The posterior wall of the cavernous sinus was studied in 15 cadaver heads (20 specimens) fixed in formalin. The heads were placed in a Sugita head holder and turned 45* from the side of dissection. The posterior wall of the cavernous sinus belongs to the dura mater of the petroclival region. It is limited superolaterally by the posterior petroclinoid ligament, medially by the dorsum sellae, and inferiorly by the petrous apex and Dorello canal. Similar to the lateral and superior wall of the sinus, the posterior wall was found to be formed by two layers: a smooth superficial dural layer and a thin less defined deep layer. This wall covers not only the posterior aspect of the cavernous sinus but a venous confluence joint also by the basilar sinus and the inferior petrosal sinus. Other anatomical structures related to the posterior wall and posterior end of the cavernous sinus are: Dorello canal, the abducens nerve, the posterior bend of the ICA with the meningo-hypophyseal trunk and its branches. The anatomy of this wall becomes important when dealing with lesions in the petroclival area.

"Letter to the Editor: Far-lateral approach with the “transverse-S” skin incision and conservative muscle dissection: a pragmatic surgical route" published on Jan 2016 by American Association of Neurological Surgeons.

Ten cadaver heads (20 specimens) fixed in formalin were dissected for this study. The heads were placed in Sugita head holder, turned 45* from the side of dissection and extended slightly to simulate the surgical position. A frontotemporal craniotomy was performed and the zygomatic arch together with part of the greater wing of the sphenoid bone removed. With the aid of the operating microscope, an extradural dissection was performed identifying the main anatomical landmarks for this approach: mandibular branch of the trigeminal nerve, Gasserian ganglion, greater petrosal nerve, arcuate eminence and the horizontal segment of the petrous carotid artery. The petrous apex removal was performed in three ways: (1) paratrigeminal, posterior to V3 and the ganglion; (2) subtrigeminal, with removal of the trigeminal impression; and (3) transcavernous, through the posterior area of Parkinson's triangle. The superior petrosal sinus and the tentorium were cut before approaching the cavernous sinus. The average measurements of the area of bone drilled were: length (parallel to the longitudinal axis of the petrous bone) 22.39 ± 2.5 mm, width (perpendicular to the longitudinal axis petrous apex) 11.25 ± 3.5 mm, depth or height 8.96 ± 1.8 mm. The surgical view obtained by this "extended" drilling of the petrous apex simplifies the removal of difficult lesions located in the posterior cavernous- petroclival area.

The walls of the cavernous sinus were studied in 15 cadaver heads (20 specimens) fixed in formalin. The heads were placed in a Sugita head holder and turned 45* from the side of dissection. The dural of the lateral, superior and posterior wall of the cavernous sinus is formed of two layers: a smooth superficial layer and a thin less defined deep layer. The superficial layer of the superior wall is continuous medially with the diaphragm sella and the deep layer with the upper part of the medial wall of the cavernous sinus which coincides with the pituitary capsule. The bottom part of the medial wall corresponds to the endosteal dura of the carotid canal. The anterior wall of the cavernous sinus is in contact with the superior orbital fissure and clinoid space at the top. The purpose of this studio is to consider the surgical strategies noticing surgical corridors through membranes respecting these important anatomical structures.

The sitting position during surgery is thought to provide important advantages, yet it remains controversial. We compared surgical and neurological outcomes for patients operated on in the sitting versus lateral position. Technically difficult procedures performed from the years 2001–2008 for complex lesions in the posterior fossa (vestibular schwannomas, other cerebellopontine angle tumors, foramen magnum meningiomas, brainstem cavernomas, pineal region tumors) were included. Outcomes in the two surgical positions were compared for all 243 patients (93 sitting, 38.3%; 150 lateral, 61.7%) and for 130/243 patients with vestibular schwannomas (50 sitting, 38.5%; 80 lateral, 61.5%). Sitting and lateral patient subgroups were clinically comparable. There were no surgical mortalities. The extent of removal and surgical and neurological outcomes were comparable. We found no advantage in surgical or neurological outcomes for use of the sitting or lateral surgical positions in technically difficult posterior fossa procedures. In vestibular schwannoma surgeries facial nerve preservation (House–Brackmann score 1–2) was related to extent of resection but not to surgical position. The choice of operative position should be based on lesion characteristics and the patient’s preoperative medical status as well as the experience and preferences of the surgeons performing the procedure.

