The Funnel: From the Skull Base to the Sacrum: New Trends, Technologies and Strategies (Acta Neurochirurgica Supplement, 135)

Skull-base surgery is a minimally invasive endoscopic procedure, which involves the surgeon inserting instruments through the natural openings in the skull—the nose or mouth—or by making a small hole just above the eyebrow. This type of surgery requires a team of specialists, which may include ENT (ear, nose, and throat), maxillofacial and neurosurgeons, as well as radiologists. The craniovertebral junction (CVJ) has a unique anatomical bone and neurovascular structure, which not only separates the subaxial cervical spine but also provides a special cranial flexion, extension and axial rotation pattern. As such, a sound knowledge of the basic principles of spine instrumentation and the region’s kinematics are essential when it comes to strategic preoperative planning. Skull-base, craniovertebral junction, spine demolitive and reconstructive surgery, neuromodulation, bioengineering and transplantation are recent tools used to improve reconstruction, restoration and rehabilitation – three key words central to the core aim of the Neurorehabilitation and Reconstruction Committee of the WFNS, which is to promte mechanical morphological and functional restoration. Contents Why the Funnel in Neurosurgery? 1 Editorial References Surgeon’s Eyes on the Relevant Surgical Target 1 Introduction 2 Loupes 3 Microscope 4 Endoscope 5 Exoscope 6 A Glimpse into the Future References New Trends in Neurosurgery: Toward a Future of Integration and Equity Among Male and Female Neurosurgeons References Tools and Modalities for Postural Ergonomics Research in Surgery and Neurosurgery 1 Introduction 2 Tools for Surgical Ergonomics Research 2.1 Subjective Tools 2.2 Objective Tools 2.3 Future Perspectives 3 Conclusion References The Impact of a Robotic Digital Microscope on the Ergonomics in a Neurosurgical Operating Theatre (A Single-Centre Experience) 1 Introduction 2 Materials and Methods 3 Results 4 Discussion 5 Conclusion References Post-mortem Imaging of Brain/Spine Injuries: The Importance of a Comprehensive Forensic Approach 1 Introduction 2 Medical Malpractice 3 Brain and Spinal Injuries at Post-mortem Computed Tomography 4 Brain and Spinal Injuries at Post-mortem Magnetic Resonance Imaging 5 Training 6 Conclusions References Technologies in Anaesthesia for the Paediatric Patient 1 Physiological Changes in the Prone Position 1.1 Cardiovascular Decreased Cardiac Index Inferior Vena Cava Obstruction 1.2 Respiratory Changes in Respiratory Physiology Lung Volumes 1.3 Complications Associated with the Prone Position Injury to the Central Nervous System Injury to the Peripheral Nervous System 1.4 Pressure Injuries Direct Pressure Injuries Pressure Necrosis of the Skin Contact Dermatitis Tracheal Compression Salivary Gland Swelling Shoulder Dislocation Indirect Pressure Injuries Macroglossia and Oropharyngeal Swelling Visceral Ischaemia Peripheral Vessel Occlusion Ophthalmic Injury 2 ... and The Most Correct Anaesthetic Approach? 2.1 Pre-assessment 2.2 Pre-induction 2.3 Induction 2.4 Positioning 2.5 Intra-Operative Management 2.6 Emergence from Anaesthesia References Further Reading The Funnel: From the Skull Base to the Sacrum. New Trends and Technologies in Anaesthesia for the Adult Patient 1 Anesthesiological Management 2 Preoperative Issues 3 Intraoperative Issues 3.1 Induction and Maintenance of Anaesthesia 4 Postoperative Issues References Methods and Principles of the Intraoperative Neurophysiologic Monitoring in Neurosurgery 1 Introduction 2 Somatosensory