp arteriovenous fistulas are abnormal connections between scalp arteries and draining veins without an intervening capillary bed. They may present as discolored nodules or pulsatile soft scalp lesions. These lesions are most commonly fed by the superficial temporal and occipital arteries with venous drainage typically occurring through extracranial veins. Intracranial venous drainage is rare. Management options include surgical excision, endovascular embolization, or direct intralesional sclerosing agent injection. Here the authors present a case of a scalp arteriovenous fistula with intracranial drainage treated with microsurgical resection by an expert interdisciplinary team, highlighting the importance of collaborative, tailored treatment strategies for optimal outcomes. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID25109.