Surgical neurology international最新文献

{"title":"Chronic opioid prescription rates in older adults: A comparison of academic and nonacademic centers following long-segment lumbar instrumentation.","authors":"Janesh Karnati, Shameel Abid, Ahmed Ashraf, Leina Lunasco, Aydin Kaghazchi, Andrew Wu, Xu Tao, Gabriel Jelkin, Sruthi Ranganathan, Sachin Shankar, Mikayla Wallace, Joseph Cheng, Owoicho Adogwa","doi":"10.25259/SNI_486_2025","DOIUrl":"10.25259/SNI_486_2025","url":null,"abstract":"<p><strong>Background: </strong>Factors influencing opioid prescribing include provider type, clinical experience, regional patterns, and institutional affiliation. This study compared the rates of chronic opioid prescriptions being given to older adults undergoing long-segment posterior lumbar fusions in academic versus nonacademic centers.</p><p><strong>Methods: </strong>Out of 20,719 patients aged ≥65 years who underwent posterior lumbar instrumentation involving 3-12 thoracolumbar levels (2010-2022), we created two matched groups that included 3,904 patients each. Patients were stratified according to whether they were treated in academic versus nonacademic centers. Matching included the utilization of 1:1 demographic and clinical factors and analyzed for opioid prescribing patterns at 3-6, 6-12, and 12-24 months postoperatively.</p><p><strong>Results: </strong>We found that patients operated on in nonacademic centers showed significantly lower odds of receiving codeine-based opioids at 3-6 and 6-12 months postoperatively. Conversely, at 12-24 postoperative months, these patients had increased odds of receiving noncodeine-based, strong, and moderate opioids versus academic center patients.</p><p><strong>Conclusion: </strong>For two cohorts of 3904 adults over 65 years of age undergoing 3-12 level thoracolumbar instrumented fusions, academic centers prescribed more opioids initially postoperatively, while nonacademic centers demonstrated higher long-term usage.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"282"},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12361695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics of infantile traumatic brain injury with a biphasic clinical course and late reduced diffusion among pediatric patients with traumatic brain injury.","authors":"Akiko Kawano, Yoshio Sakurai, Kuniya Ishii, Hiroya Yokohari, Michiaki Nagura, Yuta Uchida, Wataru Sakamoto, Shingo Kobayashi, Makoto Murase, Soichi Oya, Kohei Osada","doi":"10.25259/SNI_194_2025","DOIUrl":"10.25259/SNI_194_2025","url":null,"abstract":"<p><strong>Background: </strong>Infantile traumatic brain injury with a biphasic clinical course and late reduced diffusion (TBIRD) is a condition resembling acute encephalopathy with biphasic seizures and late reduced diffusion, marked by a bright tree appearance and potential sequelae. Although seizures are common in pediatric traumatic brain injury (TBI), distinguishing TBIRD from other seizure etiologies is crucial. This study compared the clinical characteristics of patients with traumatic brain injury (TBI), including those with and without seizures, identified TBIRD cases, and examined their distinguishing features.</p><p><strong>Methods: </strong>Data from pediatric patients with traumatic brain injury (TBI) admitted to our pediatric intensive care unit between March 2016 and July 2023 were analyzed. Patients were divided into two groups: seizure and non-seizure. Clinical features were compared, and TBIRD cases were identified within the seizure group for analysis.</p><p><strong>Results: </strong>Among the 104 patients, 28 experienced seizures, while 76 did not. The seizure group was significantly younger and had a higher prevalence of subdural hematomas (SDHs), which were strongly associated with seizures (dds ratio OR = 6.73, 95%: 1.99-22.8, <i>P</i> = 0.00216). Of the 28 seizure patients, five were diagnosed with TBIRD, all of whom presented with SDH and status epilepticus. TBIRD was absent in the patients without SDH. Status epilepticus was significantly more common in TBIRD cases than in non-TBIRD cases.</p><p><strong>Conclusion: </strong>This study suggests that seizures, a hallmark of TBIRD, are strongly associated with subdural hematoma (SDH). All TBIRD cases involved SDH and status epilepticus, whereas none of the TBIRD cases occurred without SDH. TBI patients with SDH and status epilepticus require careful management because of the risk of developing TBIRD.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"287"},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12361708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of ruptured distal anterior inferior cerebellar artery aneurysm treated by intra-aneurysmal embolization.","authors":"Takao Sasaki, Hidefumi Tabata, Hana Tobishima, Takahiro Morita, Kosuke Katayama, Atsushi Saito","doi":"10.25259/SNI_400_2025","DOIUrl":"10.25259/SNI_400_2025","url":null,"abstract":"<p><strong>Background: </strong>Endovascular treatment for true anterior inferior cerebellar artery (AICA) aneurysm is challenging for preserving the AICA trunk. Ischemic tolerance of the sacrifice of AICA is controversial. We report a rare case of ruptured distal AICA aneurysm treated by intra-aneurysmal embolization preserving the AICA trunk.