Evoked Potentials (SSEP) 3 Motor Evoked Potentials (MEPs) 4 Cortico Bulbar MEPs (CBMEPs) 5 Intraoperative EMG 6 Auditory Evoked Potentials (BAEP) 7 Visual Evoked Potentials (VEPs) 8 Mapping Techniques for Cranial Nerves and Nerve Roots 9 Conclusion References Part I: Brain and Skull Base Diffusion Tensor Imaging Technique Delineating the Prognosis for Cerebellar Mutism in Posterior Fossa Tumors: A New Tool 1 Introduction 2 Materials and Methods 3 Results 4 Discussion 5 Conclusion References Image-Guided Surgery in Complex Skull Base and Facial Fractures: Initial Experience on the Role of Intra-Operative Computer Tomography 1 Introduction 2 Materials and Methods 3 Results 4 Discussion 5 Conclusion References Pediatric Meningiomas: Current Insights on Pathogenesis and Management 1 Introduction 2 Pathogenesis: Embryology, Location, and Molecular Aspects 3 Management: Diagnosis and Treatment 4 Conclusions References Tuberculum Sellae Meningioma: Report of Two Cases and Literature Review of Limits of the Transcranial and Endonasal Endoscopic Approaches 1 Introduction 2 Surgical Technique 2.1 Frontal-Temporal Approach 2.2 The Endoscopic Endonasal Approach 3 Discussion 4 Conclusion References VHL: Trends and Insight into a Multi-Modality, Interdisciplinary Approach for Management of Central Nervous System Hemangioblastoma 1 Introduction 1.1 Haemangioblastomas 1.2 Other Manifestations 2 Methods 3 Results and Discussion 3.1 Molecular Genetics and Pathophysiology 3.2 Natural History 3.3 Multi-Disciplinary Approach and Decision Making 3.4 Treatment Modalities Surgery Embolisation Stereotactic Radiosurgery Multimodal Treatment Medical Treatments Surveillance 4 Conclusion References Further Reading Petroclival Clinoidal Folds and Relationships with Arachnoidal Membranes and Neural Structures of Anterior and Middle Incisural Spaces: Old Neuroanatomical Terms for a New Neurosurgical Speech in Cadaver Labs with Limited Resources Era. Part I: Osteology 1 Introduction 2 Materials and Methods 3 Results 3.1 Anterior and Posterior Clinoid Process 3.2 Structural Anatomy of Dura Mater in the Middle Cranial Fossa 4 Discussion 5 Conclusions References Petroclival Clinoidal Folds and Relationships with Arachnoidal Membranes of Anterior and Middle Incisural Spaces: Old Neuroanatomical Terms for a New Neurosurgical Speech in Cadaver Labs with Limited Resources Era. Part II: Free Edge of the Tentorium, Pet 1 Introduction 2 Materials and Methods 3 Results 3.1 Free Edge of the Tentorium and Petroclinoid Folds 3.2 Incisural Spaces 4 Discussion 5 Conclusions References Petroclival Clinoidal Folds and Relationships with Arachnoidal Membranes of Medial Incisural Space: Old Neuroanatomical Terms for a New Neurosurgical Speech in Cadaver Labs with Limited Resources Era. Part III: Arachnoid Membranes, Cranial Nerves, and Sur 1 Introduction 2 Materials and Methods 3 Results 3.1 The Liliequist’s Membrane (Figs. 1a–d, 2) 3.2 Pituitary Stalk and Pituitary Stalk Cisternal Space (Figs. 1a–d, 2) 3.3 Cranial Nerves (See Figs. 1, 2, 3 Part II) 4 Discussion 4.1 Anatomic Considerations 4.2 Surgical Considerations 5 Conclusions References Avoiding the Blinded Funnel: A Combined Single Piece Fronto-Temporo-Orbito-Zygomatic Craniotomy Endoscopic-Assisted Approach with Multimodal Assistance for an Epidermoid Tumor of Meckel’s Cave-Case Report 1 Introduction 2 Material and Methods 3 Results 4 Discussion References Middle Meningeal Artery Embolization for the Management of Chronic Subdural Hematomas: A New-Old Treatment 1 Middle Meningeal Artery Embolization for the Management of Chronic Subdural Hematomas: The Problem