The treatment of craniosynostosis has evolved significantly over the past few decades. While open calvarial vault reconstruction remains a good treatment option, minimally invasive techniques have been shown to yield excellent results in children treated at a young age. This chapter details the use of endoscopic strip craniectomy with postoperative helmet therapy. This surgical option relies on early release of the fused suture to allow the child's own brain growth, plus use of a cranial molding helmet, to allow for correction of head shape. This chapter details the technique used to correct sagittal, metopic, and unicoronal craniosynostosis. Compared to open surgery, studies have shown that endoscopic surgery has comparable aesthetic outcomes and improved perioperative outcomes, such as blood loss, rate of blood transfusion, and time of surgery. This chapter reviews the techniques, aesthetic outcomes, cognitive outcomes, and advances in our knowledge of the genetics of craniosynostosis.

This chapter aims to provide insightful guidance drawn from an updated litera ture search and the long experience of our multidisciplinary team in the surgical management of Cushing's disease. We will first compare the two primary TSS tech niques-microscopic and endoscopic-emphasizing the importance of surgical expertise. We will also discuss new imaging modalities, which may improve the preoperative localization of corticotroph microadenomas. Addressing scenarios where extensive imaging fails to detect pituitary tumors, the chapter analyzes diag nostic challenges, offering guidance on improving localization and effective surgi cal strategies, including the contribution of neuronavigation systems and intraoperative MRI (iMRI). This comprehensive exploration aims to empower clini cians in managing the complexities of Cushing's disease, from accurate localization to advanced surgical techniques and beyond.

Electromagnetic cranial navigation is a valuable alternative to the more commonly used optoelectric navigation, and it has several advantages in different neurosurgical indications enhancing the accuracy of surgery. Obviating the use of sharp head fixation, it has become a very helpful tool in shunt surgery and in pediatric neurosurgery. In addition, its usefulness has been shown in neuroendoscopy, tumor surgery, aneurysm surgery, and skull base approaches. Here, we provide an overview on the technique of electromagnetic navigation and summarize its main indications and advantages in cranial neuronavigation.

Intracystic IFNα proved to be a safe and effective option in the multimodal management of cystic craniopharyngioma (CRF).In our institutional experience, controversial cases have arisen concern and unanswered questions, that are becoming more common with the availability of new target therapies for other brain tumors.Reliable criteria to define the response to treatment should be defined. Additionally, the best timing of surgical resection after target therapy is not clear. Surgery is postponed in case of favorable response, but tumor relapse may present a different architecture eventually increasing surgical morbidity. Finally, in case of good response to the target therapy a close follow-up is required, since rebound may occur in exceptional cases.These data should represent the benchmark for future studies using either systemic administration of IFN or other intracystic drugs.

Hybrid operating rooms (HORs) combine a conventional state-of-the-art microsurgical theater and advanced imaging technologies, usually an intraoperative digital subtraction angiography (DSA) system. Initially developed for peripheral vascular surgery, HORs are gaining popularity among neurosurgical teams around the world. Based on their recent experience, the authors describe the launch of such a hybrid room in the University Hospital of Dijon Bourgogne and, through a narrative review of the pertinent literature, try to define the specific vascular neurosurgery conditions that may benefit from this highly demanding multidisciplinary environment. The association between intraoperative diagnostic and interventional endovascular capabilities and microsurgical management in the same location provides the possibility of immediate assessment of the surgical results, the immediate conversion to one or other technique if needed without transferring the patient, and appears to provide a very high cure rate of neurovascular malformations while minimizing the morbidity and mortality.

There are many approaches to performing selective dorsal rhizotomy (SDR). The two most commonly performed approaches are the cauda equina approach, popularized by Warwick Peacock in 1980, and the conus medullaris approach, as used initially by Foerster and later Gros, and having its modern incarnation in the work of Tae Sun Park. Peacock changed from the traditional conus approach as he felt this approach led to unpredictable outcomes and bladder and bowel complications in some patients at the time. With the modern addition of intraoperative neurophysiology and further advances in the selection of patients for SDR, this technique of performing selective dorsal rhizotomy at the level of the cauda equina lives on with long-term data in support of its use. The author elaborates on the cauda equina approach to SDR in this chapter.

