International Journal of Neurology and Neurosurgery

This article summarizes the senior author’s experience (RFS), which has been condensed to a schematic system based on road categories reflecting the anatomy and angioarchitecture of spinal vascular formations. Anatomically, spinal vascular malformations can occur within or outside the dura (i.e., intra- or extradural) and are located anteriorly or posteriorly with respect to the spinal cord. Based on their angiographic appearance, the presence of a nidus defines an arteriovenous malformation (AVM). A lesion is considered an arteriovenous fistula (AVF) if no nidus is present. Vascular malformations involving the spinal cord represent a heterogeneous and challenging group of entities with a broad clinical spectrum that ranges from neurological deficits that develop progressively over years to an insidious presentation caused by an acute hemorrhage.Multiple classification systems are frequently used to categorize these lesions based on multiple clinical and angiographic criteria. This confusing welter of nomenclature only adds to the complexity of treating these challenging lesions.This article summarizes the senior author’s experience (RFS) 36 (Table 1), which has been condensed to a chematic system based on broad categories reflecting the natomy and angioarchitecture of spinal vascular formations. Anatomically, spinal vascular malformations can occur within or utside the dura (i.e., intraor extradural) and are located anteriorly or posteriorly with respect to the spinal cord. Based on their angiographic appearance, the presence of a nidus defines an arteriovenous malformation (AVM).A lesion is considered an arteriovenous fistula (AVF) is no nidus is present.  

Three hundred and twenty five cases of hormonally inactive giant pituitary tumors, having their maximum dimension of more than 3 cm, treated surgically in our neurosurgical department from the year 1995 to November 2008 were analyzed. Depending on the extensions and the nature of their meningeal coverings these tumors were divided into four grades. Average duration of follow-up was thirty-six months.There were 135 giant pituitary tumors, which remained within the confines of sellar dura and under the diaphragma sellae and did not enter into the compartment of cavernous sinus (Grade I). Transgression of the medial wall and invasion into the compartment of the cavernous sinus (Grade II) was seen in 109 cases. Elevation of the dura of the superior wall or roof of the cavernous sinus (Grade III) was observed in 59 cases.Supradiaphragmatic- subarachnoid extension (Grade IV) was seen in 22 patients.Radical surgery by a transsphenoidal route is indicated and possible in Grade I-III pituitary tumors. Such a strategy offered a reasonable opportunity for recovery in vision and a satisfactory post-operative and long-term outcome. Biopsy of the tumor followed by radiotherapy could be suitable for Grade IV pituitary tumors. 

Key Words:Giant pituitary tumors, cavernous sinus,diaphragma sella, dura. 

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Key Words- Basilar invagination, atlas, syringomyelia. 

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Object Increasing use of endovascular techniques is shadowing the most recent developments of microvascular neurosurgery. This paper is focused on our large experience on open microsurgery of intracranial aneurysms. Our strategy is to perform simple, clean, and fast microsurgery while preserving normal anatomy. Methods Microneurosurgical techniques, initially introduced by Prof. Yasargil, have been modified by the senior author (JH) during surgery on more than 3000 aneurysm patients at two neurosurgical departments in Finland, Kuopio and Helsinki, which have altogether treated over 10000 aneurysm patients since 1936. Here we review our experience in treatment of both anterior and posterior circulation aneurysms. Results Most of the anterior circulation aneurysms are treated using the lateral supraorbital (LSO) approach, a less invasive frontally located modification of the classical pterional approach, while only distal anterior cerebral artery aneurysms (6 % of our patients) are operated using interemispheric approach. In the posterior circulation, basilar bifurcation aneurysms are approached either via the subtemporal or the transsylvian route depending on the height of the basilar tip, while most of the vertebral and posterior inferior cerebellar artery (PICA) aneurysms, if located at least 10 mm above the foramen magnum, can be treated by simple lateral suboccipital craniotomy without far lateral extension. The midbasilar region is the most difficult to approach by open surgery, and extensive skull base approaches are needed. Conclusion In our experience, microsurgical clipping is an effective and long-lasting method for treating intracranial aneurysm. With proper treatment strategy, microsurgical technique, and adequate training complication rate can be kept low.

Key Words lateral supraorbital approach, microsurgical technique, cerebral aneurysm, anterior circulation, posterior circulation, skull base surgery Running title: Principles for aneurysms surgery