and How We Work 1.1 The Disease and the Management 1.2 Middle Meningeal Artery Embolization Technical Note 1.3 Conclusion References Supraorbital Keyhole Versus Pterional Approach: A Morphometric Anatomical Study 1 Introduction 2 Material and Methods 2.1 Neurosurgical Laboratory and Equipment 2.2 Surgical Approaches and Techniques 2.3 Statistical Analysis 3 Results 3.1 Craniotomy Sizes and Target Distances 3.2 Surgical Corridors and Areas of Exposure 4 Discussion 5 Conclusions References Far Lateral Approach: “Trans-tumor Approach” on Huge Dumbbell-Shape Neurofibroma of Anterior Foramen Magnum Without Craniectomy—Anatomical Consideration and New Trend 1 Introduction 2 Case Presentation 3 Operative Technique and Anatomical Correlation 3.1 Patient Positioning 3.2 Skin Incision and Muscles Dissections 3.3 Operative Result 4 Discussion 5 Conclusion References Use of BoneScalpel Ultrasonic Bone Dissector in Anterior Clinoidectomy and Posterior Fossa Surgery: Technical Note 1 Introduction 2 Materials and Methods 2.1 Surgical Instruments 2.2 Surgical Technique 3 Results 4 Discussion 5 Conclusions References Chiari Malformation Type 1 and Syringomyelia: Why Do Patients Claim for International Guidelines? Commentary on the 2021 Chiari and Syringomyelia Consensus Document 1 Introduction 2 Materials and Methods of the Consensus Process 3 Results and Comments 3.1 Definitions 3.2 Indications to Surgery 3.3 Surgical Techniques 3.4 Outcome, Failures, Re-intervention 4 Conclusions References Evaluation of Adult and Pediatric Chiari Type 1 Malformation Patients: Do Consensus Documents Fit Everyday Practice? 1 Introduction 2 Materials and Methods 2.1 Surgery and Postoperative Management 3 Results 3.1 Pediatric Series Characteristics 3.2 Adult Population 3.3 Surgical Findings and Long-Term Outcome 4 Discussion References Percutaneous Balloon Compression for Trigeminal Neuralgia. A Comparative Study Between the Fluoroscope Guided and Neuronavigated Technique 1 Introduction 2 Materials and Methods 2.1 Statistical Analysis 3 Results 4 Discussion References The Key to a Successful PBC in Treatment of Trigeminal Neuralgia 1 Introduction 2 Target of PBC 2.1 The Semilunar Ganglion 3 A Pear in Meckel Cave 3.1 The Meckel’s Cave 3.2 Pear 4 Effective Compression 4.1 Shapes 4.2 Volume 4.3 Time 5 Tips on the Process 5.1 Position 5.2 Puncture 5.3 Cannulate 5.4 Penetrate 5.5 Inflation 6 Conclusion References The Role of the Anesthesiologist and the Modern Intraoperative Echography in Ventriculoatrial Shunt for Hydrocephalus: From Hakim to Nowadays References Part II: Spine Role of Navigation in the Surgery of Spine Tumours 1 Background 2 Methods 3 Findings and Discussions 3.1 Safe Training 3.2 Radiation 4 Conclusion References Spinal Cord Stimulation Meets Them All: An Effective Treatment for Different Pain Conditions. Our Experience and Literature Review 1 Introduction 2 Materials and Methods 2.1 Case Series 2.2 Systematic Review 3 Results 3.1 Case Series 3.2 Systematic Review 4 Discussion 4.1 SCS for FBSS 4.2 SCS for “Naive Patients” and Other Indications 5 Conclusions References Rheumatoid Diseases Involving the Cervical Spine I. History, Definition, and Diagnosis: New Trends and Technologies 1 Cervical Spine Anatomy 2 Rheumatoid Arthritis 3 Spondyloarthritis 4 Juvenile Idiopathic Arthritis 5 Imaging Modalities 6 Rheumatoid Arthritis 7 Juvenile Inflammatory Arthritis 8 Conclusions References Spinal Cord High-Frequency Stimulation. The Current Experience and Future Directions 1 Introduction 2 Materials and Methods 2.1 Statistical Analysis 3 Results 4 Discussion References Spontaneous Intracranial