The far-lateral approach (FLA) has become a mainstay for skull base surgeries involving the anterior foramen magnum and lower clivus. The authors present a surgical technique using the FLA for the management of lesions of the anterior/anterolateral foramen magnum and lower clivus. The authors consider this modification a "lazy" FLA. The vertebral artery (VA) is both a critical anatomical structure and a barrier that limits access to this region. The most important nuance of this FLA technique is the management of this critical vessel. When the lazy FLA is used, the VA is reflected laterally, encased in its periosteal sheath and wrapped in the dura, greatly minimizing the risk for vertebral injury while preserving a wide working space. To accomplish this step, drilling is performed lateral to the point where the VA pierces the dura. The dura is incised medial to the VA entry point by using a slightly curved longitudinal cut. Drilling of the condyle and the C-1 lateral mass is performed in a manner that preserves craniocervical stability. The lazy FLA is a true FLA that is based on manipulation of the VA and lateral bone removal to obtain excellent exposure ventral to the spinal cord and medulla, yet it is among the most conservative FLA techniques for management of the VA and provides a safer window for bone work and lesion management. Among 44 patients for whom this technique was used to resect 42 neoplasms and clip 2 posterior inferior cerebral artery aneurysms, there was no surgical mortality and no injury to the VA.

The R1205H mutation in the eukaryotic translation initiation factor 4G1 (EIF4G1) gene and the D620N mutation in the vacuolar protein sorting 35 (VPS35) gene were recently found in patients with autosomal dominant or sporadic forms of Parkinson's disease (PD). In the present study, 418 South African PD patients and 528 control subjects of diverse ethnicities were screened using the KASP (Kompetitive Allele Specific PCR) genotyping assay. The mutations were not found in our study, suggesting that they are not a common cause of PD in South African patients. Further studies are needed on the frequency of these 2 mutations in other sub-Saharan African populations.

Objective: We aimed to compare surgical results and complication rates in sitting versus lateral position for primary CPA tumor resection via technically difficult posterior fossa procedures.

Objective: There has been a trend toward more radical resection of tuberculum sella and paraclinoid meningiomas, with increasing drilling of the tuberculum sella, unroofing the optic canal, and/or clinoidectomy. We aimed to evaluate the safety of drilling in this area.

OBJECT Surgery for giant anterior clinoidal meningiomas that invade vital neurovascular structures surrounding the anterior clinoid process is challenging. The authors present their skull base technique for the treatment of giant anterior clinoidal meningiomas, defined here as globular tumors with a maximum diameter of 5 cm or larger, centered around the anterior clinoid process, which is usually hyperostotic. METHODS Between 2000 and 2010, the authors performed 23 surgeries in 22 patients with giant anterior clinoidal meningiomas. They used a skull base approach with extradural unroofing of the optic canal, extradural clinoidectomy (Dolenc technique), transdural debulking of the tumor, early optic nerve decompression, and early identification and control of key neurovascular structures. RESULTS The mean age at surgery was 53.8 years. The mean tumor diameter was 59.2 mm (range 50-85 mm) with cavernous sinus involvement in 59.1% (13 of 22 patients). The tumor involved the prechiasmatic segment of the optic nerve in all patients, invaded the optic canal in 77.3% (17 of 22 patients), and caused visual impairment in 86.4% (19 of 22 patients). Total resection (Simpson Grade I or II) was achieved in 30.4% of surgeries (7 of 23); subtotal and partial resections were each achieved in 34.8% of surgeries (8 of 23). The main factor precluding total removal was cavernous sinus involvement. There were no deaths. The mean Glasgow Outcome Scale score was 4.8 (median 5) at a mean of 56 months of follow-up. Vision improved in 66.7% (12 of 18 patients) with consecutive neuroophthalmological examinations, was stable in 22.2% (4 of 18), and deteriorated in 11.1% (2 of 18). New deficits in cranial nerve III or IV remained after 8.7% of surgeries (2 of 23). CONCLUSIONS This modified surgical protocol has provided both a good extent of resection and a good neurological and visual outcome in patients with giant anterior clinoidal meningiomas.

