WEBINAR # 22
Topic: Anatomy of Skull Base – Prof. Saleem Abdulrauf
Time: May 11, 2020 17:00 Islamabad, Karachi, Tashkent
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Meeting ID: 958 4085 8062
RHOTON NEUROANATOMY COURSE MODULE I (VENTRICLES)
Time: May 9, 2020
07:00 AM (Wisconsin GMT -5)
08:00 AM (US GMT -4)
12:00 PM (GMT +0)
05:00 PM (Pak time GMT +5)
05:30 PM (India GMT +5.30)
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Certificate will be given according to the Google Form Attendance
Full Attendance Mandatory to obtain Certificate for the Course
On behalf of the World Federation of Neurological Surgeons “Neuroanatomy Committee” we are pleased to launch its “1st online, dynamic educational course” to promote sound clinical judgement, enhance the neurosurgical skills of young neurosurgeons and trainees around the globe, encourage them to rise to their challenges and respond to their enquiries.
The course will encompass special presentations by distinguished faculty, case discussions and short video sessions reflecting the importance and relevance of anatomical knowledge to neurosurgical interventions.
Imad N. Kanaan & Vladimír Beneš
Chairmen of WFNS Neuroanatomy
Neurosurgery Exit Exam Preparation/ Basic Anatomy of Ventricles
Time: May 7, 202008:00 AM (US GMT -4)12:00 PM (GMT +0)01:00 PM (Coventry GMT +1)05:00 PM (Pak TIme GMT +5)
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Meeting ID: 946 6305 4115
Webinar No 6
Clinical Anatomy of Skull Base Lesions
15th April 2020 12:00PM Pak time
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Neurosurgery Department – Liaquat National Hospital
THURSDAY 5th MODULE
1: Surface Surgical Anatomy. – Phylogenetic evolution of the human brain. – The cerebral lobes. – Craniometric points of the skull. – Brain surface functional understanding through intraoperative mapping.
MODULE 2: The Cerebral Substance (I). – The white matter of the human brain. – Lateral dorsal & ventral tracts. – How I do it: awake surgery. – Technical adjuncts for glioma surgery. – How I do it: endoscopic assisted glioma surgery.
SURGICAL STATION 1: Hands-On. – Intrinsic brain tumor resection on a 3D printed model.
SURGICAL STATION 2: Break-out Session. – The case for discussion: INSULAR GLIOMA.
SURGICAL STATION 3: Quiz Session. – Sulco-gyral organization and cortical 3D understanding based on real cases.
Transnasal Endoscopic Skull Base and Brain Surgery Surgical Anatomy and its Applications
This fully revised and updated second edition of Transnasal Endoscopic Skull Base and Brain Surgery: Surgical Anatomy and its Applications builds on the acclaimed first edition, focusing on the correlation between endoscopic skull base anatomy and state-of-the-art clinical applications. Among these are the transplanum/transtuberculum, transcribrifom, transclival, and craniocervical junction surgical approaches.
Renowned skull base surgeon Aldo Stamm and leading worldwide experts have compiled a comprehensive multidisciplinary textbook with 72 chapters in 14 sections, didactically organized by regions and diseases. Detailed descriptions of sinonasal, orbital, cranial base, and intracranial anatomy, imaging modalities, and in-depth surgical navigation techniques form the foundation of this remarkable book. The content reflects significant knowledge and diverse perspectives from masters in neurosurgery, otorhinolaryngology, head and neck surgery, neuroendocrinology, intensive care, neuro-anesthesiology, and other disciplines.
Chapter summaries and highlights facilitate understanding and retention of complex concepts 1,500 beautiful anatomical, operative, and dissection illustrations and photographs enhance understanding of impacted areas 18 accompanying videos provide guidance on endoscopic transnasal approaches in patients with diverse skull base diseases Pearls, pitfalls, and nuances throughout this book provide invaluable insights on achieving optimal outcomes Neurosurgeons, otolaryngologists–head and neck surgeons, and others will greatly benefit from the step-by-step endoscopic procedural guidance and tips in this quintessential skull base surgical reference.
