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Surekha D Shetty - One of the best experts on this subject based on the ideXlab platform.
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Partial duplication of tentorium Cerebelli and complete duplication of Falx Cerebelli
Anatomy & Cell Biology, 2019Co-Authors: Satheesha B Nayak, Surekha D ShettyAbstract:Variations of the dural folds and the dural venous sinuses are infrequently reported in the existing medical literature. Such variations in the posterior cranial fossa may pose difficulties in various analytical and surgical procedures of this region. We present a rare concurrent variation of the Falx Cerebelli and tentorium Cerebelli that was detected during routine dissection of an adult male cadaver. While removing the brain, a partial duplication of tentorium Cerebelli was observed below the left half of the tentorium Cerebelli and above the left cerebellar hemisphere. This fold did not have any dural venous sinus in it. Further, a complete duplication of Falx Cerebelli with a single occipital venous sinus within its attached border was also observed. We present the review of literature and discuss the comparative anatomy of this case.
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Double Falx Cerebelli, single occipital sinus and an unusually large meningeal artery in the posterior cranial fossa: a case report
OA Case Reports, 2013Co-Authors: Satheesha B Nayak, Surekha D Shetty, Naveen Kumar, Srinivasa Rao SirasanagandlaAbstract:Introduction: Abnormalities of the dural folds are very rare. Knowledge about the abnormalities of dural folds is important for neurosurgeons and neuroradiologists as these folds might result in bleeding during the suboccipital approach to the brain and also in misinterpretations during the imaging of the posterior cranial fossa. We report the duplication of Falx Cerebelli and presence of a large meningeal artery in the posterior cranial fossa. Case Report: During the routine brain removal dissection for the undergraduate medical students, the following variations were noted in the posterior cranial fossa of an adult male cadaver aged approximately 70 years. The right and left falces were of equal length (35 mm). The gap between the two falces was broadest anteriorly and measured 15 mm, whereas the narrowest part of the gap was in the middle and measured 10 mm. The occipital sinus was plexiform and was situated in the midline between the two falces. It terminated by opening into the left sigmoid sinus. Meningeal branch of the right occipital artery was unusually large and it entered the posterior cranial fossa through the right jugular foramen. After a course of about 4 cm in the posterior cranial fossa it divided into the right and left branches. It was accompanied by two venae comitantes. Conclusion: The knowledge of the variations observed in the current case may be of use in radiological and neurosurgical procedures.
Satheesha B Nayak - One of the best experts on this subject based on the ideXlab platform.
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Partial duplication of tentorium Cerebelli and complete duplication of Falx Cerebelli
Anatomy & Cell Biology, 2019Co-Authors: Satheesha B Nayak, Surekha D ShettyAbstract:Variations of the dural folds and the dural venous sinuses are infrequently reported in the existing medical literature. Such variations in the posterior cranial fossa may pose difficulties in various analytical and surgical procedures of this region. We present a rare concurrent variation of the Falx Cerebelli and tentorium Cerebelli that was detected during routine dissection of an adult male cadaver. While removing the brain, a partial duplication of tentorium Cerebelli was observed below the left half of the tentorium Cerebelli and above the left cerebellar hemisphere. This fold did not have any dural venous sinus in it. Further, a complete duplication of Falx Cerebelli with a single occipital venous sinus within its attached border was also observed. We present the review of literature and discuss the comparative anatomy of this case.
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Double Falx Cerebelli, single occipital sinus and an unusually large meningeal artery in the posterior cranial fossa: a case report
OA Case Reports, 2013Co-Authors: Satheesha B Nayak, Surekha D Shetty, Naveen Kumar, Srinivasa Rao SirasanagandlaAbstract:Introduction: Abnormalities of the dural folds are very rare. Knowledge about the abnormalities of dural folds is important for neurosurgeons and neuroradiologists as these folds might result in bleeding during the suboccipital approach to the brain and also in misinterpretations during the imaging of the posterior cranial fossa. We report the duplication of Falx Cerebelli and presence of a large meningeal artery in the posterior cranial fossa. Case Report: During the routine brain removal dissection for the undergraduate medical students, the following variations were noted in the posterior cranial fossa of an adult male cadaver aged approximately 70 years. The right and left falces were of equal length (35 mm). The gap between the two falces was broadest anteriorly and measured 15 mm, whereas the narrowest part of the gap was in the middle and measured 10 mm. The occipital sinus was plexiform and was situated in the midline between the two falces. It terminated by opening into the left sigmoid sinus. Meningeal branch of the right occipital artery was unusually large and it entered the posterior cranial fossa through the right jugular foramen. After a course of about 4 cm in the posterior cranial fossa it divided into the right and left branches. It was accompanied by two venae comitantes. Conclusion: The knowledge of the variations observed in the current case may be of use in radiological and neurosurgical procedures.