</p><p><strong>Case description: </strong>A 77-year-old woman presented with a sudden headache and computed tomography showed a subarachnoid hemorrhage predominant in the left cerebellopontine angle. Cerebral angiography revealed a saccular aneurysm in the anterior pontine segment of the left AICA. Coil embolization underwent preserving the parent artery. There is no recanalization of the aneurysm at 26 months postoperatively. In this case, hemodynamic stress was suggested to be involved in the development of the aneurysm.</p><p><strong>Conclusion: </strong>For the patients in the old or at high risk of ischemia, intra-aneurysmal embolization should be tried as the first-line treatment.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"284"},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12361650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-degree rotation and chin-up head position for resection of glioblastomas extending into the medial part of the temporal lobe.","authors":"Hirotaka Inoue, Jun-Ichiro Kuroda, Tadashi Hamasaki, Akitake Mukasa","doi":"10.25259/SNI_307_2025","DOIUrl":"10.25259/SNI_307_2025","url":null,"abstract":"<p><strong>Background: </strong>The anterior choroidal artery and lateral posterior choroidal artery are vital structures preserved during the microsurgical treatment of glioblastomas in the temporal lobe. Nevertheless, few studies have examined the appropriate head position for identifying the choroidal arteries in resecting such glioblastomas. In general, a 45°-90° rotation to the opposite side of the lesion is commonly used; however, we have utilized a low-degree rotation (LDR) and chin-up (CU) head position.</p><p><strong>Methods: </strong>The LDR is 30-40° rotation to the opposite side of the lesion. The CU is the angle at which the line connecting the nasion and inion is tilted approximately 30° from the vertical. We retrospectively assessed six consecutive patients with glioblastomas extending into the medial part of the temporal lobe that was resected using the LDR and CU.</p><p><strong>Results: </strong>None of our six patients had an infarction in the area of the choroidal artery or any surgery-related adverse symptoms. The choroidal arteries and hippocampus were not at the deepest point of the resection cavity in the LDR and CU; therefore, these structures were identified during the early phase of surgery.</p><p><strong>Conclusion: </strong>We suggest that the LDR and CU are suitable for resecting glioblastomas extending into the medial part of the temporal lobe.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"285"},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12361703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early minimally invasive treatment of osteoporotic pedicle fractures.","authors":"Kenji Uda, Takayuki Awaya, Takashi Abe, Kazuki Ishii, Osamu Suzuki, Yoshitaka Nagashima, Yusuke Nishimura, Ryuta Saito","doi":"10.25259/SNI_534_2025","DOIUrl":"10.25259/SNI_534_2025","url":null,"abstract":"<p><strong>Background: </strong>Osteoporotic pedicle fractures are rare and may lead to spinal canal stenosis and instability (i.e., spondylolisthesis/lysis). Here, we explored the advantage of early intervention for osteoporotic vertebral fractures (OVFs) accompanied by bilateral pedicle fractures.</p><p><strong>Case description: </strong>An 81-year-old osteoporotic female presented with low-back pain without any history of trauma or prior spinal surgery. Computed tomography revealed an OVF at L3, accompanied by bilateral pedicle fractures. Conservative treatment failed, and she successfully underwent early balloon kyphoplasty at L3, plus stand-alone percutaneous pedicle screw fixation. Postoperatively, symptoms were relieved, and she was discharged without complications on postoperative day 10.</p><p><strong>Conclusion: </strong>This case highlights the efficacy of early, minimally invasive treatment for OVF, and bilateral pedicle fractures.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"283"},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12361667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Updated review of cervical white cord syndrome (WCS)/reperfusion injury (RI); A \"diagnosis of inclusion\" requiring magnetic resonance (MR) confirmation, not just a \"clinical diagnosis\".","authors":"Nancy E Epstein, Marc A Agulnick","doi":"10.25259/SNI_603_2025","DOIUrl":"10.25259/SNI_603_2025","url":null,"abstract":"<p><strong>Background: </strong>The Cervical White Cord Syndrome (WCS)/Reperfusion Injury (RI) rarely causes new major postoperative neurological deficits, and is attributed to the rapid surgical decompression of a chronically compressed/ischemic cord. Never a diagnosis based on \"clinical judgment\" alone, the WCS/RI is a <i>diagnosis of inclusion</i> that requires emergent postoperative MR confirmation of the classical \"white cord\" (i.e., high intrinsic T2W MR cord signal reflecting edema/swelling).</p><p><strong>Methods: </strong>Most frequently, postoperative MR studies in newly paretic/injured patients following cervical operations will show evidence of direct intraoperative (\"iatrogenic\") spinal cord injury. Less frequently, findings may include new non-operative vs. operative pathology (i.e., hematomas/hematomyelia, graft extrusions/malpositioning, new/residual/recurrent disc/stenosis/Ossification of the Posterior Longitudinal Ligament (OPLL), and other pathology).