Surgical neurology international最新文献

{"title":"Drill bit breakage with tip dislodgment deep into the brain parenchyma: A unique craniotomy complicatıon.","authors":"Mohammed Aladdam, Mehmet Ali Kahraman, Muhammed Emin Aksu, Mehmet Sabri Gürbüz","doi":"10.25259/SNI_416_2025","DOIUrl":"10.25259/SNI_416_2025","url":null,"abstract":"<p><strong>Background: </strong></p><p><p>Breakage of the drill bit during craniotomies is quite common; however, penetration of the dura and leptomeningeal layers and dislodging of the broken fragment into the brain parenchyma have not been previously reported.</p><p><strong>Case description: </strong></p><p><p>This case report demonstrates a unique and challenging complication in neurosurgery involving a 57-year-old male patient who presented with a large hypertensive intracerebral hemorrhage in the right hemisphere, and intractable intracranial hypertension was taken to the operating room to perform a right decompressive craniectomy and evacuation of intraparenchymal hematoma. During the craniotomy using a disposable, footed B1 drill bit, the drill bit broke and was not found during the surgery. Following the surgical procedure, the routine postoperative computed tomography scan revealed a dislodged drill bit fragment deeply embedded within the frontal lobe parenchyma. The patient was taken again to the operating room. Under fluoroscopy guidance, the drill bit was extracted successfully.</p><p><strong>Conclusion: </strong></p><p><p>We present this unique case as it can be encountered in daily neurosurgical practice and present our recommendations for management and prevention of such a rare complication, which can be helpful to other neurosurgeons.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"333"},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202586","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":"Analysis of the carotid bifurcation levels for carotid endarterectomy.","authors":"Masaru Honda","doi":"10.25259/SNI_561_2025","DOIUrl":"10.25259/SNI_561_2025","url":null,"abstract":"<p><strong>Background: </strong>We have already introduced the visualization of the posterior belly of the digastric muscle, which is a major component of the styloid diaphragm (SD). This helped the carotid endarterectomy (CEA) simulation considering the carotid bifurcation or carotid plaque height and their accessibility. In CEA cases, we examined the relationship between the SD and carotid bifurcation to determine whether the high bifurcation cases have the specific clinical profiles.</p><p><strong>Methods: </strong>Eighty-seven consecutive CEA-treated Japanese patients were evaluated, and the location of the carotid bifurcation, thyroid cartilage (TC), hyoid bone (HB), and gonion was measured on the computed tomography angiography, referred to the heights of cervical vertebra bodies.</p><p><strong>Results: </strong>Mean vertebral levels of the carotid bifurcation, TC, HB, and gonion were 3.9 ± 0.6, 5.5 ± 0.6, 4.2 ± 0.5, 3.9 ± 0.6, and 2.9 ± 0.6, respectively. Seven carotid bifurcations located higher than the SD. There were no statistical differences in the distribution of sex, age, and coexisting diseases except for coronary artery disease (<i>P</i> = 0.02) between normal (4.0 ± 0.6) and high bifurcation (3.4 ± 0.4) cases. The multivariate analyses revealed that the coronary artery disease (<i>P</i> = 0.04), twisted internal carotid artery (ICA) (<i>P</i> = 0.031), and TC levels (<i>P</i> = 0.007) were correlated with the high bifurcation.</p><p><strong>Conclusion: </strong>The high bifurcation correlates with the twisted ICA, high TC, and alternatively low gonion levels. The visualized SD could be the landmark for the CEA indication and preparation and enables meticulous surgical manipulation of the distal end of the carotid plaque.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"324"},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202612","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":"Baseline radiological parameters associated with good neurological outcome following ventriculoperitoneal shunt in normal pressure hydrocephalus: A single-center study on 82 patients.","authors":"Riccardo Paracino, Pierfrancesco De Domenico, Riccardo Antonio Ricciuti, Fabrizio Mancini, Mauro Dobran","doi":"10.25259/SNI_975_2024","DOIUrl":"10.25259/SNI_975_2024","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic normal pressure hydrocephalus (iNPH) is a benign neurologic condition with treatment response rates ranging only between 30 and 50%. Several studies have attempted to identify clinical or radiological predictive factors of a favorable and sustained response to shunting, with conflicting and inconclusive results. With this report, we aimed to define the role of the Evans index (EI), enlargement of temporal horns, lateral ventricular bulges, and isolated elements of disproportionally enlarged subarachnoid spaces (high-convexity tightness and sulcal focal dilation) in predicting outcomes following ventriculoperitoneal shunt (VPS) placement.</p><p><strong>Methods: </strong>All patients referred to Ospedali Riuniti of Ancona, Italy, from 2010 to 2021 were retrospectively examined for evaluation of iNPH. Clinical notes and neuroimaging were reviewed. After screening, 82 patients undergoing VPS procedures for iNPH were included in this series. Most (82.9%) patients were aged >65, with a male-to-female ratio of 1.92:1.