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Falcine meningioma is usually approached ipsilaterally, and the technique for tumor removal has traditionally been performed under microscopy. We report a surgical procedure for large falcine meningioma by an endoscopic contralateral interhemispheric transfalcine keyhole approach.The study period was from September 2019 to March 2021. Study participants were patients with World Health Organization grade I meningioma showing falx attachment, excluding neurofibromatosis, who underwent initial surgery at our institution. The surgical procedure begins with a small contralateral craniotomy of about 3 cm, followed by insertion of an endoscope. The tumor attachment to the falx is excised, exposing the tumor. Internal decompression is performed, and the lesion is dissected from the surrounding brain before removal through the falx.An endoscopic contralateral interhemispheric transfalcine keyhole approach was used to resect 4 cases of large falcine meningioma. The mean operation time was 265 minutes (range: 216-294 minutes), achieving Simpson grade I removal in all cases. No evidence of cerebral infarction, cerebral edema, or new neurological complaints related to impaired venous return was seen using this surgical method.In the case of falcine meningioma, the endoscopic keyhole contralateral technique allows detachment of the tumor from the falx and safe manipulation in a minor field of view. In addition, because the craniotomy is smaller and the operation time is shorter, this procedure offers a less-invasive approach for the patient. This technique is thus, in our opinion, quite advantageous.

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.

Objective: The optimal treatment of patients with craniopharyngioma remains controversial. In recent years, we have removed tumors radically via an endoscopic endonasal approach (EEA) in all cases of primary craniopharyngioma. We present here our surgical strategy and outcomes of primary craniopharyngiomas via an EEA.Methods: Between 2015 and 2021, we resected 37 consecutive cases of primary craniopharyngioma via EEA. Aggressive resections had been originally planned in all cases. To help choose the adequate surgical management, we created the five groups included the intrasellar, prechiasmatic, retrochiasmatic, intra-3rd-ventricle and large lobulated type. Bony removal of the dorsum sellae, upper clivus and posterior clinoid process was added in cases with retrochiasmatic or third ventricular lesions, and a combination of EEA and transcranial approach was selected with large multi-lobulated tumors and lateral extension.Results: 16 tumors were classified as retrochiasmatic, 12 tumors as intra-3rd-ventricle, 4 tumors as prechiasmatic, 3 tumors as large lobulated, and 2 tumors as intrasellar type. Gross total resection (GTR) was achieved in 89.2%, near-total resection (NTR) in 8.1%, and subtotal resection (STR) in 2.7%. The pituitary stalk was preserved intraoperatively in 27.0%. Visual improvement was noted in 76.7%. Neuropsychological function status was improved or preserved in all cases. Tumor recurrence was detected 3.0% of GTR, 33.3% of 3 NTR and 100% of STR cases with the mean follow-up period of 32.7 months.Conclusion: Adequate surgical management according to the anatomical location of the lesion via EEA results in good visual and cognitive outcomes with increased extent of resection.

Background Atopic dermatitis is a chronic inflammatory skin disease associated with pruritus. Skin affected by atopic dermatitis not only shows a high percentage of Staphylococcus aureus colonization, but corneal barrier dysfunction is also known to occur. It is considered a risk factor for bacterial infections in various areas of the body. However, the relationship between atopic dermatitis and bacterial infection following neurological surgery has not yet been reported. Here, we present a case of atopic dermatitis in which the surgical site became infected twice and finally resolved only after the atopic dermatitis was treated. Case presentation A 50-year-old Japanese woman with atopic dermatitis underwent cerebral aneurysm clipping to prevent impending rupture. Postoperatively, she developed repeated epidural empyema following titanium cranioplasty. As a result of atopic dermatitis treatment with oral antiallergy medicines and external heparinoids, postoperative infection was suppressed by using an absorbable plastic plate for cranioplasty. The patient’s postoperative course was uneventful for 16 months. Conclusions Atopic dermatitis is likely to cause surgical-site infection in neurosurgical procedures, and the use of a metal implant could promote the development of surgical-site infection in patients with dermatitis.

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.

We report a rare case in which a pituitary tumor co-occurred with a giant mucocele. The mucocele's computed tomography(CT)values fell markedly when it collapsed, and we report the associated considerations.This case involved a 42-year-old male patient. For 20 years, his visual acuity had progressively declined, and it suddenly rapidly worsened over a month. Cranial CT revealed a massive tumor in the sphenoid sinus and a pituitary tumor. A region of high absorption extended from the paranasal sinus to the skull base. Two days after the patient's initial presentation, he experienced a sudden loss of vision. Therefore, we performed an urgent re-examination. The CT value of the paranasal lesion was found to have sharply declined. The sinus lesion was diagnosed as a mucocele. Emergent endoscopic surgery was performed.iActinomyces meyeri/iwas detected in the samples cultures.The causes of mucocele exhibiting abnormally high signal intensity on CT include the accumulation of hemosiderin due to repeated bleeding in the cyst. Furthermore, we inferred that theiActinomyces meyeri/ihad been taking up metallic elements in vivo for a long time. The marked reduction in the lesion's CT value was considered to have been due to the destruction of the mucocele. The contents of the mucocele flowed out and were replaced with newly produced mucus, which exhibits low absorption values.We treated a patient with a giant mucocele involving distraction of the frontal base and a pituitary adenoma. In such cases, surgery should be performed when visual acuity deteriorates suddenly.

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