</p><p><strong>Results: </strong>WCS/RI after cervical spine surgery is extremely rare, being reported in only 17 cases as of 2020, and cannot be diagnosed based on \"clinical judgment\" alone; rather, it requires a STAT corroborate postoperative MR to demonstrate the classical \"white cord\". However, most likely postoperative MR studies document \"iatrogenic\" cord injuries, and less likely show new non-surgical and/or new surgical compressive pathology warranting reoperations to remediate the extent/severity of neurological injuries.</p><p><strong>Conclusion: </strong>The postoperative diagnosis of WCS/RI should never be established based on \"clinical judgment alone\". Rather, WCS/RI is a <i>diagnosis of inclusion</i> that requires STAT postoperative MR documentation of the classical swollen/edematous \"white cord\".</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"279"},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12361648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large posterior fossa meningioma presenting with hemifacial spasm.","authors":"Hana Asagiri, Satoshi Tsutsumi, Akane Hashizume, Kazuki Uwabe, Natsuki Sugiyama, Hideaki Ueno, Hisato Ishii","doi":"10.25259/SNI_460_2025","DOIUrl":"10.25259/SNI_460_2025","url":null,"abstract":"<p><strong>Background: </strong>Hemifacial spasms are involuntary paroxysmal muscle contractions commonly presenting as unilateral involvement of the orbicularis oculi and oris muscles.</p><p><strong>Case description: </strong>A 62-year-old woman presented with spasms of progressively increasing frequency for 2 months in the right orbicularis oculi muscle, with subsequent involvement of the orbicularis oris muscle. Cerebral magnetic resonance imaging revealed an intensely enhanced dural-based tumor in the right posterior fossa. On constructive interference in steady-state (CISS) imaging, the right cerebellopontine angle cistern showed marked narrowing, and the right facial nerve could not be identified. The patient underwent tumor resection in the prone position, with intraoperative abnormal muscle response (AMR) monitoring. Upon tumor resection, the late variable components of AMR disappeared. Microscopic findings of the resected specimen were consistent with those of meningiomas. Postoperatively, the patient's hemifacial spasm significantly improved. The CISS sequence revealed restoration of the narrowed right cerebellopontine angle cistern, with clear visualization of the right facial nerve and no signs of neurovascular contact.</p><p><strong>Conclusion: </strong>Large posterior fossa meningiomas can cause hemifacial spasms, and AMR might serve as a predictive indicator of the postoperative resolution of these spasms.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"273"},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12361662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enlarged suprameatal tubercle drilling for distal venous microvascular decompression of the trigeminal nerve, anatomical description: Two-dimensional video.","authors":"Abraham Gallegos Pedraza, Matias Baldoncini, Álvaro Campero, Edgar G Ordonez-Rubiano, Mariano Montes de Oca Delgado, Yazeed Mohammed Aldhfyan, Mickaela Echavarría Demichelis","doi":"10.25259/SNI_288_2025","DOIUrl":"10.25259/SNI_288_2025","url":null,"abstract":"<p><strong>Background: </strong>An enlarged suprameatal tubercle (EST) has been described as an uncommon anatomical variant that may be encountered during cerebellopontine angle surgery. It can limit exposure during microvascular decompression (MVD) of the trigeminal nerve, particularly when the neurovascular conflict is located distal to the root entry zone (REZ), potentially posing a surgical challenge.</p><p><strong>Case description: </strong>We present the case of a 66-year-old woman with a history of medically refractory left-sided V2-V3 typical trigeminal neuralgia, previously treated with radiofrequency ablation without clinical improvement. Magnetic resonance imaging (fast imaging employing steady-state acquisition sequence) demonstrated a vascular loop compressing the left trigeminal nerve. A left retrosigmoid craniotomy was performed. Initial exploration of the REZ showed no arterial contact; the superior cerebellar artery and anteroinferior cerebellar artery were identified without compressive involvement. However, the superior petrosal vein was found to have intimate contact with the trigeminal nerve, forming a loop and producing a visible compression at the entrance to Meckel's cave, with an indentation on the nerve sheath. The neurovascular conflict was clearly visualized only after careful drilling of an EST. Following this maneuver, MVD was successfully performed using a Teflon pledget. Medical treatment was discontinued postoperatively due to the patient's longstanding poor response to pharmacological and ablative therapies. The patient had an uneventful recovery, was discharged 48 h after surgery, and experienced complete resolution of neuralgia without new neurological deficits. At 3-month follow-up, she remained in complete remission, with no complications reported.