</p><p><strong>Results: </strong>Small baseline EI was associated with a significant improvement in gait apraxia scores (0.36 ± 0.04 vs. 0.40 ± 0.05, <i>P</i> = 0.04) and urinary incontinence episodes (0.38 ± 0.03 vs. 0.40 ± 0.05, <i>P</i> = 0.04). An EI > 0.40 was associated with a reduced likelihood of gait improvement (30.2%) in contrast to symptom stability or worsening (53%, <i>P</i> = 0.03). Similarly, an EI > 0.40 was associated with a reduced likelihood of continence improvement compared to stability or worsening of episode frequency (21.8% vs. 54%, <i>P</i> = 0.004). The presence of moderately compressed or obliterated cortical sulci was associated with a significant improvement of modified Rankin scale (mRS) functional status following surgery compared to patients with no convexity tightness (78% vs. 49.1%, <i>P</i> = 0.02 and 39.1% vs. 16.9%, <i>P</i> = 0.03, respectively). A large preoperative EI was predictive of poor response in the domains of gait apraxia (odds ratio [OR] = 0.001, 95% confidence interval [CI]: 0.001-0.4, <i>P</i> = 0.004) and urinary continence (OR = 0.001, 95% CI: 0.001-0.3, <i>P</i> = 0.003). The strongest predictors of improved mRS performance status were moderately (OR= 3.72, 95% CI: 1.22-11.35, <i>P</i> = 0.02) or severely compressed cortical sulci (OR= 3.15, 95% CI: 1.07-9.26, <i>P</i> = 0.03).</p><p><strong>Conclusion: </strong>The EI is a significant parameter predictive of enhanced gait function and urinary continence postsurgery. Furthermore, noteworthy evidence supports the association of high-convexity tightness with improved overall functional scores following surgical intervention.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"325"},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202601","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":"Unusual presentation of temporal bone meningioma as chronic otitis media: A case report.","authors":"Settawut Thongpech, Rachanun Loganpai","doi":"10.25259/SNI_469_2025","DOIUrl":"10.25259/SNI_469_2025","url":null,"abstract":"<p><strong>Background: </strong>Temporal bone meningiomas are uncommon tumors that can present with symptoms mimicking more familiar otologic conditions, such as chronic otitis media. Because these neoplasms are rare and their symptoms nonspecific - especially in adult patients - they are often misdiagnosed, leading to delays in appropriate treatment.</p><p><strong>Case description: </strong>We present the case of a 53-year-old Thai woman who developed persistent left-sided ear pain, itching, aural fullness, and mucopurulent discharge over a 2-month period. Her symptoms progressed despite multiple courses of oral and topical antibiotics. Audiometry revealed unilateral hearing loss, and imaging studies, including high-resolution computed tomography and gadolinium-enhanced magnetic resonance imaging, identified a 2.1 × 1.9 × 1.8 cm extra-axial lesion in the left cerebellopontine angle, extending into the petrous temporal bone. The patient underwent retrosigmoid craniotomy for tumor resection. Gross total excision was achieved, and histopathologic analysis confirmed a World Health Organization Grade I psammomatous meningioma. Her postoperative course was uneventful, and follow-up imaging showed no recurrence.</p><p><strong>Conclusion: </strong>Temporal bone meningiomas, though rare, should be considered in adults with chronic otologic symptoms that fail to resolve with standard therapy. Neuroimaging is essential in refractory cases to identify underlying skull base pathology. Early diagnosis and timely surgical intervention are critical to prevent neurological complications, including cranial nerve deficits and brainstem compression.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"323"},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202570","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 recurrence of herniated nucleus pulposus after percutaneous endoscopic lumbar discectomy: A retrospective cohort study of 1,278 patients.","authors":"Settawut Thongpech, Verapan Kuansongtham, Sumroeng Neti, Thanet Wattanawong, Withawin Kesornsak, Pawin Kasempipatchai, Khin Myat Myat Lwin, Boonsub Sakboonyarat, Krit Pongpirul","doi":"10.25259/SNI_574_2025","DOIUrl":"10.25259/SNI_574_2025","url":null,"abstract":"<p><strong>Background: </strong>Some have determined that percutaneous endoscopic lumbar discectomy (PELD) effectively treats lumbar herniated nucleus pulposus, but there is concern regarding a high 6-month postoperative recurrence rate. Risk factors reportedly associated with the heightened risk of disc recurrences include high body mass index (BMI), male sex, and operative approach. Further, it may be difficult to differentiate recurrent discs from other pathologies/factors that may mimic disc recurrence.