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The endoscopic endonasal corridor for odontoidectomy (EEO) is a valuable route in expert's hand to manage craniovertebral junction (CVJ) pathologies of the midline. The possibility to preserve part of the C1 anterior arch along to an adequate preoperative planning, makes this option a viable choice especially in elderly patients with multiple comorbidities who cannot sustain a second procedure closed in time. Indeed, the current case shows the results of EEO in the presence of ventral compression due to degenerative non-rheumatoid retro -odontoid pannus in an 80-year-old male. Due to the absence of instability preoperatively and the C1 anterior arch preservation, no posterior instrumentation was planned nor was necessary at follow-up. A step-by-step description of the technique is showed. [ABSTRACT FROM AUTHOR]

• The stimulation of the surrounding area of usual DBS targets improves Parkinsonian symptoms. • The possible role of caudal Zona Incerta in improving motor symptoms in selected patients affected by Parkinson's Disease. • The Volume of tissue activated (VTA) as parameter to describe the clinical outcome. • Brain Mapping software integration in clinical practice could improve clinical outcome. Deep Brain Stimulation (DBS) of the subthalamic nucleus (STN) is a well-recognized intervention for Parkinson's Disease (PD). We used LEAD-DBS, a toolbox facilitating DBS electrode reconstructions and computer simulations based on postoperative MRI and CT imaging, to investigate the interaction and followed benefits of electrical field generated by STN-DBS and surrounding areas, such as caudal Zona Incerta (cZI). Thirty-two PD patients, treated with directional STN-DBS in the period 2016–2018 at the Walton Center NHS Foundation Trust, were retrospectively recruited. Their MRI and CT imaging were analyzed with LEAD-DBS to measure the volume of tissue activated (VTA). Considering the clinical outcome based on the UPDRS III score improvement of 62.65% at 6 months follow up, we found a VTA intersection of 21.5% with motor STN and 61.7% with cZI. These observations may support the contribution of cZI deep stimulation to improve clinical outcome of PD patients treated with DBS, promoting the intriguing path of dual targeting. [ABSTRACT FROM AUTHOR]

In surgical practice during endoscopic endonasal approach, growth hormone-secreting pituitary neuroendocrine tumor (GH-secreting PitNET) patients show morphologic differences in the nasal cavities and sinuses, leading to a narrower surgical field and a carotid prominence and potentially increasing the complexity of the surgical and the risk of complications. The aim of the study is to evaluate the anatomical differences of the sphenoid sinus between patients with GH-secreting PitNETs and patients with nonfunctioning pituitary neuroendocrine tumor (NF-PitNET) who underwent endoscopic endonasal approach. This is a monocentric retrospective study conducted at the author's institution. The minimum intercarotid distance, the largest diameter of the sphenoid sinus (DSS), and the distance between vomer and clivus (VCD) were collected and compared. Presence, localization, and course of intersphenoid sinus septum were also evaluated. One hundred consecutive patients were identified: 57 males (57%) and 43 females (43%), with a mean age of 55 years. Sixty patients had NF-PitNET (60%) and 40 had GH-secreting PitNET (40%). GH-secreting PitNET group presented inferior values of intercarotid distance (16.8 ± 3.94 mm vs. 20.4 ± 3.94 mm, P < 0.001), DSS (32.5 ± 9.81 mm vs. 38.6 ± 11.03 mm, P = 0.006), and VCD (25.5 ± 6.96 mm vs. 29.6 ± 8.47 mm, P = 0.012) compared to NF-PitNET group. Intersphenoid sinus septum showed no differences between the 2 groups. Intercarotid distance, DSS, and VCD resulted smaller in acromegalic patients, confirming that patients with GH-secreting PitNETs have a narrower surgical field. A meticulous anatomical preoperative planning and neuronavigation are important to recognize the sphenoid anatomical landmarks in order to reduce the risk of complications, especially in acromegalic patients. [ABSTRACT FROM AUTHOR]

To analyze whether significant differences exist between free-hand three-dimensional (3D) planning–guided cortical bone trajectory (CBT) screw placement and 3D-printed template–guided CBT screw positioning in terms of accuracy, size of screws, and potential complications. In this retrospective study, data of adult patients in whom CBT screws were placed for lumbar degenerative pathologies were extracted from a prospectively collected database and analyzed. Patients in whom screws were placed using free-hand 3D planning–guided technique were compared with patients in whom screws were positioned using customized 3D-printed templates. Size of the screws, accuracy, clinical outcomes, and complications were analyzed. The study evaluated 251 patients (1004 screws). The free-hand 3D planning–guided group included 158 patients (632 screws), and the 3D-printed template–guided group included 93 patients (372 screws). The 3D-printed template–guided group involved screws of larger size from L3 to S1. Differences between the 2 groups in terms of accuracy parameters reached statistical significance (P ≤ 0.05). With the use of 3D patient-matched template guides, mean diameter and length of CBT screws could be safely increased due to improved accuracy of screw placement. Based on previous evidence regarding CBT biomechanical properties, these advantages could allow increased fixation strength over traditional convergent pedicle screw trajectories. Further biomechanics studies are needed. [ABSTRACT FROM AUTHOR]