Purpose: In this study, we describe the complications we encountered during digital subtraction angiographies (DSA) in our initial three years of experience and evaluate the risk factors in our patient population. Materials and methods: A series of 507 patients with different pathological processes were diagnosed via digital subtraction angiography (DSA) in our institution from April 2019 through May 2022 and were retrospectively evaluated. During the angiography, the date of the procedure, patient age, gender, comorbidities, catheter types, number of catheters used, and all procedure-related complications were recorded, even if they did not cause any neurological sequelae. Complications were categorized as neurological, non-neurological, or local. Results: Our study included a total of 507 patients. Of these, 256 (50.5%) were male, and 251 (49.5%) were female. The mean age of patients was 49.2 years (range 5-91). The most preexisting comorbidity in patients was hypertension (22.5%). Of 507 patients, a total of 10 patients had either a neurological complication, radiological complication, or angio-site-related complication, and the overall rate of complications was 0.02%. In 6 patients with neurological complications, 3 (0.6%) had permanent neurological deficits, and 3 (0.6%) had transient deficits. In 4 patients with non-neurological complications, asymptomatic vasospasms were encountered in two cases; internal carotid artery (ICA) dissection was experienced in one case, and scrotal hematoma was observed in one case. Conclusion: Complications following DSA are rare but must be minimized with knowledge of the characteristics of the patients and determining the proper indication. Although the risk is low, complications such as thromboembolism can cause permanent neurological deficits and even death.

The objective of this study was to demonstrate that trigeminal schwannomas (TSchs) located in different cranial fossae can be resected entirely through Meckel's cave which is expanded by the tumor by taking either an endoscope-assisted pterional epidural approach (EA-PEA) or an endoscope-assisted lateral suboccipital retrosigmoid approach (EA-LSRA). Additionally, we describe a modified classification based on Jefferson's system to determine the surgical approach. This is a retrospective study of 19 patients with TSchs in different cranial fossae who underwent EA-PEA or EA-LSRA. According to the proposed system, lesions in the middle fossa are classified as type A, those in the posterior fossa are type B, and lesions in both fossae are type C, the same as in Jefferson classification. Our modifications begin by classifying lesions extending into different fossae. Those located primarily in the middle cranial fossa are denoted type C1, whereas one predominantly occupying the posterior cranial fossa is type C2. Lesions with extracranial extensions are classified as type D. Patients with type A, type C1, and type D lesions underwent EA-PEA, while those with type B and C2 lesions were treated through EA-LSRA. Thirteen patients (68.4%) underwent EA-PEA and 6 (31.6%) underwent EA-LSRA. Gross total resection was accomplished in 16 patients (84.2%). No complications were observed. Our study demonstrates that EA-PEA and EA-LSRA can lead to gross total resection in patients with complex TSchs. Endoscope assistance facilitates the visualization of residual tumor. The proposed classification system is a guide for determining the surgical approach.

Aim: The semi-sitting position for intracranial surgery provides substantial surgical advantages, including improved gravitational drainage of cerebrospinal fluid and venous blood, clearer visualization, reduced intracranial pressure, and minimized cerebellar retraction. Although historically associated with complications such as venous air embolism, recent advancements in anesthetic management and intraoperative monitoring have markedly enhanced its safety profile Material and Methods: We retrospectively analyzed 17 consecutive intracranial surgeries performed in the semi-sitting position at a single center between 2019 and 2024 by a senior neurosurgeon. Patient demographics, lesion characteristics, surgical details, and outcomes were reviewed. Preoperative cardiac evaluation excluded patients with significant right-to-left intracardiac shunts. Continuous end-tidal CO₂ monitoring was used intraoperatively to detect venous air embolism. Results: Pathologies included diverse intracranial lesions in the cerebellum and pineal region. Gross total resection was achieved in 15 cases (88%). No clinically significant VAE or other intraoperative complications were detected, and no postoperative neurological deficits occurred. Our series supports the growing body of evidence that semi-sitting position is both safe and effective when applied with appropriate technique and perioperative protocols. Despite limitations related to retrospective design, small sample size, and the absence of highly sensitive monitoring tools, our findings are consistent with recent literature reporting low rates of serious complications. Conclusion: The semi-sitting position remains a viable and advantageous surgical approach for selected intracranial procedures, offering excellent surgical exposure and favorable clinical outcomes with minimal complication rates. Further prospective studies with larger cohorts and comparative controls are recommended to reinforce these findings.

The anterior nucleus of the thalamus (ANT) is a key node of the hippocampal–diencephalic memory system and an established target for deep brain stimulation in drug-refractory epilepsy, yet its temporal connectivity remains incompletely characterized. This study delineates a dorsal posterolateral fiber bundle between the ANT and the amygdalo-uncal region, for which we propose the term anterior thalamo-temporal projection (ATTP). Fourteen hemispheres from seven human brains were examined using Klingler fiber dissection. The ATTP was identified in all 14 dissected hemispheres, following a dorsal posterolateral course through the pulvinar–lateral geniculate corridor and forming one macroscopic endpoint at the ANT, with no demonstrable ventral continuation. The reproducibility of a corresponding tractographic pattern was evaluated in 20 hemispheres from 10 Human Connectome Project participants using a repeated-run diffusion tractography protocol. An anatomically concordant tractographic pattern was reconstructed in 17 of 20 hemispheres (85%). The position of the ANT relative to the anterior commissure–posterior commissure line was also measured. The ANT position varied predominantly along the anteroposterior axis. To our knowledge, this study provides the first systematic microsurgical and tractographic delineation of the ATTP, establishing an anatomical framework for future investigations of medial temporal connectivity and patient-specific ANT neuromodulation.

Background/Objectives: Perirolandic brain metastases are challenging to resect because small deviations from the surgical corridor may cause sensorimotor deficits. This study evaluated the stage-specific value and limitations of general-purpose, non-navigated B-mode intraoperative ultrasonography (iUS) with MRI-based frameless neuronavigation in a consecutive surgical cohort of perirolandic metastases. Methods: In this single-center, single-surgeon retrospective case series, 15 consecutive adults underwent microsurgical resection of perirolandic brain metastases using MRI-based frameless neuronavigation and a general-purpose B-mode ultrasound system, without functional mapping or neurophysiological monitoring. Extent of resection was assessed on contrast-enhanced MRI obtained 24 to 36 h after surgery, and post-resection cavity iUS findings were compared descriptively with early postoperative MRI. Results: Gross-total resection was achieved in 13 patients (86.7%). iUS modified intraoperative targeting in 6 of 15 patients: the entry point was repositioned after findings consistent with intraoperative brain shift in 4, and the lesion was localized in interhemispheric corridors in 2. Post-resection iUS suspected residual tissue in 7 of 14 patients, but only 1 corresponded to residual tumor on MRI; a thin remnant on the motor cortex was not identified as suspicious for residual tumor on iUS. A new or worsened motor deficit occurred in 2 patients (13.3%); at follow-up, this was persistent at 20 months in 1 and partially improved in the other. No patient required reoperation, and there was no 30-day mortality. Conclusions: General-purpose B-mode iUS aided exposure confirmation and trajectory refinement but had limited value for excluding thin residual tumor. When functional mapping or neurophysiological monitoring is unavailable, it may provide accessible real-time anatomical guidance; however, because it lacks functional information, it should not be considered an alternative to these functional adjuncts.