Hypotension: Controversies in Treatment 1 Introduction 2 Pathogenesis 3 Diagnosis 4 Therapeutic Options 5 Conclusion References Pedicle Screw Placement Aided by C-Arm Fluoroscopy: A “Nevermore without” Technology to Pursue Optimal Spine Fixation 1 Introduction 2 Materials and Methods 3 Results 4 Discussion 5 Limitations 6 Conclusion References Comparison Between Ventricular and Spinal Infusion Tests in Suspected Normal Pressure Hydrocephalus 1 Introduction 2 Methods 3 Data Collection 4 Results 5 Discussion 6 Limitations 7 Conclusions References Spinal Dural Arteriovenous Fistulas: A Retrospective Analysis of Prognostic Factors and Long-Term Clinical Outcomes in the Light of the Recent Diagnostic and Technical Refinements 1 Introduction 2 Materials and Methods 3 Results 4 Discussion 5 Conclusions References Vertebral Candidiasis, the State of the Art: A Systematic Literature Review 1 Introduction 2 Materials and Methods 2.1 Study Setting and Design 2.2 Inclusion and Exclusion Criteria 2.3 Search Strategy and Study Selection 2.4 Data Extraction and Analysis 3 Discussion and Literature Review 3.1 Study Selection and Characteristics. 3.2 Localization, Symptoms, and Risk Factors 3.3 Etiology and Diagnosis 3.4 Treatment Protocols, Clinical Outcomes, and Complications 3.5 Limitations 4 Conclusion References Part III: Cervical Combined Transoral Exoscope and OARM-Assisted Approach for Craniovertebral Junction Surgery. New Trends in an Old-Fashioned Approach 1 Introduction 2 Methods 3 Results 4 Discussion 4.1 3D 4 K Exoscope 4.2 O-Arm Neuronavigation and the Intraoperatory System 4.3 3D 4 K Exoscope Lights 4.4 3D 4 K Exoscope Shadows 4.5 O-Arm Neuronavigation System Lights 4.6 O-Arm Neuronavigation System Shadows 5 Conclusions References Minimally Invasive Instrumentation of the Cervical Spine: Past, Present, and Future 1 Background 2 Material and Methods 3 Past 4 Present 5 Future References Hybrid Implants in Anterior Cervical Spine Surgery: The State of the Art and New Trends for Multilevel Degenerative Disc Disease 1 Introduction 2 Methods 3 Statistical Analysis 4 Results 5 Discussion 6 Conclusions References The Submandibular Approach: A Descriptive Perspective of the Retropharingeal Corridor to the Craniocervical Junction (Microscopic- vs. Endoscopic-Assisted Dissections) 1 Introduction 2 Anatomical Description of the Clival Region 3 Surgical Methods 4 Discussion 5 Conclusions References Central Atlantoaxial Dislocation: Presenting Symptoms, Diagnostic Parameters, and Surgical Treatment from Reports on 15 Surgically Treated Patients 1 Introduction 2 Material and Methods 2.1 Clinical Evaluation 2.2 Radiological Evaluation 2.3 Surgery 3 Results 4 Discussion 5 Conclusion References Atlantoaxial Anterior Transarticular Screw Fixation: Indications and Surgical Technique 1 Introduction 2 Discussion 2.1 Indications 2.2 Contraindications Fixed Rotatory C1-C2 Luxation 3 Step-by-Step Technical Description 4 Tips and Tricks 5 Conclusions References Neuronavigated Retropharyngeal Anterior Screw Fixation of the Odontoid for the Treatment of C2 Type II Fractures: Case Report 1 Introduction 2 Materials and Methods 3 Preoperative Evaluation 4 Surgical Technique 5 Results 6 Discussion References New Trend in Craniovertebral Junction Surgical Strategy: Technical Note for the Treatment of Hangman’s Fractures Through a Minimally Invasive Approach 1 Introduction 2 Methods 3 Surgical Technical Description 4 Discussion 5 Conclusions References Direct Transpedicular C2 Fixation for the Surgical Management of Hangman’s Fractures: A “Second Youth” for the Judet Approach 1 Introduction 2 