</p><p><strong>Methods: </strong>In this retrospective cohort study, we reviewed demographic, clinical, radiological, and operative data for 1,278 patients undergoing PELD from 2011 to 2022. Recurrent discs were defined by recurrent radicular symptoms appearing at least 4 weeks postoperatively and were confirmed by magnetic resonance imaging scans to be at the same level and on the same side. Using Cox proportional hazards models, we predicted recurrence rates. We also utilized Kaplan-Meier survival analysis to evaluate recurrence-free survival stratified by BMI, surgical approach, and sex.</p><p><strong>Results: </strong>The 6-month recurrence rate was 1.02/100 person-months. In multivariable analysis, male sex, BMI ≥25 kg/m², and the use of the extraforaminal approach were independent predictors of disc recurrence. Kaplan- Meier curves demonstrated significantly lower recurrence-free survival among male patients, overweight/obese individuals, and those treated through the extraforaminal approach.</p><p><strong>Conclusion: </strong>Male sex, high BMI, and extraforaminal approaches proved to be significant independent risk factors correlating with early disc recurrence rate following PELD.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"322"},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202613","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":"Neuropsychiatric outcomes in responsive neurostimulation: A single-center experience.","authors":"Stephen Jaffee, Zarrar Nashman, Jason Gandhi, Trent Kite, Vineetha Yadlipalli, Carol Schramke, Dorian Mateusz Kusyk, Alexander Whiting","doi":"10.25259/SNI_139_2025","DOIUrl":"10.25259/SNI_139_2025","url":null,"abstract":"<p><strong>Background: </strong>Responsive neurostimulation (RNS) is an emerging technology for treating drug-resistant epilepsy (DRE). While seizure outcomes are well-documented, there is a paucity of literature evaluating the postoperative neurocognitive effects of RNS implantation in epilepsy patients utilizing the comprehensive neuropsychological tests often performed in pre-surgical evaluations. We compared pre- and post-RNS implantation neuropsychological evaluation results to elucidate neurocognitive changes.</p><p><strong>Methods: </strong>We retrospectively reviewed charts of DRE patients who received RNS implants at our institution between 2017 and 2024 who underwent both pre- and post-operative neuropsychiatric evaluations. Evaluations included general abilities, attention, memory, language, visual-spatial/construction naming, executive function, and motor skills. Statistical significance was set at <i>P</i> < 0.05, and the threshold for clinically significant change was 2-3 for the American National Adult Reading Test (AMNART) premorbid estimate and 3-5 for all other measured neuropsychiatric outcomes.</p><p><strong>Results: </strong>We included 14 patients, and their mean age at RNS implantation was 39.1 years. The median seizure reduction in our cohort was 75%, with a 100% responder rate. The mean follow-up time for postoperative neuropsychiatric evaluation was 14.3 months. The vast majority of paradigms demonstrated no significant change. There was a small statistically and clinically significant reduction in the AMNART premorbid estimate (Mean change: -2.07, <i>P</i> = 0.0376) and verbal comprehension index (VCI) to normalized intelligence quotient scores (Mean change: -3.21, <i>P</i> = 0.0441). There was also a small statistically significant reduction in VCI Sum Scaled Scores (Mean change: -1.79, <i>P</i> = 0.0376) and Visual Spatial Construction Rey Figure Copy Raw Scores (Mean change: -2.19, <i>P</i> = 0.0249), but neither was clinically significant. Finally, there was a statistically significant but non-clinically significant increase in the Arithmetic Scaled Score (Mean change: ±1.21, <i>P</i> = 0.0055).</p><p><strong>Conclusion: </strong>RNS was not associated with significant changes across multiple neuropsychology paradigms and may help attenuate the progressive neurocognitive decline often seen in DRE patients. Future research is needed to elucidate these trends further.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"321"},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202564","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":"Endoscopic subtemporal keyhole anterior transpetrosal approach in small cerebellopontine angle tumors with trigeminal neuralgia: A case series of three patients.","authors":"Donny Wisnu Wardhana, Farhad Balafif, Tommy Alfandy Nazwar, Fachriy Balafif, Anisa Nur Kholipah, Hiroki Morisako, Takeo Goto","doi":"10.25259/SNI_552_2025","DOIUrl":"10.25259/SNI_552_2025","url":null,"abstract":"<p><strong>Background: </strong>Surgical management of cerebellopontine angle (CPA) lesions remains challenging due to the region's complex anatomy. The microscopic anterior transpetrosal approach or combined petrosectomy is the standard technique for trigeminal schwannomas and CPA meningiomas, but requires extensive craniotomy and dissection. For smaller tumors, the endoscopic anterior transpetrosal approach (eATPA) offers a less invasive alternative, providing access to the petrous apex and Meckel cave with minimal temporal lobe retraction. This report presents the initial experience in Indonesia utilizing the keyhole eATPA technique, assessing feasibility, safety, and outcomes.