This book includes complimentary access to a digital copy on https://medone.thieme.com.
Subthalamic nucleus anatomy
Located ventral to the thalamus. It is also dorsal to the substantia nigra and medial to the internal capsule. It was first described by Jules Bernard Luys in 1865, and the term corpus Luysi or Luys’ body is still sometimes used.
Güngör et al., aimed to delineate the 3D anatomy of the STN and unveil the complex relationship between the anatomical structures within the STN region using fiber dissection technique, 3D reconstructions of high-resolution MRI, and fiber tracking using MR diffusion tractography utilizing a generalized q-sampling imaging (GQI) model.
Fiber dissection was performed in 20 hemispheres and 3 cadaveric heads using the Klingler method. Fiber dissections of the brain were performed from all orientations in a stepwise manner to reveal the 3D anatomy of the STN. In addition, 3 brains were cut into 5-mm coronal, axial, and sagittal slices to show the sectional anatomy. GQI data were also used to elucidate the connections among hubs within the STN region.
The study correlated the results of STN fiber dissection with those of 3D MRI reconstruction and tractography using neuronavigation. A 3D terrain model of the subthalamic area encircling the STN was built to clarify its anatomical relations with the putamen, globus pallidus internus, globus pallidus externus, internal capsule, caudate nucleus laterally, substantia nigra inferiorly, zona incerta superiorly, and red nucleus medially.
This study examines the complex 3D anatomy of the STN and peri-subthalamic area. In comparison with previous clinical data on STN targeting, the results of this study promise further understanding of the structural connections of the STN, the exact location of the fiber compositions within the region, and clinical applications such as stimulation-induced adverse effects during DBS targeting 1).
Mavridis et al., used cerebral magnetic resonance images (MRIs) from 26 neurosurgical patients and for the anatomic study 32 cerebral hemispheres from 18 normal brains from cadaver donors. They measured and analyzed the STN dimensions (based on its stereotactic coordinates).
At stereotactic level Z = -4, the STN length was 7.7 mm on MRIs and 8.1 mm in anatomic specimens. Its width was 6 mm on MRIs and 6.3 mm in anatomic specimens. The STN was averagely visible in 3.2 transverse MRI slices and its maximum dimension was 8.5 mm. The intercommissural distance was 26.3 mm on MRIs and 27.3 mm in anatomic specimens. They found statistically significant difference of the STN width and length between individuals <60 and ≥60 years old.
The identification of the STN limits was easier in anatomic specimens than on MRIs and easier on T2 compared to T1-weighted MRIs sections. STN dimensions appear slightly smaller on MRIs. Younger people have wider and longer STN 2).
The dendritic arborizations are ellipsoid, replicating in smaller dimension the shape of the nucleus.
The dimensions of these arborizations (1200,600 and 300 μm) are similar across many species—including rat, cat, monkey and human—which is unusual. However, the number of neurons increases with brain size as well as the external dimensions of the nucleus. The principal neurons are glutamatergic neurons, which give them a particular functional position in the basal ganglia system. In humans there are also a small number (about 7.5%) of GABAergic interneurons that participate in the local circuitry; however, the dendritic arborizations of subthalamic neurons shy away from the border and majorly interact with one another 3).
The STN has been divided into three distinct subdivisions, motor, limbic, and associative parts in line with the concept of parallel information processing. The extent to which the parallel information processing coming from distinct cortical areas overlaps in the different territories of the STN is still a matter of debate and the proposed role of dopaminergic neurons in maintaining the coherence of responses to cortical inputs in each territory is not documented.
The subthalamic nucleus receives its main input from the globus pallidus, not so much through the ansa lenticularis as often said but by radiating fibers crossing the medial pallidum first and the internal capsule.
These afferents are GABAergic, inhibiting neurons in the subthalamic nucleus.
Excitatory, glutamatergic inputs come from the cerebral cortex (particularly the motor cortex), and from the pars parafascicularis of the central complex. The subthalamic nucleus also receives neuromodulatory inputs, notably dopaminergic axons from the substantia nigra pars compacta. It also receives inputs from the pedunculopontine nucleus.