Microsurgical Anatomy of Periventricular White Matter from the Endoventricular Perspective.

Understanding the spatial disposition of fiber bundles is a requisite for efficient operative planning in cerebral surgery, respecting the most eloquent structures even when not seen by the naked eye. In this study, we used fiber dissection to show critical relationships between the lateral ventricles and white matter fasciculi. Twenty cerebral hemispheres obtained from body donation were used to study the lateral ventricles, white matter tracts, and their anatomic relationships. We used a variant of the method described by Ludwig and Klingler for fiber dissection, from inside the ventricular cavity after removing the ependyma. After removing the ventricular ependyma, adjacent structures were exposed. Corpus callosum fibers form the roof of the lateral ventricle, as well as the anterior wall and floor of the frontal horn. The tapetum, optic radiations, and association fasciculi dominate in the atrium and occipital horn, with distinct fiber orientation patterns. The medial wall of the occipital horn is marked by the presence of the major forceps fibers underneath the bulb of the corpus callosum. The temporal horn walls are characterized by multiple elements, including the hippocampus medially, tapetum fibers laterally and posteriorly, and key neighboring bundles, such as the optic radiations superiorly and the inferior longitudinal fasciculus inferiorly. Fiber dissection through ependyma removal is an effective method for studying anatomic relationships with adjacent white matter bundles, important for developing a precise anatomic mental picture necessary for effective and safe brain surgery

Central Nervous System Siderosis Associated with Multiple Cerebral Aneurysms: Literature Review and Description of an Additional Case

Background: Superficial siderosis (SS) of the central nervous system is a rare disease characterized by deposition of hemosiderin along the leptomeninges due to chronic or recurrent bleeding into the subarachnoid space. The association of unruptured intracranial aneurysm (IA) and cortical SS is quite rare. Methods: A systematic literature review to assess possible commonalities and/or differences of previous reported cases was undertaken. We report an additional case from our institution. Results: A 40-year-old woman presented with a history of generalized seizures over the past year. There was no clinical history suggestive of aneurysm rupture. Magnetic resonance imaging revealed 2 aneurysms of the right middle cerebral artery (MCA) bifurcation associated with hemosiderin deposition along the right sylvian fissure and a third aneurysm of the left MCA bifurcation. Magnetic resonance imaging showed wall enhancing thickening of the larger right MCA aneurysm. The patient underwent surgical clipping of all 3 MCA aneurysms in a staged procedure. Histological examination revealed hemosiderin deposits within the aneurysm wall and surrounding gliosis. Conclusions: Our literature review found 24 reported cases of unruptured IA associated with cortical SS. The possible source for leakages could be neovessels visible in IA walls. The case reported illustrates an uncommon presentation of recurrent bleeding from an IA as a source of SS. The presence of an apparently unruptured IA surrounded by cortical SS on imaging studies is of high relevance as this should be considered a sign of aneurysm wall instability and should indicate prompt treatment

Minimally invasive management of cervical spondylodiscitis. A multicenter experience

The urgent etiological diagnosis represents the main management objective of cervical spondylodiscitis (CSD) to start as soon as possible antibiotic treatment to prevent neurological deterioration. The present study aimed to evaluate a multicenter experience implementing a minimally invasive surgical approach (MISA) to manage CSD such pathology vs the most complex and aggressive surgical strategies currently used.This retrospective multicenter study used a database of 70 patients from five European neurosurgical centers. Patients with primary CSD underwent MISA via a limited funnel shaped cervical microdiscectomy with 4-mm anterior and 6-mm posterior longitudinal ligaments incision, PUS drainage, and extensive washing of the interbody and epidural space without fusion. Diagnosis was confirmed by clinical, imaging, laboratory, and perioperative histopathology and bacteriology.Of the 70 patients, 41 were men (58,5%), with an average age of 47.67 years. Severe neck pain affected 45 patients, while 51 had single-level cervical spondylodiscitis, 14 had double-level, and 5 had triple-level involvement. Staphylococcus aureus was identified in 49 cases. Each patient received a mean of three months of antibiotics. Inflammatory markers (C-reactive protein) were moderate for four weeks, then normalized by 8-12 weeks, except in one recurrence. After an average 48-month follow-up, all patients fully recovered without neurological deficit, spinal instability, or kyphotic deformity. Radiological exams confirmed bony fusion, with no recurrences of infection. MISA treatment offers a valuable, stable, and less invasive option for treating CSD, effectively identifying causative microorganisms and decompressing the spinal cord, leading to excellent patient outcomes

The Human Rights of Migrants with Irregular Status: Giving Substance to Aspirations of Universalism

This open access book explores the conceptual challenges posed by the presence of migrants with irregular immigration status in Europe and the evolving policy responses at European, national and municipal level. It addresses the conceptual and policy issues raised, post-entry, by this particular section of the migrant population. Drawing on evidence from different parts of Europe, the book takes the reader through philosophical and ethical dilemmas, legal and sociological analysis to questions of public policy and governance before addressing the concrete ways in which those questions are posed in current policy agendas from the international to the local level. As such this book is a valuable read to researchers, practitioners and policy makers as well as to students working on irregular migration in Europe in a comparative and/or country based perspective