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Susumu Oikawa, Kazuhiko Kyoshima and Shigeaki Kobayashi

an aneurysm is proximal or distal to the dural ring influences surgical indications and the patient's prognosis. On the other hand, the anatomy of the carotid cave, which was introduced by Kobayashi, et al., 10 as a site for aneurysm formation, is often misunderstood. 3, 17 We report on the surgical anatomy of the juxta—dural ring area, which we studied by means of anatomical and radiographic investigations performed in cadaver specimens. Materials and Methods Twenty sides of cadaver specimens of the cavernous sinus and sphenoid bone that were fixed in

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Ulises García-González, Daniel D. Cavalcanti, Abhishek Agrawal, L. Fernando Gonzalez, Robert C. Wallace, Robert F. Spetzler and Mark C. Preul

representations of the distribution of the DVS. To the best of our knowledge, the surgical anatomy of this venous system has not previously been reported in the neurosurgical literature. Background to the Study of the DVS The DVS was first described by Guillaume Dupuytren, 14 who was best known as the first surgeon to perform successful drainage of a brain abscess in a patient with fever and seizures. His special interest in neurosurgical procedures brought his attention to these veins immersed in the diploë. Soon after, Gilbert Breschet described the anatomy of the

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Susumu Oikawa, Kazuhiko Kyoshima and Shigeaki Kobayashi

Object

The authors report on the surgical anatomy of the juxtadural ring area of the internal carotid artery to add to the information available about this important structure.

Methods

Twenty sides of cadaver specimens were used in this study. The plane of the dural ring was found to incline in the posteromedial direction. Medial inclination was measured at 21.8š on average against the horizontal line in the anteroposterior view on radiographic studies. Posterior inclination was measured at 20.3š against the planum sphenoidale in the lateral projection, and the medial edge of the dural ring was located 0.4 mm above the tuberculum sellae in the same projection. The lateral edge of the tuberculum sellae was located 1.4 mm below the superior border of the anterior clinoid process. The carotid cave was situated at the medial or posteromedial aspect of the dural ring; however, two of the 20 specimens showed no cave formation. The carotid cave contained the subarachnoid space in 13 sides, the arachnoid membrane only in three sides, and the extraarachnoid space in two sides. The authors propose that the marker of the medial side of the dural ring, which is more proximal than the lateral, is the tuberculum sellae in the lateral view on radiographic studies. In the medial aspect of the dural ring the intradural space can be situated below the level of the tuberculum sellae because of the existence of the carotid cave.

Conclusions

The authors found that an aneurysm arising from the medial side of the juxtadural ring area even below the tuberculum sellae is a potential cause of subarachnoid hemorrhage.

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Katsuyuki Asaoka, Yutaka Sawamura, Masabumi Nagashima and Takanori Fukushima

direct communication between the hypoglossal and facial nerves. The distance from the pes anserinus, which is the diverging point of the facial nerve trunk in the parotid gland, to the external genu in the facial canal and the distance from the pes anserinus to the nearest point on the high-cervical hypoglossal nerve were measured. Dissection for Surgical Anatomy Microsurgical dissections were performed under an operating microscope with 4 × to 40 × magnification. All observations were made from the surgeon's angle of view, and procedures were consistent with those

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Maria Peris-Celda, Avital Perry, Lucas P. Carlstrom, Christopher S. Graffeo, Colin L. W. Driscoll and Michael J. Link

components have been previously reported, 3 , 15 , 22 , 26 but few with relevant surgical anatomy, 16 , 18 , 24 and to our knowledge none of them focusing on relationships between internal and external landmarks. Middle fossa approaches are utilized to access a variety of pathologies arising in the temporal bone, middle fossa, or posterior fossa. In the latter case, it can be the access route to lesions in the IAC, such as vestibular schwannomas, or to other posterior fossa pathologies through the petrous apex. The classical middle fossa approach without frontotemporal

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R. Shane Tubbs, Elizabeth C. Tyler-Kabara, Alan C. Aikens, Justin P. Martin, Leslie L. Weed, E. George Salter and W. Jerry Oakes

that functional improvement following decompression of this nerve can be expected up to 1 year after surgery. Performing surgery more than 1 year following injury in symptomatic patients is associated with a poorer prognosis for functional recovery. 21 Conclusions We have identified the surgical anatomy of the QS, a potential site of entrapment for the axillary nerve. Fascial bands appear to be a normal finding in cadaveric specimens, with none demonstrating gross muscle atrophy of the deltoid or teres minor muscles. The axillary nerve should be situated in

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Allan H. Friedman

The author describes and details the anatomy of the carpal tunnel and surrounding structures pertinent to the surgical treatment of carpal tunnel syndrome. Potential complications of both open and endoscopic carpal tunnel release are discussed as well as techniques to avoid or minimize poor patient outcomes.

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Sam Safavi-Abbasi, Noritaka Komune, Jacob B. Archer, Hai Sun, Nicholas Theodore, Jeffrey James, Andrew S. Little, Peter Nakaji, Michael E. Sughrue, Albert L. Rhoton and Robert F. Spetzler

.6 None; no CSF leak APF = anterior pericranial flap; FU = follow-up; GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; MCC = motorcycle collision; MVC = motor vehicle collision; NF1 = neurofibromatosis type 1; TFPF = temporalis fascia-pericranial flap. Results Surgical Anatomy of the Scalp The numerous layers of well-vascularized tissue that constitute the scalp allow for several flap options during flap selection for skull base repair. The scalp consists of skin, subcutaneous tissue, galea aponeurotica, subgaleal loose connective tissue, and

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Limin Xiao, Shenhao Xie, Bin Tang, Jialing Hu and Tao Hong

the surgical anatomy and technical nuances of the EEAC approach in 6 cadaveric heads. The surgical experience and results of this novel approach are also presented in treating 6 patients with tumors and aneurysms involving the paraclinoid region. Methods Microsurgical and Endoscopic Dissections Six embalmed and injected adult cadaveric heads were prepared for microsurgical and endoscopic dissection. The research was approved by our institutional ethics committee. The heads were positioned supine and tilted 15° to the right. The supratentorial cerebral lobes were

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Wei-Hsin Wang, Stefan Lieber, Roger Neves Mathias, Xicai Sun, Paul A. Gardner, Carl H. Snyderman, Eric W. Wang and Juan C. Fernandez-Miranda

only represents the first and most basic step required for the exposure of the foramen lacerum. In this study we investigated the surgical anatomy of the foramen lacerum and its adjacent structures using cadaveric dissections and imaging studies, propose several key surgical landmarks, and demonstrate the surgical technique for its full exposure with illustrative cases. Methods Anatomical Dissection Ten lightly embalmed human head specimens were prepared for dissection by cannulation of the carotid arteries, vertebral arteries, and internal jugular veins and injected