</p><p><strong>Case description: </strong>In 2024, three patients with ~2 cm CPA lesions compressing the trigeminal nerve-one trigeminal schwannoma and two CPA meningiomas-underwent eATPA using a pure endoscopic four-hands technique. The procedure included a 3 cm subtemporal craniotomy, intradural identification of the Greater Superficial Petrosal Nerve with intraoperative monitoring, drilling of Kawase triangle, opening of Meckel cave, tumor resection, and trigeminal nerve decompression. Total resection and successful decompression were achieved in all cases. Trigeminal neuralgia improved: The two CPA meningioma patients experienced complete pain relief, while the schwannoma patient had residual facial numbness. Operative time was 4-5 h due to the learning curve, with minimal bleeding, no cerebrospinal fluid leakage, and no new neurological deficits. Patients reported mild incisional pain and were discharged within 3 days. At 3-6 months' follow-up, all remained clinically stable.</p><p><strong>Conclusion: </strong>This early experience suggests the keyhole eATPA technique is a feasible, safe, and effective approach for small CPA lesions, offering favorable clinical outcomes and faster post-operative recovery.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"330"},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202616","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":"Immunoexcitoxicity as the mechanism of CNS damage from COVID-19 \"vaccinations\".","authors":"Russell L Blaylock","doi":"10.25259/SNI_734_2025","DOIUrl":"10.25259/SNI_734_2025","url":null,"abstract":"","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"335"},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202750","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":"Case of osteomyelitis caused by <i>Cutibacterium acnes</i> after full-endoscopic spinal surgery.","authors":"Saori Takeuchi, Satoru Yabuno, Masatoshi Yunoki, Koji Hirashita","doi":"10.25259/SNI_720_2025","DOIUrl":"10.25259/SNI_720_2025","url":null,"abstract":"<p><strong>Background: </strong>Full-endoscopic spinal surgery (FESS) is an effective technique for reducing the risk of surgical site infection. However, postoperative infections do occur but are only rarely reported.</p><p><strong>Case description: </strong>A 71-year-old male underwent a left L45 FESS for foraminal stenosis and disc herniation. Postop day 40, he developed the sudden onset of severe low back pain/sciatica. Although he remained afebrile and laboratory tests showed only mild inflammation (C-reactive protein: 2.1 mg/dL, white blood cell count within the normal range), the lumbar magnetic resonance and computed tomography (CT) studies revealed L4/5 osteomyelitis. The CT-guided biopsy documented <i>Cutibacterium acnes</i> (formerly <i>Propionibacterium acnes</i>), and the patient responded well to antibiotic treatment alone, without requiring additional surgical intervention.</p><p><strong>Conclusion: </strong>This case describes the 40-day delayed postoperative-onset of osteomyelitis following a right L45 FESS caused by <i>C. acnes</i>.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"327"},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202568","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":"Telovelar approach for resection of a pons metastasis: Three-dimensional surgical video.","authors":"Ricardo Lourenço Caramanti, Erica Antunes Effgen, Raysa Moreira Aprigio, Matheus Rodrigo Laurenti, Feres Chaddad-Neto","doi":"10.25259/SNI_495_2025","DOIUrl":"https://doi.org/10.25259/SNI_495_2025","url":null,"abstract":"<p><strong>Background: </strong>Although metastases are the most common type of brain tumors, only 3-7% of them affect the pons. Due to its rarity and the high surgical morbidity, most cases are treated with radiotherapy; however, in selected cases, surgery can bring benefits such as improving the mass effect, local control of the disease, and avoiding the high risk of late neurological deficits caused by the scatter of radiation in radiotherapy treatment.</p><p><strong>Case description: </strong>We present a 72-year-old female with a history of 3 weeks of progressive dizziness and a decrease in sensitivity. The physical examination had a positive Romberg test. The neurologic investigation was performed by magnetic resonance imaging, which showed a unique pontine tumor with peripheral contrast enhancement and a necrotic center. Brain stem tractography revealed lateral displacement of sensitive fibers, allowing a safe approach to the tumor through the floor of the fourth ventricle. A microsurgical resection through a telovelar approach was proposed. The patient showed no worsening of symptoms, and a postoperative MRI revealed complete lesion resection. Tumor biopsy confirms lung metastasis diagnosis.</p><p><strong>Conclusion: </strong>In this three-dimensional video, the authors present step-by-step microsurgical techniques for performing a pontine metastasis resection using a telovelar approach. It is essential to emphasize that technical and anatomical knowledge, combined with adequate patient selection, are crucial for achieving optimal results in cases of brainstem metastases.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"334"},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12478282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202596","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}