Technical Case Reports 2.1 Case Illustration 1 2.2 Case Illustration 2 2.3 Surgical Technique 3 Literature Review 4 Results 5 Discussion 6 Conclusion References Computerized Three-Dimensional Analysis: A Novel Method to Assess the Effect of Open-Door Laminoplasty 1 Introduction 2 Materials and Methods 2.1 Surgical Technique and Clinical Data 2.2 Acquisition Protocol and Image Processing 2.3 Virtual Model Analysis 3 Results 4 Discussion 5 Conclusions References Nuance in Craniovertebral Junction Surgical Approach for Posterior C1-C2 Harms Stabilization: “Window Transposition” of the External Vertebral Venous Plexus for Bloodless C1 Lateral Mass Screw Insertion: Anatomical Aspects and Technical Notes 1 Introduction 2 Methods 3 Results 3.1 Surgical Technique Description 4 Discussion 4.1 Harms Surgical Technique 4.2 Vertebral Venous Plexuses in the Craniocervical Junction (CCJ) Region 4.3 Bleeding Control in C1-C2 Fixation: Literature Review 4.4 Authors’ Technical Notes and Considerations 5 Conclusions References Emergency Treatment of Cervical Vertebromedullary Trauma: 10 Years of Experience and Outcome Evaluation 1 Introduction 2 Materials and Methods 3 Results 4 Discussion 5 Conclusion References Long-Term Clinical and Radiographic Outcomes After Bryan Cervical Disk Arthroplasty: A Systematic Literature Review 1 Introduction 2 Material and Methods 2.1 Study Setting and Search Strategy 2.2 Inclusion and Exclusion Criteria 2.3 Data Extraction and Analysis 3 Results 3.1 Study Selection 3.2 Patient Characteristics 3.3 Diagnosis 3.4 Surgical Technique 3.5 Sagittal Alignment 3.6 Residual Motion of the Bryan Prosthesis and Cervical Range of Motion (ROM) 3.7 Periprosthetic Ossification (PO) 3.8 The Fate of the Adjacent Segments 3.9 Clinical and Functional Outcomes 3.10 Complications 4 Discussion 4.1 Limitations 5 Conclusion References Multilevel Corpectomy for Subaxial Cervical Spondylodiscitis: Literature Review and Role of Navigation, Intraoperative Imaging and Augmented Reality 1 Introduction 2 Materials and Methods 2.1 Data Extraction 2.2 Case Illustration 3 Results 4 Discussion 5 Conclusion References Lateral Approach to the Cervical Spine to Manage Degenerative Cervical Myelopathy and Radiculopathy 1 Introduction 2 Materials and Methods 3 Results 4 Discussion 5 Conclusion References Comparison Between Sagittal Balance Outcomes After Corpectomy, Laminectomy, and Fusion for Cervical Spondylotic Myelopathy: A Matched Cohort Study 1 Introduction 2 Material and Methods 3 Results 4 Discussion 5 Conclusions References Minimally Invasive Posterior Cervical Fusion: A Handsome Option 1 Introduction 1.1 Minimally Invasive Surgical Technique for PCF 2 Clinical Indications 3 Discussion 4 Conclusion References Spinal Intradural Extramedullary Tumors: A Retrospective Analysis on Ten-Years’ Experience of Minimally Invasive Surgery and a Comparison with the Open Approach 1 Introduction 2 Materials and Methods 3 Surgical Technique 4 Data Extraction 5 Results 6 Discussion 7 Conclusions References Correlation Between Cervical Spine Sagittal Alignment and Clinical Outcome After Standalone Intersomatic Titanium Cage CeSPACE for Cervical Anterior Discectomy and Fusion in Cervical Degenerative Disk Diseases 1 Introduction 2 Materials and Methods 2.1 Patient Selection and Data Collection 2.2 Surgical Technique 2.3 Clinical and Radiological Evaluations 2.4 Statistical Analysis 3 Results 4 Discussion References Part IV: Dorsal Spinal Epidural Atypical Meningioma: Case Report and Review of the Literature 1 Introduction 2 Materials and Methods 3 Results 3.1 Case Report 4 Histopathology 5 Discussion 6 