INTRODUCTION:Rosai-Dorfman disease is a benign non-neoplastic proliferative disorder of histiocytes originally described in the cervical lymph nodes. Extranodal sites were later recognized, and by 1990, they were shown to represent over 40% of cases; however, central nervous system involvement is still considered rare. We review the literature, which shows a steady increase in reports of Rosai-Dorfman disease involving the brain and/or spine.METHODS:A literature search was performed for the period 1969-2008, using multiple search engines, with keywords Rosai-Dorfman disease, central nervous system Rosai-Dorfman disease and sinus histiocytosis with massive lymphadenopathy.RESULTS:By December 2008, 111 cases of Rosai-Dorfman disease involving the central nervous system had been reported in the literature, including our cases. In the central nervous system, Rosai-Dorfman disease is ubiquitous. Although it is characterized by unique, indeed pathognomonic, histopathological cytoarchitecture, it may be mistaken for many other neoplastic and inflammatory histioproliferative diseases. Surgical resection with post-operative corticosteroids remains the treatment of choice.CONCLUSIONS:Rosai-Dorfman disease involving the central nervous system appears to be more common than previously thought and may well assume a more prominent place in the differential diagnoses of dural-based lesions. Expert awareness of the characteristic histopathology and immunohistochemistry of the disease is required for accurate diagnosis.

On November 8, 1895, while doing cathode ray research, Wilhelm Conrad Roentgen (1845–1923) discovered the x-ray. By mid-January 1896, scientific and news articles on x-rays appeared in Lancet, the British Medical Journal, Nature, Science, and leading newspapers worldwide. Nearly 1000 articles and several textbooks on x-rays and radioactivity were published in 1896.1 A few months after Roentgen’s breakthrough, Henri Becquerel described the radiation-emitting properties of uranium, and Marie and Pierre Curie discovered polonium and radium–two new radioactive elements. Roentgen, Becquerel, the Curies, and more than 20 other scientists received Nobel Prizes in Physics, Chemistry, or Medicine for groundbreaking research relating to x-rays and radiation during the twentieth century.

Malignant gliomas are characterized by a short median survival which is largely impacted by the resistance of these tumors tochemo‐ and radiotherapy. Recent studies suggest that a small subpopulation of cancer stem cells, which are highly resistant to γ‐radiation, has the capacity to repopulate the tumors and contribute to their malignant progression. γ‐radiation activates the process of autophagy and inhibition of this process increases the radiosensitivity of glioma cells; however, the role of autophagy in the resistance of glioma stem cells (GSCs) to radiation has not been yet reported. In this study we examined the induction of autophagy by γ‐radiation in CD133+ GSCs. Irradiation of CD133+ cells induced autophagy within 24–48 hr and slightly decreased the viability of the cells. γ‐radiation induced a larger degree of autophagy in the CD133+ cells as compared with CD133− cells and the CD133+ cells expressed higher levels of the autophagy‐related proteins LC3, ATG5 and ATG12. The autophagy inhibitor bafilomycin A1 and silencing of ATG5 and beclin1 sensitized the CD133+ cells to γ‐radiation and significantly decreased the viability of the irradiated cells and their ability to form neurospheres. Collectively, these results indicate that the induction of autophagy contributes to the radioresistance of these cells and autophagy inhibitors may be employed to increase the sensitivity of CD133+ GSCs to γ‐radiation. © 2009 UICC

Intracranial atherosclerotic disease (ICAD) is a frequent cause of stroke that is sometimes underdiagnosed. In this review, we survey the literature concerning ICAD and present the prognostic factors and the therapeutic options pertinent to it by comparing medical, surgical and endovascular approaches.

