Jacques J. Morcos and Stephan A. Munich
Peter S. Amenta and Jacques J. Morcos
The cerebellopontine angle is the site for a wide-range of neoplastic and vascular pathologies. The retrosigmoid craniotomy remains the primary means by which to gain surgical access to this anatomically complex region. We present our standard technique for the completion of a retrosigmoid craniotomy and the resection of a left-sided vestibular schwannoma. Anatomy pertinent to the approach, including, the transverse and sigmoid sinuses, cranial nerves, and internal auditory canal (IAC) is displayed. Special emphasis is placed on patient positioning, adequate bone removal, and tumor resection. The drilling of the IAC and tumor dissection from the VII-VIII complex is also highlighted. Hearing preservation was achieved.
The video can be found here: http://youtu.be/FFZju5vcBi0.
Ashish H. Shah, Anthony C. Wang and Jacques J. Morcos
Superficial arteriovenous malformations (AVMs) with favorable Spetzler-Martin grading are amenable to primary surgical resection. Careful preoperative workup including preoperative angiograms is essential to identify feeding artery aneurysms and deep venous drainage. The authors present a 37-year-old female who presented with a Spetzler-Martin Grade II right parietal superficial AVM with a 5-mm feeding artery aneurysm from the posterior cerebral artery. Given the risk of hemorrhage, the AVM was resected completely without any complications. On subsequent postoperative angiograms, the feeding artery aneurysm diminished in caliber. Feeding artery aneurysms may regress spontaneously after resection of an AVM due to flow-related changes.
The video can be found here: https://youtu.be/PpwODc9iI3g.
Jacques J. Morcos
Linda Alberga, Ingrid Menendez, Howard J. Landy, Jacques J. Morcos and Allan D. Levi
The Department of Neurological Surgery at the University of Miami/Jackson Memorial Hospital's legacy of patient care, teaching, and research in the neurosciences extends over a period of 50 years. The department's founder was Dr. David Reynolds. The subsequent chairman, Dr. Hubert Rosomoff, formed a solid foundation that helped put the department on the map. Drs. Barth Green and Roberto Heros, the immediate past chair and co-chairman, garnered both national and international attention for the department. Dr. Green focused his career on complex spine and spinal cord disorders, and was pivotal in creating the world's largest research center for spinal cord injuries. Dr. Heros is a master educator and pioneer neurovascular surgeon, as well as a former president of several neurosurgical national and international organizations. In aggregate, the department has made major contributions to the foundations of neurosurgery.
Simon Buttrick, Jacques J. Morcos, Mohamed S. Elhammady and Anthony C. Wang
Extradural anterior clinoidectomy is a versatile technique to increase exposure of the sellar and parasellar region. It is of particular use in the resection of clinoidal meningiomas, as sphenoidal and clinoidal hyperostosis can cause compression of the optic nerve. Extradural clinoidectomy follows a series of steps, consisting of (1) unroofing of the superior orbital fissure, (2) unroofing of the optic canal, (3) removal of the optic strut, and (4) removal of the anterior clinoid process. The authors show these steps in detail, as well as their application to the resection of a large clinoidal meningioma.
The video can be found here: https://youtu.be/O1Fcef29ETg.
Jacques J. Morcos
Ramachandra P. Tummala, Ernesto Coscarella and Jacques J. Morcos
Resection of the petrous temporal bone to various degrees provides different levels of access to lesions of the posterior fossa. Although their nomenclature can be confusing, the numerous variants of the transpetrosal approaches can be classified broadly into anterior and posterior groups. The posterior transpetrosal approaches include the retro-labyrinthine, translabyrinthine, and transcochlear, whereas the ones in the anterior group are extensions of the basic middle fossa approach. Both the anterior and posterior approaches have the potential of exposing the cerebellopontine angle and the petroclival region.
The posterior approaches are based on the standard mastoidectomy and involve resection of the petrous bone to various degrees. This results in progressively increased exposure anteriorly, but comes at the expense of hearing in the translabyrinthine approach and of hearing and facial strength in the transcochlear approach.
In contrast, the middle fossa approaches spare the lateral petrous bone and involve resection of the medial petrous bone to various degrees. All of the middle fossa approaches are designed to preserve hearing. Extensions of the middle fossa approaches involve resection of bone within the Kawase rhomboid and division of the tentorium to provide exposure of the posterior fossa.
Toshio Matsushima, Ken Matsushima, Shigeaki Kobayashi, J. Richard Lister and Jacques J. Morcos
Dr. Albert L. Rhoton Jr. was a pioneer of the study of microneurosurgical anatomy. Championing this field over the past half century, he produced more than 500 publications. In this paper, the authors review his body of work, focusing on approximately 160 original articles authored by Rhoton and his microneuroanatomy fellows. The articles are categorized chronologically into 5 stages: 1) dawn of microneurosurgical anatomy, 2) study of basic anatomy for general neurosurgery, 3) study for skull base surgery, 4) study of the internal structures of the brain by fiber dissection, and 5) surgical anatomy dealing with new advanced surgical approaches. Rhoton introduced many new research ideas and surgical techniques and approaches, along with better microsurgery instruments, through studying and teaching microsurgical anatomy, especially during the first stage. The characteristic features of each stage are explained and the transition phases of his projects are reviewed.