Journal of Neurosurgery Academy

Surgical video of transsylvian resection of prechiasmatic craniopharyngioma

2026-04-01T11:31:49+00:00

The Sylvian fissure (SF), also referred to as the lateral sulcus, is one of the most prominent anatomical landmarks on the lateral surface of the cerebral hemisphere. This fissure separates the frontal and parietal lobes superiorly from the temporal lobe inferiorly and forms an important corridor in neurosurgical procedures. Within the depth of the fissure lies the Sylvian cistern, which contains critical neurovascular structures such as the middle cerebral artery (MCA) and its branches, superficial Sylvian veins, and arachnoid trabeculae. We present an operative video of a 16-year-old boy who presented with a bifrontal headache and visual impairment for 1 month. He was subjected to transsylvian resection of the suprasellar lesion, after which there was significant improvement in his symptoms. This manuscript highlights the surgical technique of SF dissection with emphasis on the principles of microneurosurgery.

Step by step endoscopic CSF leak repair: cribriform defect

2026-04-13T11:03:29+00:00

Background: Cerebrospinal fluid (CSF) rhinorrhea from anterior skull base defects carries a significant risk of
ascending bacterial meningitis and mandates definitive surgical repair. Spontaneous leaks occurring in the context
of elevated intracranial pressure represent a distinct and increasingly recognised clinical subset associated with
identifiable radiological markers of idiopathic intracranial hypertension. Transnasal endoscopic repair has emerged
as the preferred approach, offering direct visualisation, low morbidity, and success rates exceeding 90%.
Objective: To present a detailed step-by-step video account of transnasal endoscopic CSF leak repair employing
a multilayer gasket-seal closure augmented with a vascularised nasoseptal flap, with full documentation of surgical
decision-making, intraoperative technique, and perioperative management principles.
Case Description: A 45-year-old female presented with a 3-month history of spontaneous, left-sided, posturedependent
clear rhinorrhea. High-resolution CT of the paranasal sinuses demonstrated a focal bony defect (2 mm)
in the left cribriform plate with adjacent fluid density. MRI cisternography confirmed active CSF communication
through this defect at the junction of the nasal septum and the middle turbinate attachment, along with an empty
sella and periventricular white matter signal changes indicative of chronically elevated intracranial pressure.
Surgical Technique: The procedure was performed under general anaesthesia using a fully endoscopic transnasal
approach. Sequential operative steps comprised: (1) anterior septoplasty via a Killian incision using a bovine-tip
electrode for corridor creation and concurrent harvest of cartilage for gasket use; (2) endoscopic identification and
cauterisation of the herniated meningocele sac, followed by precise delineation of the cribriform defect measuring
8 mm 3 mm straddling the middle turbinate attachment; (3) partial middle turbinectomy for optimal exposure
and margin preparation; (4) intracranial underlay placement of fascia lata harvested from the ipsilateral thigh; (5)
press-fit insertion of a carved autologous cartilage gasket within the bony defect; (6) extracranial overlay placement
of a second fascia lata layer; and (7) inset of a posteriorly pedicled nasoseptal flap based on the posterior septal
branch of the sphenopalatine artery, secured with fibrin glue over the entire repair construct.
Results: No intraoperative complications were encountered. Complete resolution of rhinorrhea was achieved
immediately postoperatively. The patient was discharged on postoperative day 3. Follow-up endoscopy at 6 weeks
demonstrated full mucosalisation of the repair site with intact flap healing. Acetazolamide therapy was initiated for
presumed raised intracranial pressure and continued under ophthalmological surveillance.

Hybrid operating theatre in neurosurgery: the future of neurosurgery

2026-04-04T07:39:47+00:00

Cisternostomy: surgical technique and technical nuances in the management of intracranial hypertension

2026-04-10T07:42:43+00:00

Cisternostomy is a microsurgical strategy aimed at lowering intracranial pressure (ICP) by re-establishing cerebrospinal fluid (CSF) communication across basal cisterns. In contrast to decompressive craniectomy, it achieves effective relaxation of the brain while preserving the calvarium. Over the past decade, growing clinical data have supported its use in traumatic brain injury (TBI) and aneurysmal subarachnoid hemorrhage (SAH). This article provides a detailed, stepwise description of the operative technique, emphasises key anatomical landmarks, and highlights practical nuances that improve safety and completeness of decompression.

Endoscopic endonasal approach to sellar-suprasellar lesions

2025-03-12T07:32:00+00:00

The endoscopic endonasal approach through the transphenoidal and transtubercular access provides an excellent and panoramic view of the sellar-suprasellar lesions. The indications include pituitary adenomas, craniopharyngiomas, meningiomas, etc. The surgery is done using a zero-degree endoscope and, if required, angled endoscopes for resecting tumors around the corners. Tumors going lateral to the optic nerves are contraindications. Cerebrospinal fluid leak is a common complication of this skull base approach; however, it has been decreased significantly with the use of the nasoseptal mucosal flap. This educational video article describes a step-by-step approach to a case of pituitary macroadenoma, along with the indications, contraindications, advantages, limitations, complications, and their avoidance of this approach.