M. Garcia - One of the best experts on this subject based on the ideXlab platform.
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ORIGINAL RESEARCH INTERVENTIONAL Tentorial Dural Fistulas: Endovascular Management and Description of theMedial Dural-Tentorial Branch of the
2016Co-Authors: Superior Cerebellar Artery, James V. Byrne, M. GarciaAbstract:BACKGROUND AND PURPOSE: TDAVFs are uncommon causes of spontaneous intracranial hemorrhage. A retrospective review of their management was performed after repeatedly observing a previously under-recognized medial dural-tentorial branch of the SCA. MATERIALS ANDMETHODS: Thirteen patients were diagnosed with TDAVFs by CT/MR imaging and DSA during a 5.8-year period. Seven patients presented after intracranial hemorrhage. Twelve patients were treated endovascularly, and one, surgically. RESULTS: Eleven TDAVFs were located in the midline (7 at the Falx Cerebelli and 4 at the torcular), and 2 were petrotentorial. All torcular TDAVFswere associatedwith sinus thrombosis and showed bidirectional drainage relative to the tentorium. No sinus thrombosis was seen in the Falx Cerebelli subtype, which drained infratentorially only, except in 1 patient who had had unrelated surgery previously. Venous drainage was directly to cortical veins except for 1 petrotentorial and 2 torcular TDAVFs. A branch of the SCA, the medial dural-tentorial artery, was observed in 5 midline TDAVFs. Its anatomy was defined with selective angiography. Endovascular therapy resulted in a cure in 5 and subtotal occlusion in 6, and staged treatment is ongoing in 1 patient. One patient was cured after surgery. CONCLUSIONS: TDAVFs frequently cause intracranial hemorrhage and therefore warrant treatment. Endovascular therapy proved effective in this series, and arteriography was essential for understanding the various fistula subtypes and for treatment planning. We emphasize the importance of recognizing the medial dural-tentorial artery of the SCA with its characteristic course along the tentorium on angiography. This artery should be included in future anatomic descriptions of the cranial blood supply
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Tentorial Dural Fistulas: Endovascular Management and Description of the Medial Dural-Tentorial Branch of the Superior Cerebellar Artery
AJNR. American journal of neuroradiology, 2013Co-Authors: James V. Byrne, M. GarciaAbstract:BACKGROUND AND PURPOSE: TDAVFs are uncommon causes of spontaneous intracranial hemorrhage. A retrospective review of their management was performed after repeatedly observing a previously under-recognized medial dural-tentorial branch of the SCA. MATERIALS AND METHODS: Thirteen patients were diagnosed with TDAVFs by CT/MR imaging and DSA during a 5.8-year period. Seven patients presented after intracranial hemorrhage. Twelve patients were treated endovascularly, and one, surgically. RESULTS: Eleven TDAVFs were located in the midline (7 at the Falx Cerebelli and 4 at the torcular), and 2 were petrotentorial. All torcular TDAVFs were associated with sinus thrombosis and showed bidirectional drainage relative to the tentorium. No sinus thrombosis was seen in the Falx Cerebelli subtype, which drained infratentorially only, except in 1 patient who had had unrelated surgery previously. Venous drainage was directly to cortical veins except for 1 petrotentorial and 2 torcular TDAVFs. A branch of the SCA, the medial dural-tentorial artery, was observed in 5 midline TDAVFs. Its anatomy was defined with selective angiography. Endovascular therapy resulted in a cure in 5 and subtotal occlusion in 6, and staged treatment is ongoing in 1 patient. One patient was cured after surgery. CONCLUSIONS: TDAVFs frequently cause intracranial hemorrhage and therefore warrant treatment. Endovascular therapy proved effective in this series, and arteriography was essential for understanding the various fistula subtypes and for treatment planning. We emphasize the importance of recognizing the medial dural-tentorial artery of the SCA with its characteristic course along the tentorium on angiography. This artery should be included in future anatomic descriptions of the cranial blood supply.
Juha Hernesniemi - One of the best experts on this subject based on the ideXlab platform.
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Midline and Paramedian Supracerebellar Infratentorial Approach to The Pineal Region: A Comparative Clinical Study in 112 Patients.
World neurosurgery, 2020Co-Authors: Joham Choque-velasquez, Julio C. Resendiz-nieves, Behnam Rezai Jahromi, Roberto Colasanti, Szymon Baluszek, Sajjad Muhammad, Juha HernesniemiAbstract:Objective The midline supracerebellar infratentorial (SCIT) approach and its paramedian development are commonly used for dealing with pineal lesions. Comparative clinical studies are lacking, however. We aim to establish the better performance of the paramedian SCIT approach in terms of clinical safety in surgically treated pineal cysts and pineal region tumors. Procedural functionality and effectiveness have been also analyzed. Methods A comparative analysis of clinical, radiologic, pathologic, and surgical features, and outcome was performed between 55 midline and 57 paramedian SCIT approaches that were exclusively performed in 112 patients (57 pineal cysts and 55 tumors of the pineal region) operated in sitting position by a single surgeon. Information was retrieved from hospital records and microsurgical videos. Results The paramedian SCIT approach linked with fewer postoperative complications (odds ratio [OR]: 0.40) and fewer approach-related complications (OR: 0.28) than the midline SCIT approach. The SCIT paramedian approach was achieved in a shorter time, by a smaller bone flap, and with fewer complex procedural steps than the midline approach. The SCIT paramedian approach did not require the opening of the Falx Cerebelli, midline cerebellar retraction, section of the midline cerebellar draining veins, nor wide opening of the dura. Gross total resection, size of the lesion, microsurgical time for removal, histopathological diagnosis and postoperative outcome were statistically similar in both groups. Conclusions The SCIT approach represents a safer and more functional approach for the removal of cysts and tumors of the pineal region than the classic midline approach, while maintaining the same effectiveness.