M.-J. Chiu, Taipei, Taiwan M.C. Christensen, Bagsvaerd, Denmark A.B. Conforto, Sao Paulo, Brazil L.A. Corey, Richmond, Va., USA G. Corso, Aosta, Italy E. Cubo, Madrid, Spain A. Culebras, Syracuse, N.Y., USA R. D’Alessandro, Bologna, Italy J.-F. Dartigues, Bordeaux, France F. Davis, Chicago, Ill., USA M. Debouverie, Nancy, France L.M. de Lau, Rotterdam, The Netherlands V. Demarin, Zagreb, Croatia J. de Pedro Cuesta, Madrid, Spain R.K. Dhamija, New Delhi, India O. Dogu, Mersin, Turkey Y. Doi, Wako, Japan W.J. D’Souza, Melbourne, Vic., Australia A. Elbaz, Paris, France M. Elias, Orono, Me., USA A.W. Engberg, Hellerup, Denmark J.M. Ferro, Lisbon, Portugal J.L. Fisher, Columbus, Ohio, USA M. Flaherty, Dublin, Ireland G. Franklin, Seattle, Wash., USA P.D. Frenzen, Washington, D.C., USA G. Friday, Wynnewood, Pa., USA R. Friedland, Cleveland, Ohio, USA L. Frost, Silkeborg, Denmark V. Gallo, London, UK E. Granieri, Ferrara, Italy J. Grigsby, Aurora, Ill., USA W. Grisold, Vienna, Austria M.N. Haan, Ann Arbor, Mich., USA G. Hankey, Perth, W.A., Australia J. Harsh, Hattiesburg, Miss., USA W.A. Hauser, New York, N.Y., USA J.E. Heck, Lyon, France H. Heinzl, Vienna, Austria V.W. Henderson, Stanford, Calif., USA P. Heuschmann, Munster, Germany R. Hilsabeck, Encino, Calif., USA R. Hintzen, Rotterdam, The Netherlands M. Hutterer, Innsbruck, Austria A.A. Adeolu, Ibadan, Nigeria H. Akiyuki, Chiba, Japan S.M. Albert, Pittsburgh, Pa., USA K.D. Allen, Durham, N.C., USA N.B. Allen, New Haven, Conn., USA L.E. Almaguer-Mederos, Holguin, Cuba A. Alperovitch, Paris, France R. Al-Shahi, Edinburgh, UK M. Alter, Wynnewood, Pa., USA L.-C. Alvaro, Bilbao, Spain A. Anand, Chandigarh, India N. Andelic, Oslo, Norway D. Anderson, Bethesda, Md., USA M.A. Arami, Tehran, Iran C. Armon, Springfield, Mass., USA J. Artigas-Pallares, Sabadell, Spain H.O. Atladottir, Aarhus, Denmark L. Ayalon, Ramat Gan, Israel M. Balderesch, Florence, Italy A. Barber, Auckland, New Zealand S. Barker-Collo, Auckland, New Zealand E. Beghi, Milano, Italy J. Benito-Leon, Madrid, Spain D. Bennett, Chicago, Ill., USA D. Bennett, Oxford, UK D. Benninger, Bethesda, Md., USA F. Bermejo-Pareja, Madrid, Spain N. Bharucha, Mumbai, India M. Billiard, Montpellier, France M.M. Blewett, Madison, Wisc., USA J. Bower, Rochester, Minn., USA G. Boysen, Copenhagen, Denmark C. Brayne, Cambridge, UK J. Breitner, Seattle, Wash., USA M. Breteler, Rotterdam, The Netherlands L. Broer, Rotterdam, The Netherlands R. Brouns, Antwerp, Belgium K. Bruins Slot, Oslo, Norway A. Brusco, Torino, Italy S.F. Cappa, Milano, Italy A. Carolei, L’Aquila, Italy K. Carter, Christchurch, New Zealand T.D. Carter, Melbourne, Vic., Australia H. Chen, Bethesda, Md., USA

We present a case of de novo fibrosarcoma in a 43-year-old male, with MRI documented evolution from a 5 mm hyperintense area to 5 cm tumor mass in a 12-month period. The diagnosis of low-grade fibrosarcoma was established by three experienced neuropathologists. The patient underwent gross total resection with adjuvant fractionated conformal radiotherapy. Following first recurrence 3 months later, the patient was reoperated and stereotactic radiosurgery of a residual tumor was performed thereafter. The pathological diagnosis was similar, but with additional extensive radiation effects. Six months later the patient underwent aggressive surgical resection for second recurrence. The pathological diagnosis was WHO grade IV glioblastoma. The etiology of this highly unusual progression from primary mesenchymal neoplasm to high-grade glioma is discussed.

Basel · Freiburg · Paris · London · New York · Bangalore · Bangkok · Shanghai · Singapore · Tokyo · Sydney Neuroepidemiology 2008;31:201–223 Published online: September 19, 2008 DOI: 10.1159/000156450 The abstracts are only available online, free of charge, under www.karger.com/doi/10.1159/000156450 XIIIth National Meeting of the Italian Neuroepidemiology Association Verona, Italy, September 26–28, 2008 Chairperson Adriano Chiò, Torino