This paper provides an overview of optic pathway hypothalamic gliomas (OPHGs), neoplastic lesions that are mainly low-grade gliomas with predominance of pilocytic astrocytomas. They typically occur more frequently in children, but arise also in adults. While some tumors affect the optic nerve alone, the majority of them invade the hypothalamus and optic chiasm as well as adjacent structures. According to the pertinent literature, most authors consider extensive or curative tumor resection not feasible because of high risk for visual loss or severe hypothalamic side effects. Therefore, radiochemotherapy is a widely used modality to treat these challenging lesions. The authors of the present article describe a different strategy of selecting and treating surgically patients with OPHG. Similar to their management of low-grade gliomas in other intracranial location, they have treated a number of OPHGs microsurgically with curative intention. The present patient series comprises 56 individuals (42 pediatric and 14 adult patients). The authors achieved microsurgical gross total (99-100% tumor volume reduction) and near total tumor resection (90-98% volume reduction) in 42 patients (75.0%). There was no surgical mortality, and the rate of complications was low. Postoperatively, the patient's visual and endocrine function remained either intact or at a very satisfactory level in the vast majority of cases. These results differ from those found in previous publications dealing with OPHGs. In the author's experience, proper patient selection played an important role in achieving a good outcome. They conclude that microsurgical management should be considered an important part of the treatment plan in OPHGs. Patients should undergo surgery in an early stage before irreversible symptoms have occurred, and gross total tumor resection should be attempted in well-selected cases. Intentional partial OPHG resection and repeat surgery may help prolonging the symptom-free and tumor progression-free intervals.

Cystic anomalies of the posterior fossa constitute an important chapter of the malformations of this region. Their interpretation is largely based on the existence of a pouch described by Joseph Blake in 1900. We have reviewed the ancient literature on which this description is based. All human data were obtained from only three fetuses. The histological and embryological analysis of these observations leads us to remain very cautious as to their significance. Indeed, this region of the posterior fossa is very fragile and subject to numerous technical artifacts. In addition, errors in fetal age lead us to believe that one of the observations cannot be used. It is therefore appropriate to be very careful when using this old literature. All these elements justify the need to revisit this problem in order to determine the normal development of this region in humans.

In this chapter, the current status of dorsal rhizotomy is reviewed, highlighting its significant evolution over the past four decades. The first major advancement was sparked by Fasano's introduction of intraoperative neurophysiological procedures and Peacock's modification of the surgical site to the cauda equina. Subsequent advancements in surgical and neurophysiological techniques have expanded the indications for rhizotomy beyond spastic cerebral palsy, a condition affecting 0.2% of live births worldwide. Dorsal rhizotomy can significantly benefit children with spasticity by improving their mobility, daily activities, and social participation.

Glioblastoma (GB) remains the most prevalent and aggressive primary tumor of the central nervous system, with median overall survival between 14 and 20months. Maximal extent of resection is associated with extended overall survival. Lobectomy may lend itself in the management of patients with glioblastomas in certain anatomical areas for accomplishing maximal or even supramaximal resection. Patients with good preoperative KPS, with a tumor confined to one lobe, and no infiltration of the subependymal zone are good candidates for lobectomy.Preoperative considerations: A thorough medical history, a detailed neurological examination, along with diagnostic work-up is essential in decision-making and proper surgical planning. Neurocognitive evaluation is also of paramount importance.Frontal lobectomy: High-speed drill is used for performing a frontotemporal craniotomy in non-dominant cases, while a more extensive fronto-parieto-temporal osseous flap is required in dominant cases for detailed cortical and subcortical mapping via an awake procedure. A corticectomy is then performed along with subpial resection of the white matter of the involved lobe.Temporal lobectomy: The same craniotomy strategy is used in temporal lobectomies. A corticectomy is performed through the inferior temporal gyrus, removal of the underlying white matter, and entrance to the ipsilateral temporal horn. After the neocortical resection, the mesial temporal structures have to be removed under the microscope. The importance of subpial resection technique cannot be overemphasized. Complications such as neurocognitive deficits, paresis, dysphasia, infections, hydrocephalus, and hemorrhage are mainly reported in lobectomies performed for epilepsy. In GB lobectomy studies, no statistically significant differences were observed regarding complications. In the pertinent literature, lobectomy demonstrates a mean overall survival of 25months, compared to 13.72months for gross total resection (GTR), and a progression-free survival of 16.13months, compared to 8.77months for GTR.