Tailored frontotemporoorbitozygomatic (FTOZ) craniotomy for a large anterior clinoidal meningioma

Large anterior clinoidal meningiomas are tumors that arise on the anterior clinoid often compressing and encasing the nearby neurovascular structures such as the carotid artery and the optic nerve. These remain as very challenging cases for neurosurgeons because of the issues concerning preservation of critical structures and gross total excision. In this video submission, we will show a case of a large anterior clinoidal meningioma through a tailored frontotemporoorbitozygomotic craniotomy with emphasis on anterior clinoidectomy and the different corridors that can be obtained by this particular approach. The methodical dissection of the tumor and the other critical structures can also be seen.

Positron Emission Tomography Scan: A Good Way to Untie the Gordian Knot of Infection in Case of Multiple Ventriculoperitoneal Shunts

Delayed infection from an implanted device can be challenging to diagnose. Here, we report a case of a 56-year-old male patient with history of congenital hydrocephalus and previous placement of a ventriculoperitoneal (VP) shunt who presented with sepsis without any evidence of shunt infection at follow-up 3 years after his most recent shunt implantation. The VP shunt contained 2 residual ventricular catheters and 2 residual peritoneal catheters, as the patient has had multiple VP shunt revisions since childhood. The patient was unresponsive to multiple antibiotic regimens. Of note, 2-[18]-fluoro-2-deoxy-D-glucose-positron emission tomography scan revealed hypermetabolism at the distal end of the latest implanted abdominal catheter without any abnormality of migrated cerebral catheters, highlighting the advantageous use of 2-[18]-fluoro-2-deoxy-D-glucose-positron emission tomography to identify the infected catheter when multiple devices are involved. Removal of abdominal catheters confirmed the localized infection, and follow-up was uneventful after shunt replacement.

First Report of a Pineal Cyst Associated with Corpus Callosum Lipoma

A 37-year-old man with no medical history, apart from a lifelong horizontal diplopia, underwent brain magnetic resonance imaging, which revealed a curvilinear posterior pericallosal lipoma and a pineal cyst. Corpus callosum lipomas, with an incidence of 0.1%-0.5%, do not require neurosurgical treatment, except in rare cases of malformations causing epilepsy. The indications for surgery of pineal cysts, whose incidence is 0.6%, are controversial, except in case of hydrocephalus. In this case, ophthalmologic examination and magnetic resonance imaging were not consistent for a tectal plate compression and the findings were considered incidental. The association of these 2 abnormalities, which has not been described before, might reflect an interrelated embryologic development for pineal gland and midline lipomas, which derive from aberrant mesenchymal primitive meninx.