Journal of Neurosurgery Academy

Endoscopic surgery in lumbar spine diseases

Magomed Lepshokov — 2025-09-29

Endoscopic techniques for lumbar spine surgery have evolved into a safe and effective alternative to conventional microsurgical procedures. Minimally invasive procedures offer significant advantages by reducing approach related muscle and tissue trauma, perioperative blood loss, postoperative pain, and length of hospital stay. The introduction of tubular endoscopic systems has facilitated the use of bimanual microsurgical techniques, enabling precise decompression of neural structures with a favorable learning curve. This article outlines the use of the EasyGO! endoscopic tubular system in degenerative disease of the lumbar spine, with a particular focus on the technical nuances of the approach. Endoscopic lumbar decompression using the tubular system represents safe and effective option for the treatment of degenerative spinal pathologies.

The origin of neuroplastic surgery: the birth of a novel supersubspeciality of neurosurgery

Kodeeswaran M. — 2025-09-29

Exoscope-endoscope-assisted minimal invasive contralateral interhemispheric approach for a lateral ventricular subependymal giant cell astrocytoma

Chandrashekhar Gendle — 2025-09-26

Subependymal giant cell astrocytoma (SEGA) is a slow-growing, WHO grade 1 tumor that often arises near the foramen of Monro within the lateral ventricles and predominantly occurs in patients with tuberous sclerosis complex. Traditionally, transcortical-transventricular and interhemispheric-transcallosal approaches have been established for SEGA resection. In this paper, we present advanced visualization tools such as exoscopes and endoscopes that offer enhanced surgical precision by improving depth perception, illumination, and ergonomics for the resection of SEGA through a minimally invasive contralateral interhemispheric keyhole approach. A 55-yearold lady presented to us with a progressively worsening headache for 1 year. MRI showed a subependymal tumor in the right lateral ventricle, suggestive of SEGA. She was positioned with her head turned to the left. A linear incision was marked across the midline as per the shortest contralateral trajectory in neuronavigation guidance. A left parasagittal keyhole craniotomy was made, and the dura was reflected over the SSS. Under 3D exoscopy, dissection was advanced via an interhemispheric approach, and both pericallosal arteries were identified and safeguarded. Targeted callosotomy was performed after confirmation on navigation. The tumor was grayish, soft, and partly suckable. Following maximal resection with an exoscope, an angled endoscope was introduced to identify hidden slivers of tumor tissue, which were then carefully excised. She improved following surgery, with a post-op scan showing no residual tumor. The histopathology was in favor of SEGA. The exoscopic-endoscopic assisted minimally invasive excision of SEGA demonstrates promise as a safe and effective alternative to traditional microscopy, with particular advantages for deep-seated lateral ventricular tumors where enhanced visualization and improved ergonomics can significantly benefit surgical outcomes.

Technical nuances for achieving successful STA-MCA bypass anastomosis

Katsumi Takizawa — 2025-09-26

The success of bypass surgery hinges on two key goals: ensuring long-term bypass patency while minimizing ischemic complications by reducing clamping time. While off-the-job training in anastomosis techniques is crucial, it’s not enough. Many vital skills—such as preparing the recipient artery and establishing an optimal surgical field— can only be mastered through real surgical experience. This paper shares practical tips and insights from our specific technique. We emphasize the universal principle of performing each step with precision and thoroughly confirming its accuracy before moving on, a discipline essential for successful bypass surgery regardless of the specific school of thought or technique.

Minimally invasive tubular microdiscectomy: a video-based guide

Syed R. H. Peeran — 2025-09-27

Tubular microdiscectomy (TM) offers a minimally invasive alternative to open lumbar discectomy. Using a small port, surgeons can access the herniated disc with minimal tissue disruption and achieve effective neural decompression. This video-based article provides a comprehensive step-by-step guide to TM, from patient positioning to final decompression, emphasizing strategies for safe and effective outcomes.

Microscissor DREZotomy for intractable brachial neuralgia

Sachin A. Borkar — 2025-09-29

Dorsal Root Entry Zone lesioning (DREZotomy), also known as Lissauer tractotomy, is a microsurgical technique originally described in the 1970s for managing intractable neuropathic pain and spasticity. This article reviews the historical evolution and technical nuances of DREZotomy, focusing on the methods established by Sindou and Nashold, including their respective approaches to incision and lesioning. A case of a patient with a pan brachial plexus injury and severe neuropathic pain is presented, where DREZotomy provided complete pain relief. The surgical technique, anatomical landmarks, and intraoperative considerations are described, along with potential complications affecting posterior column, spinocerebellar, and corticospinal pathways. This report highlights the role of DREZotomy as an effective intervention for neuropathic pain secondary to brachial plexus avulsion.

Microsurgical resection of a huge pontine cavernoma with bulbar disturbance

Saparov Nurgeldi — 2025-09-30

Pontine cavernous malformations are rare vascular lesions that carry a significant risk of hemorrhage and
neurological deficits because of their location within the brainstem. We describe the case of a young patient
who presented with bulbar symptoms secondary to a pontine cavernoma. Alongside the clinical details, we
review similar cases reported in the literature, including presentations such as trigeminal neuralgia and other
cranial nerve syndromes arising from pontine lesions. The report outlines the surgical approach, intraoperative
techniques, and postoperative management in detail. Advanced neuromonitoring and careful selection of safe
entry zones were critical to the operative plan. The patient experienced a favorable recovery, with improvements
noted during rehabilitation and on follow-up imaging. In discussing this case, we highlight the balance between
achieving maximal safe resection, often subtotal in brainstem surgery, and minimizing the risk of rehemorrhage
while preserving neurological function.