</p><p><strong>Conclusion: </strong>When addressing neurovascular pathologies of the posterior fossa, a comprehensive understanding of microsurgical anatomy is critical, especially when extending the traditional retrosigmoid approach. Removing the suprameatal tubercle offers several key anatomical and surgical benefits and has been described as a safe option when compression of the nerve is not in the REZ and might be not evident with the initial exposure of anatomical structures.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"276"},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12361673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of outpatient middle meningeal artery embolization for chronic subdural hematoma.","authors":"David Barkyoumb, Kishore Balasubramanian, Sufyan Ibrahim, Muhammad Waqas, Heather Graham, Hakeem J Shakir","doi":"10.25259/SNI_395_2025","DOIUrl":"10.25259/SNI_395_2025","url":null,"abstract":"<p><strong>Background: </strong>Middle meningeal artery embolization (MMAe) has emerged as a safe and efficacious treatment for chronic subdural hematoma (cSDH). Performing this procedure on an outpatient basis has the opportunity to accelerate recovery and provide economic advantages. However, data supporting such protocols remain limited. This study aims to substantiate the feasibility of outpatient MMAe by describing its success at our institution.</p><p><strong>Methods: </strong>A single-center retrospective cohort analysis of all patients undergoing outpatient MMAe for cSDH was conducted between August 2023 and March 2025. Primary outcomes included procedural complication rates, postprocedural emergency department (ED) return rates, and 30-day readmission rates. Secondary outcomes included hematoma recurrence or expansion, degree of symptom resolution, and radiographic outcomes.</p><p><strong>Results: </strong>64 patients were included in the analysis, with a median age of 76 years (interquartile range [IQR]: 68-80). The majority of embolizations (77%) served as primary treatment. The median hematoma depth was 11 mm (IQR 7-15), with bilateral hematomas present in 42% of cases. No intra-procedural complications occurred; however, two patients suffered minor postprocedural complications. The 30-day readmission rate was 5% (<i>n</i> = 3), with no readmissions within 48 h. 17% of patients (<i>n</i> = 11) returned to the ED - the median time from embolization to ED presentation was 12 days (IQR 4-17 days). Among 52 patients (81%) with long-term follow-up, 4% suffered hematoma recurrence requiring surgical drainage, 58% achieved complete resolution of symptoms, and 29% showed improvement in symptoms.</p><p><strong>Conclusion: </strong>The study suggests that outpatient MMAe can be both safe and feasible for select patients with cSDH.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"277"},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12361709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144983437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrosigmoid approach for the resection of a large choroid plexus papilloma: Three-dimensional operative video.","authors":"Marcos Vinicius Sangrador-Deitos, Rodrigo Uribe-Pacheco, Gerardo Yoshiaki Guinto-Nishimura, Juan Francisco Villalonga, Matias Baldoncini, Alvaro Campero","doi":"10.25259/SNI_296_2025","DOIUrl":"10.25259/SNI_296_2025","url":null,"abstract":"<p><strong>Background: </strong>Choroid plexus papillomas of the infratentorial compartment are rare, benign tumors, commonly arising from the inferior roof of the fourth ventricle, with frequent extension into the foramina of Magendie and Luschka and toward the cerebellopontine cistern. Clinical presentation often reflects intracranial hypertension due to cerebrospinal fluid obstruction and, occasionally, hypersecretion. Neurological deficits may include cranial nerve palsies, cerebellar signs, and altered mental status secondary to brainstem and cerebellar compression. Gross total resection remains the treatment of choice to maximize oncological control and preserve neurological function. Surgical approach selection depends on tumor size, extent, and proximity to critical neurovascular structures. While the retrosigmoid approach is traditionally performed in the lateral position, a semi-sitting position may enhance visualization and maneuverability for lesions extending into the cerebellopontine and cerebellomedullary cisterns.</p><p><strong>Case description: </strong>We present a 16-year old with a 1-year history of progressive headache and right hemiparesis due to a large choroid plexus papilloma involving the posterior fossa cisterns. Microsurgical resection was achieved through a retrosigmoid craniotomy in the semi-sitting position following detailed preoperative planning.</p><p><strong>Conclusion: </strong>The semi-sitting retrosigmoid approach offers direct access to the cerebellopontine and cerebellomedullary angles, enabling precise dissection of critical neurovascular structures in a clear surgical field. This operative video illustrates key anatomical and technical considerations, supporting the approach as a safe and effective strategy for complete tumor resection and favorable long-term outcomes. The patient provided informed consent for the procedure and publication.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"274"},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12361659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}