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An extended endoscopic endonasal approach (EEA) has become standard for parasellar and midline skull base lesions. However, postoperative leakage of cerebrospinal fluid (CSF) can result from dural defects after lesion removal. We present a simple and effective technique, the Osaka sliding knot, to prevent CSF leakage. Between November 2018 and March 2021, a total of 41 patients underwent reconstruction of skull base defects with intraoperative high-flow CSF leaks after extended EEA by using this closure technique, of whom only 1 patient experienced postoperative CSF leakage. This technically simple and efficient method seals the dural defect to prevent CSF leakage after surgeries using an extended EEA.

Subarachnoid hemorrhage (SAH) with an intracerebral hematoma (ICH) shows an unfavorable prognosis. In the present study, we examined the characteristics of SAH with ICH and its prognosis.Subjects comprised 218 patients with SAH who underwent surgery between January 2007 and December 2015. We compared age, sex, the location of the aneurysm, treatment procedures, medical history (hypertension, diabetes, and heart disease), the Glasgow Coma Scale (GCS) score on admission, rerupture rate, hydrocephalus, the diameter of the aneurysm, cerebral vasospasm, perioperative cardiopulmonary complications, and the Glasgow Outcome Scale (GOS) score after 2 months between patients with SAH with and without ICH. The interval from the onset of SAH until surgery, the location of ICH, and hematoma volume were investigated as prognostic factors for SAH with ICH.Among all subjects, 82 had SAH with ICH. GCS scores on admission were poorer in patients with SAH with ICH than in those without ICH (P .001), and middle cerebral artery aneurysms were more likely to form hematomas (P .001). GOS scores after 2 months were also poorer in patients with SAH with ICH (P .01). The size of aneurysms was larger in the 82 patients with SAH with ICH than in those without ICH (P .001), and the rerupture rate was higher (P .001). The unfavorable prognosis of patients with SAH with ICH was associated with age and GCS score on admission.A young age and a favorable GCS score on admission may be associated with a favorable prognosis for patients with SAH with ICH, and SAH with ICH may easily rerupture.

Deep regions are not visible in three-dimensional (3D) printed rapid prototyping (RP) models prepared from opaque materials, which is not the case with translucent images. The objectives of this study were to develop an RP model in which a skull base tumor was simulated using mesh, and to investigate its usefulness for surgical simulations by evaluating the visibility of its deep regions. A 3D printer that employs binder jetting and is mainly used to prepare plaster models was used. RP models containing a solid tumor, no tumor, and a mesh tumor were prepared based on computed tomography, magnetic resonance imaging, and angiographic data for four cases of petroclival tumor. Twelve neurosurgeons graded the three types of RP model into the following four categories: ‘clearly visible,’ ‘visible,’ ‘difficult to see,’ and ‘invisible,’ based on the visibility of the internal carotid artery, basilar artery, and brain stem through a craniotomy performed via the combined transpetrosal approach. In addition, the 3D positional relationships between these structures and the tumor were assessed. The internal carotid artery, basilar artery, and brain stem and the positional relationships of these structures with the tumor were significantly more visible in the RP models with mesh tumors than in the RP models with solid or no tumors. The deep regions of PR models containing mesh skull base tumors were easy to visualize. This 3D printing-based method might be applicable to various surgical simulations.

Background: The objective of this study was to identify risk factors involved in the severity of deep subcortical white matter (DSWMH) and periventricular (PVH) hyper-intensities on MRI, which are white matter lesions. Methods: The subjects were 506 consecutive asymptomatic patients examined in a brain dry-dock. The severities of DSWMH and PVH were classified using the Fazekas scale. Regarding risk factors, in addition to sex, age, cigarette smoking, alcohol drinking, and renal function, hypertension, diabetes, dyslipidemia, and gout were divided into 3 grades: without the disease, being treated, or untreated, and evaluated. Results: Regarding the normal group as grade 0 on the Fazekas scale, the relationship between the DSWMH severity and each risk factor was investigated. In addition to an increase with aging (p