Surgery for diaphragma sellae meningioma: how I do it.

Surgery for diaphragma sellae meningiomas (DSM) remains challenging due to the intimate neurovascular relationships of the tumor. Excision of DSM along with a decompression of the optic apparatus requires a good knowledge of the skull base anatomy and a precise preoperative evaluation of the tumor extensions. We describe the key steps of transcranial approach for DSM with a video illustration. The surgical anatomy is described along with the advantages and limitations of this approach. The transcranial approach allows a safe tumor excision with an early and adequate control of the neurovascular structures, while minimizing postoperative CSF rhinorrhea

Finding My New Balance.

All of us walk with faith, unaware of what lies ahead in our life, until we have that fall, my story is about how I lost my balance and regained it in a better form. Little did I know about this rare brain tumor that was slowly taking over my neural commands. To fight for my life was the only aim prior to surgery and getting back to living my life after neurosurgery was aiming higher than before. This narrative essay is about my trials and tribulations of a rare brain tumor that presented with audio-vestibular symptoms. It portrays vividly my experience of this brain tumor, and importantly vestibular rehabilitation that which allows the brain to achieve recovery of neural functions due to its inherent properties of neural plasticity

Thin films with high surface roughness: thickness and dielectric function analysis using spectroscopic ellipsometry

An optical surface roughness model is presented, which allows a reliable determination of the dielectric function of thin films with high surface roughnesses of more than 10 nm peak to valley distance by means of spectroscopic ellipsometry. Starting from histogram evaluation of atomic force microscopy (AFM) topography measurements a specific roughness layer (RL) model was developed for an organic thin film grown in vacuum which is well suited as an example. Theoretical description based on counting statistics allows generalizing the RL model developed to be used for all non-conducting materials. Finally, a direct input of root mean square (RMS) values found by AFM measurements into the proposed model is presented, which is important for complex ellipsometric evaluation models where a reduction of the amount of unknown parameters can be crucial. Exemplarily, the evaluation of a N,N’-dimethoxyethyl-3,4,9,10-perylene-tetracarboxylic-diimide (DiMethoxyethyl-PTCDI) film is presented, which exhibits a very high surface roughness, i.e. showing no homogeneous film at all

To Look Beyond Vasospasm in Aneurysmal Subarachnoid Haemorrhage.

Delayed cerebral vasospasm has classically been considered the most important and treatable cause of mortality and morbidity in patients with aneurysmal subarachnoid hemorrhage (aSAH). Secondary ischemia (or delayed ischemic neurological deficit, DIND) has been shown to be the leading determinant of poor clinical outcome in patients with aSAH surviving the early phase and cerebral vasospasm has been attributed to being primarily responsible. Recently, various clinical trials aimed at treating vasospasm have produced disappointing results. DIND seems to have a multifactorial etiology and vasospasm may simply represent one contributing factor and not the major determinant. Increasing evidence shows that a series of early secondary cerebral insults may occur following aneurysm rupture (the so-called early brain injury). This further aggravates the initial insult and actually determines the functional outcome. A better understanding of these mechanisms and their prevention in the very early phase is needed to improve the prognosis. The aim of this review is to summarize the existing literature on this topic and so to illustrate how the presence of cerebral vasospasm may not necessarily be a prerequisite for DIND development. The various factors determining DIND that worsen functional outcome and prognosis are then discussed

Sixth Nerve Palsy from Cholesterol Granuloma of the Petrous Apex.

Herein, we report a patient who had an isolated sixth nerve palsy due to a petrous apex cholesterol granuloma. The sixth nerve palsy appeared acutely and then spontaneously resolved over several months, initially suggesting a microvascular origin of the palsy. Subsequent recurrences of the palsy indicated a different pathophysiologic etiology and MRI revealed the lesion at the petrous apex. Surgical resection improved the compressive effect of the lesion at Dorello's canal and clinical improvement was observed. A relapsing-remitting sixth nerve palsy is an unusual presentation of this rare lesion

