搜索结果：Neurosurgical focus: Video

White matter microdissection represents a valuable method for studying the three-dimensional organization of the human brain. Building on Klingler's classical technique, this approach has regained importance as both a research and educational tool in microneurosurgery. While the white matter dissection of the lateral aspect of the brain has been extensively described, the medial surface has received comparatively less attention. This article represents the second part of a three-paper series on white matter microdissection. It provides a structured, step-by-step demonstration of the dissection of the medial aspect of the brain, with a specific focus on the limbic lobe. As in the first paper, the core content is the supplementary video, which, through editing and annotation, has an enhanced didactic value. The dissection was performed according to the Klingler technique and recorded during the 8th Sulci, Gyri, Ventricles and Fiber Dissection Hands-on Course (Taipei, 2025). The procedure was conducted under microscopic magnification and edited into a didactic video presentation. All identifiable participants provided informed consent for publication. The dissection proceeds through nine main stages, beginning with the identification of the medial sulci and gyri and continuing with the sequential removal of cortical layers and white matter bundles. This systematic approach exposes the cingulum, inferior longitudinal fasciculus, callosal fibers, hippocampal formation, tapetum, thalamic peduncles, and mammillothalamic tract, illustrating the organization of the limbic lobe and the relationships between major white matter tracts and the ventricular walls. This work presents a comprehensive and didactic video demonstration of the medial hemispheric white matter dissection, highlighting the continuity and spatial relationships of limbic and periventricular structures. It contributes to a systematic and anatomically grounded understanding of cerebral white matter organization and supports the educational role of white matter microdissection in neurosurgical anatomy.

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.

Open-door laminoplasty is an established posterior decompression technique for multilevel cervical myelopathy. However, the procedure is technically demanding and may result in complications such as hinge fracture, facet joint violation, and improper gutter placement. The authors present an operative video demonstrating O-arm-based intraoperative navigation during open-door laminoplasty in a 75-year-old man with multilevel ossification of the posterior longitudinal ligament (OPLL) and severe cervical canal stenosis. Navigation allowed precise localization of the medial facet, controlled hinge preparation, and accurate screw placement. Postoperative CT confirmed adequate decompression without complications, suggesting that navigation may enhance the safety and precision of laminoplasty. The video can be found here: https://stream.cadmore.media/r10.3171/2026.4.FOCVID2630.

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.

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.

Surgeons' visual and ergonomical challenges are long-standing concerns since the use of microscopes in surgical procedures. Although devices have been improved in the last few decades, the problem of narrow visual fields in high magnification surgeries persists. This study aims to identify the visual ergonomics challenges among microsurgeons and assess the need for novel assistive surgical solutions. The study consisted of two parts: a survey and a hands-on experiment. Sixteen surgeons from neurosurgery and otolaryngology (ENT) specialties were invited to semi-structured interviews on challenges encountered when using surgical microscopes and evaluation of the two proposed technological solutions: CPM (context-preserving magnification) and IT (instrument transparency). Following a demonstration of these software solutions, a survey utilizing a Likert scale was administered. The second part of the study involved twelve practicing neurosurgeons who performed a task using a novel solution and compared it to a standard operative microscope setting. The most common challenges reported were visual obstruction of field by instruments (93.75%), blurring of structures and light reflection (81.25%), and loss of context (68.75%). 50% of surgeons agreed that adjusting zoom and focus takes a considerable amount of time from surgery and 56% stated that they had at least one episode of difficulty seeing depth. Notably, 69% of respondents expressed interest in testing prototypes of both proposed solutions in real surgery, with a particular preference for instrument transparency. Furthermore, the context-preserving magnification solution hands-on trial demonstrated a 40% reduction in task completion time for 60% of participants. However, one participant found no advantage, and others took longer to complete tasks with the solution compared to standard settings. Our solution addresses the top visual challenges and instrument obstruction remains a top challenge in high magnification microsurgery. We showed that surgeons are highly likely to use novel assistive technologies that provide wider visual field and transparent instruments.

Complications from spine surgery are not just devastating because they happen, or because we believe that complications can be avoided, but are magnified because many of the complications occur in elective cases. Catastrophic outcomes in surgeries that are intended to improve lifestyle and comfort do not fit our sensibility. In the first Neurosurgical Focus issue on complications published in October 2024, most of the complications shared involved cranial neurosurgery. Many of these complications occurred in cases in which there was no acceptable option except to operate, such as cases involving extensive arteriovenous malformations, tumors, and aneurysms. In life-threatening diseases, the existence of challenged outcomes is often considered the trade-off. In spine surgery, however, we face risks of worse functional outcomes in patients who often have other options. We roll stochastic dice with each surgery. A 2% risk of a certain complication occurs with random precision and strikes with 100% completeness. This makes complications in spine surgery hard to express to patients in their full reality, hard to process for the surgeon when they do occur, and sometimes hard to bring to light, because the presence of a serious complication in an elective case horrifies. This issue of Neurosurgical Focus, like the laudable issue before, attempts to grapple with these challenges by presenting spinal complications in all of their attendant difficulties. These case illustrations were all written by esteemed and senior neurosurgeons who share hundreds of years of experience among them. The authors have a track record of sound judgment and technical excellence but are laying bare the challenges they have faced, primarily because they recognize the benefits of awareness and of the personal lessons they learned. A layer of anonymity is created by disassociating individual work from the authors. Videos were narrated by an individual who was not involved in video or case preparation.