Conclusions References Costotransversectomy in the Surgical Treatment of Mediolateral Thoracic Disk Herniations: Long-Term Results and Recent Minimally Invasive Technical Adjuncts 1 Introduction 2 Materials and Methods 3 Clinical Symptoms 4 Radiological Signs 5 Surgical Technique 6 Methods 7 Results 7.1 Illustrative Case 8 Discussion 9 Conclusions References The Thoracoscopic Approach in Spinal Cord Disease 1 Introduction 2 Methods 2.1 Surgical Anatomy and Technique 2.2 Discectomy 2.3 Spinal Fusion 2.4 Vertebral Bone Screw Insertion 3 Results 4 Discussion and Conclusion References Cirq Robotic Assistance for Thoracolumbar Pedicle Screw Placement: Overcoming the Disadvantages of Minimally Invasive Spine Surgery 1 Introduction 2 Materials and Methods 2.1 Robot-Assisted Technique 2.2 Fluoroscopy-Guided Technique 3 Statistical Analyses 4 Results 5 Discussion 6 Conclusion References Further Reading Part V: Lumbar Toward the End of the Funnel: The Ventriculus Terminalis—The State of Art of an Ancient Entity with a Recent History 1 Introduction 2 Embryological Basis 3 Clinical Pathophysiology 4 Diagnosis 5 Therapeutic Strategies 6 Conclusion References Cystic Dilatation of the Ventriculus Terminalis: Examining the Relevance of the Revised Operative Classification Through a Systematic Review of the Literature, 2011–2021 1 Introduction 2 Materials and Methods 3 Results 4 Discussion 4.1 Demographics 4.2 Clinical Presentation 4.3 Referral Pathways 4.4 Surgical Management and Relevance of the Operative Classification 4.5 Level of Evidence and Recommendations 4.6 Study Limitations 5 Conclusions References Does Laminectomy Affect Spino-Pelvic Balance in Lumbar Spinal Stenosis? A Study Based on the EOS X-Ray Imaging System 1 Introduction 2 Methods and Materials 2.1 Patient Population 2.2 Imaging Evaluation 2.3 Statistical Analysis 3 Results 4 Discussion 5 Conclusion References Transtubular Endoscopic Neuronavigation–Assisted Approach for Extraforaminal Lumbar Disk Herniations: A New Trend for a Common Neurosurgical Disease 1 Introduction 2 Materials and Methods 3 Results 4 Discussion 5 Conclusion References Long-Term Clinical and Radiological Evaluation of Low-Grade Lumbar Spondylolisthesis Stabilization with Rigid Percutaneous Pedicle Screws 1 Introduction 2 Materials and Methods 3 Results 4 Discussion 5 Conclusions References Fluoroscopy-Assisted Freehand Versus 3D-Navigated Imaging-Assisted Pedicle Screw Insertion: A Multicenter Study 1 Introduction 2 Materials and Methods 3 Results 4 Discussion 5 Conclusions References Extreme Lateral Interbody Fusion (XLIF) with Lateral Modular Plate Fixation: Preliminary Report on Clinical and Radiological Outcomes 1 Introduction 2 Material and Methods 2.1 Patient Selection and Demographics. 2.2 Operations and Technical Note 3 Results 3.1 Radiographic Findings 4 Discussion 5 Limitations and Further Studies 6 Conclusion References A New Interlaminar/Interspinous and Facet-Joint Stabilization System in Lumbar Degenerative Disk Disease: 2 Years of Results 1 Introduction 2 Material and Methods 2.1 Device Characteristics 2.2 Patient Selection 2.3 Surgical Intervention and Technique 2.4 ISCHIA and FILICUDI Implantation 3 Results 3.1 Surgical Results 3.2 Reoperation Data (Patients Removed from the Study) 3.3 Statistical Analyses 3.4 Clinical Outcomes 3.5 Radiological Outcomes 4 Discussion 5 Conclusions References Posterior Surgical Ligation and Cyst Decompression -via Needle Puncture- of a Large Anterior Sacral Pelvic Meningocele Through Posterior Sacral Laminectomy 1 Introduction 2 Case Presentation 3 Surgery 4 Discussion 5 Conclusion References