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One burr-hole craniotomy: Suboccipital midline approach to the fourth ventricle in Helsinki neurosurgery.
Surgical neurology international, 2018Co-Authors: Joham Choque-velasquez, Juha HernesniemiAbstract:Background In this video-abstract, we present one burr-hole craniotomy for the standard suboccipital midline approach developed in Helsinki neurosurgery for the microsurgical management of forth ventricle lesions, distal posterior inferior cerebellar artery aneurysms, and tumoral and vascular lesions of the vermis, cisterna magna region, and posterior brainstem as well. Case Description We prefer to position the patient in sitting praying position. A midline straight single-layer incision starts on the inion and extends caudally toward the level of C2. The muscles are divided with diathermia along the occipital bone. Three curved retractors, two upward and one downward, provide a wide clean space for the craniotomy. Finger palpation and blunt dissection with cottonoids balls provide identification of the foramen magnum and the spinous process of C1. A burr-hole is made 1 cm lateral and below the level of the transverse sinus. After the detachment of the dura with a curved angled dissector, two cuts from both sites of the burr-hole are made with the craniotome. In case of an adherent dura particularly present in elderly patients, a long blunt flexible dissector (yasargil dissector) is used for the detachment of the bone from the dura. A craniotomy around the midline overlying the occipital sinus and the Falx Cerebelli is performed to expose medial aspects of cerebellar tonsils, the medulla oblongata, and the occipital sinus. Special care should be taken to avoid damaging the vertebral artery and the epidural sinuses running at the foramen magnum. A few drill holes are made for tack-up sutures. After a craniocervical-based opening of the dura, the fourth ventricle is accessed directly by telovelar route. Conclusion The described one burr-hole craniotomy may represent the more efficient manner for performing the suboccipital midline approach to the fourth ventricle. Videolink http://surgicalneurologyint.com/videogallery/suboccipital-midline-approach/.
Ghaffar Shokouhi - One of the best experts on this subject based on the ideXlab platform.
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A complex dural-venous variation in the posterior cranial fossa: a triplicate Falx Cerebelli and an aberrant venous sinus.
Folia morphologica, 2007Co-Authors: Mohammadali Mohajel Shoja, R. S. Tubbs, Marios Loukas, Ghaffar Shokouhi, W. J. OakesAbstract:Variations of the dural folds and the dural venous sinuses are seldom reported in the extant medical literature. Such variations in the posterior cranial fossa may be problematic in various diagnostic and operative procedures of this region. We report our observation of an extremely rare variation of the Falx Cerebelli and posterior cranial fossa venous sinuses encountered upon dissection of a young male cadaver. In this specimen the Falx Cerebelli was duplicated with dimensions of 45.3 × 5.1 mm and 49.8 × 5.3 mm for the right and left falces respectively. The distance between the two falces was 3.2, 4.5 and 7.8 mm at their proximal, middle and distal thirds. An accessory small Falx (31.8 × 2 mm) was also found approximately 3.4 mm lateral to the right Falx Cerebelli and blended with the lateral surface of the right Falx Cerebelli. There was only one occipital venous sinus (diameter, 2.5 mm) and no marginal sinus was detected. At the right floor of the posterior cranial fossa (posterolateral to the foramen magnum) an additional dural venous sinus was found, which connected the terminal portion of the right sigmoid sinus to the occipital and right transverse sinuses via one medial and two lateral branches respectively. We believe that such a complex dural-venous variation in the posterior cranial fossa has not previously been reported. Neurosurgeons and neuroradiologists should be aware of such variations, as these could be potential sources of haemorrhage during suboccipital approaches or may lead to erroneous interpretations of imaging of the posterior cranial fossa.
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A rare variation of the posterior cranial fossa: Duplicated Falx Cerebelli, occipital venous sinus, and internal occipital crest
Folia morphologica, 2006Co-Authors: Mohammadali Mohajel Shoja, R. S. Tubbs, Amir Afshin Khaki, Ghaffar ShokouhiAbstract:Folds of the meningeal layer of the dura mater, the Falx cerebri and tentorium Cerebelli, traverse the vertebrate intracranial cavity and thus compartmentalise the brain. The Falx Cerebelli, another dural fold, is found in the posterior cranial fossa and attaches to the inferior aspect of the tentorium Cerebelli and to the internal occipital crest. We present a case of a duplicated Falx Cerebelli, occipital venous sinus and internal occipital crest that was detected upon routine dissection of a male cadaver. Since haemorrhage of a dural venous sinus can be a fatal complication of posterior cranial fossa surgery, knowledge of venous sinus variations in this region may prevent unpredictable complications during intracranial procedures.