Hydrothermal alteration and fluid pH in alkaline-hosted epithermal systems

Epithermal gold mineralisation is found in a wide compositional range of host lithologies, but despite the diversity the alteration mineral assemblages are often similar between deposits. Notable exceptions are those gold deposits hosted in alkaline host rocks. Alkaline-hosted epithermal deposits are rare, but important, as they include some of the world’s largest known epithermal deposits by contained metal (e.g. Ladolam, Cripple Creek, Porgera). As well as the exceptional gold contents, the alkaline-hosted systems tend to exhibit different alteration mineral assemblages, with less quartz and widespread silicification than sub-alkaline-hosted equivalents, and greater enrichments in tellurium, and a scarcity of acid alteration (advanced argillic) types. In this study, geochemical modelling is used to demonstrate that 300 °C hydrothermal fluids in equilibrium with alkali, silica-undersaturated host rocks at low water/rock ratios reach significantly higher pH than equivalents in sub-alkaline lithologies. A maximum, near-neutral pH (5.5–6) is buffered by reactions involving quartz in silica-saturated alkaline and calc-alkaline lithologies. In silica-undersaturated, alkaline host rocks, quartz is exhausted by progressive water-rock interaction, and pH increases to 7 and above. Both tellurium and gold solubility are favoured by neutral to high fluid pH, and thus there is a clear mechanism within these hydrothermal systems that can lead to effective transport and concentration to produce gold telluride ore deposits in alkaline igneous hosts. This modelling demonstrates that alkaline rocks can still be altered to advanced argillic assemblages; the paucity of this alteration type in alkaline hosts instead points to NaCl ≫ HCl in magmatic volatile phases at the initiation of hydrothermal alteration

Gamma knife radiosurgery for arteriovenous malformations: general principles and preliminary results in a Swiss cohort.

Arteriovenous malformations (AVMs) are a type of vascular malformation characterised by an abnormal connection between arteries and veins, bypassing the capillary system. This absence of capillaries generates an elevated pressure (hyperdebit), in both the AVM and the venous drainage, increasing the risk of rupture. Management modalities are: observation, microsurgical clipping, endovascular treatment and radiosurgery. The former can be used alone or in the frame of a multidisciplinary approach. We review our single-institution experience with gamma knife radiosurgery (GKR) over a period of 5 years. The study was open-label, prospective and nonrandomised. Fifty-seven consecutive patients, benefitting from 64 GKR treatments, were included. All were treated with Leksell Gamma Knife Perfexion (Elekta Instruments, AB, Sweden) between July 2010 and August 2015. All underwent stereotactic multimodal imaging: standard digital subtraction angiography, magnetic resonance imaging and computed tomography angiography. We report obliteration rates, radiation-induced complications and haemorrhages during follow-up course. The mean age was 46 years (range 13-79 years). The mean follow-up period was 36.4 months (median 38, range 12-75 months). Most common pretherapeutic clinical presentation was haemorrhage (50%). The most common Pollock-Flickinger score was between 1.01 and 1.5 (46%) and Spetzler-Martin grade III (46%). In 39 (60.1%) of cases, GKR was performed as upfront therapeutic option. The mean gross target volume (GTV) was 2.3 ml (median 1.2, range 0.03-11.3 ml). Mean marginal dose was 22.4 Gy (median 24, range 18-24 Gy). The mean prescription isodose volume (PIV) was 2.9 ml (median 1.8, range 0.065-14.6 ml). The overall obliteration rates (all treatments combined) at 12, 24, 36, 48 and 60 months were 4.8, 16.9%, 37.4, 63.6 and 78.4%, respectively. The main predictive factors for complete obliteration were: higher mean marginal dose (23.3 vs 21.0 Gy), lower GTV (mean 1.5 vs 3.5 ml) and absence of previous embolisation (at 60 months 61.8% prior embolisation compared with 82.4% without prior embolisation) (for all p <0.05). Eight (14%) patients experienced complications after GKR. Overall definitive morbidity rate was 3.1%. No patient died from causes related to GKR. However, during the obliteration period, one case of extremely rare fatal haemorrhage occurred. Radiosurgery is a safe and effective treatment modality for intracranial AVMs in selected cases. It can be used as upfront therapy or in the frame of a combined management. Obliteration rates are high, with minimal morbidity. The treatment effect is progressive and subsequent and regular clinical and radiological follow-up is needed to evaluate this effect