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Osamu Akiyama, Ken Matsushima, Abuzer Gungor, Satoshi Matsuo, Dylan J. Goodrich, R. Shane Tubbs, Paul Klimo Jr., Aaron A. Cohen-Gadol, Hajime Arai and Albert L. Rhoton Jr.

T he pulvinar, the largest and most posterior thalamic nucleus, is one of the most inaccessible sites in the brain. It can be the site of pathological lesions such as cavernous and arteriovenous malformations and gliomas. 7 , 14 , 19 , 34 , 43 The pulvinar is located adjacent to the interhemispheric fissure , partially in the lateral ventricle and partially in the cisterns in the posterior part of the tentorial incisura. Operative indications for approaching the pulvinar are a matter of debate, and surgical approaches are challenging because of the complex

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Wolfgang J. Weninger and Gerd B. Mülle

Object

In this study the authors analyze the peculiarities of the parasellar anatomy and the topography of surgical approaches to the parasellar region (PSR) in human infants.

Methods

Forty-nine specimens of the PSR obtained at autopsy were studied using microdissection and histological analysis. Important distances between anatomical landmarks were measured with the aid of a dissecting microscope. One serially sectioned specimen was three-dimensionally reconstructed and analyzed on the computer screen by using the authors' new episcopic reconstruction technique.

The anatomy of the infant PSR differs distinctly from that of the adult. The parasellar portion of the internal carotid artery (ICA) does not form a siphon, but takes a straight course, and the venous pathways as well as the cranial and sympathetic nerves have different topographical relationships. Analyses of surgical approaches demonstrate that, in young children, the anterolateral approach can be used to reach the pterygopalatine compartment, the superior ophthalmic vein, and those pathological processes that extend from the orbit into the PSR. The approach via Parkinson's triangle can be used in 45% of cases to access the pathological processes that occur in the voluminous space above and behind the posterior flexure of the parasellar ICA. Taking this route, sympathetic nerve fibers passing through the PSR are not at risk, but some arterial branches that run within the lateral wall of the sinus can complicate this approach.

Conclusions

This study presents a guideline that can assist radiologists and neurosurgeons in the planning and performance of interventions within the PSR of neonates and young children.

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Jean-François Hirsch and Christian Sainte-Rose

surface of the tumor. The first part of this article describes a new technique that minimizes the cortical damage due to this surgical approach. Surgical approaches to deep cerebral tumors often require the opening of a ventricle either because the lesion cannot be reached without a transventricular approach (such as a thalamic tumor), because the lesion is located within the ventricle, or because part of a ventricular wall is invaded by the lesion. In some cases a communication is established between the ventricle and the subdural space; this often leads to

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Jorge A. Monges, Marcelo Galarza, Fidel P. Sosa and Alejandro Ceciliano

large meningeal vessels, or less frequently, from pial cerebral vessels. 4 Transarterial embolization is useful to reduce shunt flow. Although direct puncture of the venous pouch through the posterior fontanel and transvenous embolization are theoretically possible, the transfemoral and transumbilical venous approaches are reported as being technically easier and safer. 3 We attempted a direct surgical approach of the AVF with subsequent removal of the clot. We believed that interventional angiography was not possible to implement. Although a direct surgical

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Samuil M. Blinkov, Gabib A. Gabibov and Vassiliy A. Tcherekayev

) nervus trochlearis; 3) nervus frontalis; 4) musculus levator palpebrae superioris; 5) m. obliquus superior; 6) vein from a muscle; 7) orbital fat; 8) superficial vein; 9) periorbita; 10) m. rectus superior; 11) vein from a muscle; 12) orbital fat; 13) artery to a muscle; 14) arteria lacrimalis; 15) vena lacrimalis; 16) nervus lacrimalis. Fig. 3. Diagrams showing different surgical approaches to the orbital part of the optic nerve. A: Muscles lying under the roof of the orbit: musculus obliquus superior (1); m. levator palpebrae superioris (2); m. rectus

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Edward F. Chang, Rodney A. Gabriel, Matthew B. Potts, Mitchel S. Berger and Michael T. Lawton

T he potential and specific risks of surgery for eloquent CMs are directly associated with the surgical approach to and resection of the lesion. Although general agreement exists for resection of symptomatic CMs when surgical risks are acceptably low, the optimal management of eloquent CMs located in the supratentorial compartment is unclear. Deep and eloquent regions in the supratentorial compartment include those areas that would produce significant neurological impairment from injury, including the thalamus, basal ganglia, sensorimotor cortex, language

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Gabrielle Santangelo, Jonathan Stone, Tyler Schmidt, G. Edward Vates, Howard Silberstein and Pierre Girgis

P enetrating spinal trauma in the pediatric population is relatively rare. One recent report shows the incidence of spinal trauma in children to be less than 10% of all spinal trauma cases, and of these, only 4% were penetrating wounds. 13 We report the case of a 3-year-old girl in whom a wooden splinter penetrated the thecal sac and cauda equina. The appearance of the splinter in images obtained using different imaging modalities is discussed along with the surgical approach. Case Report Presentation The patient is a 3-year-old girl with no significant medical

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Tomoaki Kinoshita, Isao Ohki, Kenneth R. Roth, Kageharu Amano and Hideshige Moriya

, wearing a light canvas corset, and were discharged home as soon as they were independently ambulatory. Discussion Bilateral fenestrations or laminotomies via the traditional surgical approach, which preserve the central part of the posterior osteoligamentous arch, also offer a significant advantage in terms of conferring vertebral stability compared with total laminectomy; 15, 20 however, the former may not provide adequate central decompression of the thecal sac. Thus, these procedures are not preferred in the treatment of degenerative spondylolisthesis in

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Vincent Y. Wang, Adam S. Kanter and Praveen V. Mummaneni

O ssified ligamentum flavum in the thoracic spine is a rare cause of myelopathy, with most reports coming from the Japanese and Chinese literature. 1 , 3 , 5 , 7 , 8 Infrequent cases have also been reported among other ethnic groups. 2 , 10 The majority of patients present following an extended period of increasing symptoms. Surgical decompression with a wide laminectomy or laminoplasty has remained the standard treatment for OLF. We present a case of OLF removed via a minimally invasive surgical approach by using an expandable tubular retractor system

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Ryuta Suzuki, Jun-ichiro Asai, Goro Nagashima, Hiroshi Itokawa, Chih-Wei Chang, Masayuki Noda, Michio Fujimoto and Tsukasa Fujimoto

% of patients still had unacceptable amounts of residual tumor after the initial resection. To achieve maximal removal of the tumor in a safe manner, we have developed a transcranial echo-guided transsphenoidal surgical approach. Several image-guided systems, including intraoperative MR imaging, fluoroscopic frameless stereotaxy, endoscopy, image-guided endoscopy, and computer-assisted navigation systems, have already been added to the transsphenoidal procedure. 4, 7, 10–12, 14 Nevertheless, this technique of transcranial echo-guided transsphenoidal surgery is