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.

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.

This video demonstrates the role of navigation in optimizing awake single-position prone lateral transpsoas interbody fusion with simultaneous posterior decompression and instrumentation under spinal anesthesia. Awake spine surgery is constrained by the duration of spinal anesthesia and demands a coordinated workflow, making navigation essential. The patient was a 77-year-old man with significant cardiac comorbidities and neurogenic claudication from severe L3-4 stenosis. Technical pearls are presented addressing navigational accuracy in the conscious patient and strategies promoting near-simultaneous workflow between the lateral and posterior approaches. Navigation supports both procedural accuracy and workflow efficiency throughout the case. The video can be found here: https://stream.cadmore.media/r10.3171/2026.4.FOCVID25238.

Fetal closure of an open neural tube defect offers the potential to limit progressive neurological injury and improve long-term outcomes. Myeloschisis presents unique challenges due to the technical complexity of mobilizing the skin and achieving adequate soft tissue coverage, particularly in the sacral region. In this video, the authors demonstrate an open fetal myeloschisis closure in a fetus with an S1-level defect and associated grade 3 hindbrain herniation. The preoperative counseling process, surgical technique, and perioperative course are highlighted, with a focus on pearls for the exposure and closure of the uterus. The video can be found here: https://stream.cadmore.media/r10.3171/2026.1.FOCVID25231.

Integrating robotics with neuronavigation and tubular dilation enables minimally invasive posterior stabilization and tumor resection. A 40-year-old woman presented with diffuse spinal metastases with spinal cord compression. This surgical video demonstrates the authors' entire minimally invasive workflow for robot-assisted percutaneous pedicle screw placement, arthrodesis, and navigated tubular resection. The authors review their institutional experience with 14 cases using this workflow. The advantages of this approach include the high accuracy of pedicle screw placement, minimal blood loss, and expedited time to postoperative chemoradiation therapy compared to traditional open, nonrobotic approaches. The video can be found here: https://stream.cadmore.media/r10.3171/2026.4.FOCVID25225.

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.

Prenatal surgery for open spina bifida has demonstrated improved neurological and functional outcomes compared to postnatal closure. However, open fetal surgery is associated with increased obstetric complications. Minimally invasive fetoscopic approaches were developed to decrease maternal morbidity from large hysterotomies while preserving fetal benefits. Single- and two-layer fetoscopic closure techniques have been described but there is concern for the ability to achieve watertight closure. Watertight closure is critical for preventing postoperative complications, particularly cerebrospinal fluid leakage and wound dehiscence. This video describes a case presentation for a novel three-port, three-layer fetoscopic repair modeled after a postnatal closure technique. The video can be found here: https://stream.cadmore.media/r10.3171/2026.1.FOCVID25230.

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.

Evacuating intrauterine hematomas during fetoscopic myelomeningocele repair can be challenging. The NICO Myriad (Stryker Inc.) has been previously described to resect brain tumors, as an adjunct in intraventricular neuroendoscopy, and, most recently, has been proven to effectively remove intracerebral hematomas at clinical and cost-effective significance. This device has not been described in fetal neurosurgery. In this video, the NICO Myriad was utilized during a minilaparotomy fetal myelomeningocele repair to mechanically aspirate an intrauterine hematoma noted at the end of the operation. The surgical technique and technical nuances of using the NICO Myriad during fetoscopic myelomeningocele repair are reviewed. The video can be found here: https://stream.cadmore.media/r10.3171/2026.1.FOCVID25233.

Single-position lateral decubitus lumbar interbody fusion has been shown to be an effective alternative to the classic two-stage approach. The application of 3D navigation can facilitate single-position surgery with the benefit of significantly reducing radiation exposure. In this operative video, use of 3D navigation for lateral percutaneous screw placement is highlighted, followed by key steps in leveraging navigation for the lateral lumbar interbody fusion. Nuances in the use of 3D navigation for the lateral portion of the surgery are emphasized for challenging cases with disc space collapse and lateral osteophytes. The video can be found here: https://stream.cadmore.media/r10.3171/2026.4.FOCVID2636.

Minimally invasive spine surgery continues to evolve, with the single-position prone transpsoas lateral approach offering simultaneous lateral and posterior access without repositioning. This technique minimizes tissue disruption while enabling efficient single-position surgery. The authors present the case of a 57-year-old male with left-sided back pain and radiculopathy recalcitrant to conservative treatment. MRI revealed multilevel degeneration, with single photon emission CT (SPECT) highlighting L2-3 pathology. After exhausting conservative measures, he underwent a minimally invasive prone lateral lumbar interbody fusion at L2-3 with the use of navigation. This video highlights the technical steps and advantages of this approach and navigated technique. The video can be found here: https://stream.cadmore.media/r10.3171/2026.4.FOCVID2639.

Fetal repair of myelomeningocele remains an effective intervention to decrease hindbrain herniation and reduce the need for postnatal CSF shunting. Effectiveness depends on a watertight closure; however, there are challenges to achieving such. Often, a separate, watertight dural closure is difficult due to the thinness and fragility of the dural membrane. This video demonstrates the approach utilizing a previously described myofascial rotation of the bilateral paraspinal muscles to construct a robust closure even without the need for a separate dural closure or patch reinforcement. This method has been associated with improved primary closure rates and fewer postnatal procedures. The video can be found here: https://stream.cadmore.media/r10.3171/2026.1.FOCVID25235.