Dwyer Cowan (nieceroute21)

This 2-dimensional video demonstrates pre- and postoperative imaging, positioning and set-up of operating room, anatomical and surgical nuances of the skull base approach, and the operative technique for microdissection of the schwannoma from the critical neurovascular structures ( Fig. 2 ). In summary, the lateral suboccipital approach in semisitting position is a powerful tool in the armamentarium for the microsurgical management of various pathologies residing in the posterior cranial fossa, especially large and vascularized schwannomas. Provided the necessary anesthesiological precautions and intraoperative procedures the semisitting position is safe and effective. The link to the video can be found at https//youtu.be/-9o_qJGkQhg .We present a case of a large jugular tubercle meningioma that was removed through a midline suboccipital subtonsillar approach in semisitting position. The patient is a 49-year-old woman with chronic, medication-resistant cephalgias but devoid of any subjective focal neurological deficit. On magnetic resonance imaging (MRI), an extra-axial lesion, originating from the left jugular tubercle was discovered. There was significant obliteration of the peripontine cisternal space, and compression of the adjacent pontomedullary junction; the lesion also extended into the left jugular foramen. On physical exam, an absent gag reflex was noted on the left, as well as a moderate deviation of the uvula to the contralateral side (partial Vernet's syndrome). A gross-total resection was achieved, histopathology confirmed a World Health Organization (WHO) grade I angiomatous meningioma with a low-proliferation index. The patient was discharged home 4 days after surgery with intact function of the lower cranial nerves (CN) following immediate and complete resolution of the preexisting partial CNs IX and X deficits. At 2-year follow-up, there was no indication of intradural residual or recurrence. In summary, the midline suboccipital subtonsillar approach is a simple and effective tool with limited morbidity in the armamentarium for the microsurgical management of pathologies residing in the posterior cranial fossa or the craniocervical junction. Major limitations exist for lesions extending above the internal acoustic canal or those of fibrous consistence featuring widespread adhesion to the ventral brainstem or vascular encasement. Provided the necessary anesthesiological precautions and intraoperative procedures the semisitting position is safe and effective. The link to the video can be found at https//youtu.be/bbVXagwhDCo .We report a case of craniocervical junction dural arteriovenous fistula (dAVF) presented with myelopathy and normal pressure hydrocephalus, and was treated with hybrid approach of embolization and surgical disconnection. A 68-year-old gentleman presented with 1 year history of unsteady gait and sphincter disturbance. Magnetic resonance imaging (MRI) showed abnormally enlarged and tortuous vessels over right cerebellomedullary cistern. Digital subtraction angiogram (DSA) showed Cognard's type-V dAVF at craniocervical junction. Catheter embolization was performed via external carotid artery and finally surgical disconnection was done with far lateral approach ( Fig. 1 ). Postoperative DSA showed no more arteriovenous shunting ( Fig. 2 ). Clinically the patient improved after a course of rehabilitation. Dural AVF at craniocervical junction is rare and its clinical presentation can be highly variable from subarachnoid hemorrhage to brainstem dysfunction. Identification of the exact fistula site is essential in surgical planning. Surgery is effective and safe to achieve complete obliteration and good clinical outcome. 1 2 3 4 5 6 The link to the video can be found at https//youtu.be/xI48stSlWpY .Objectives Dural arteriovenous fistulas (DAVFs) at the cervicomedullary junction are uncommon and often accompanied by subarachnoid hemorrhage (SAH). We aim to illustrate in detail the microsurgical p