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The course of the facial nerve (FN) has been extensively investigated in patients with vestibular schwannomas (VSs). FN running dorsally to the tumor capsule accounts for less than 3% of the cases. Diffusion tensor imaging (DTI)-based fiber tracking helps to preoperatively identify the FN. During surgery, a higher risk of injury is associated with the dorsal location of the FN. The authors demonstrate the nuances and tricks to identify and preserve a dorsal displaced FN during resection of a large VS, T3b according to the Hannover classification, through the retrosigmoid-transmeatal approach. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID2182.

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MATERIAL AND METHODS: A case of 60-year-old woman with idiopathic syringomyelia and progressive myelopathy by dorsal arachnoid web is discussed. One focal indentation along the dorsal surface of the spinal cord at the T3 vertebral body level revealed the scalpel sign, a radiologic entity diagnostic of a dorsal thoracic arachnoid web. RESULTS: T2-T3 laminectomy for the resection of dorsal arachnoid band was performed. Careful sectioning of the web resulted in visual apparent relief of the compression and good functional recovery. CONCLUSION: In patients with presumed idiopathic syringomyelia, imaging studies should be closely inspected for the presence of transverse arachnoid web. This extramedullary transverse band of arachnoid tissue extends to dorsal surface of the spinal cord, resulting in mass effect and dorsal indentation, known as scalpel sign because of its apparent resemblance to a scalpel on sagittal imaging. Early diagnosis with early intervention may benefit greatly patients. Surgical resection of transverse arachnoid web is a minimally invasive procedure with low morbidity, and can result in resolution of syringomyelia and improvement in neurological function.

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PURPOSE: The goal of this study was to develop a method to reduce the costs of intraoperative high-field magnet resonance imaging (iMRI). The results of a series of 29 gliomas removed with this technique are presented. METHODS: A series of 29 patients with brain gliomas were operated on using a low-cost method of high-field intraoperative MRI (Signa 1.5 T. MR Excite, GE Inc.). The patients were transported during surgery to the neuroradiological department through a specially located lift in order to perform the intraoperative examinations ("outside iMRI"). The time required for the procedure as well as the possible related complications, such as infection, were analyzed. RESULTS: After studying the intraoperative images, additional tumor resection was needed in 12 of the 29 patients. The median time required to perform the iMRI was 25 min. There was no infection or other complications related to the procedure in this series. CONCLUSIONS: This method offers all clinical advantages of high-field iMRI inside of the operating room, with very low costs and additional advantage of integrating the neurosurgical/ neuroradiological teams. This strategy will give an alternative to several neurosurgical departments in the world to perform high-quality iMRI at very low cost.

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OBJETIVOS: As desordens do desenvolvimento cortical (DDC) constituem a segunda causa de epilepsia refratária. Diversas patologias estão incluídas nas DDC. Seu diagnóstico foi facilitado com o desenvolvimento na neuroimagem. MÉTODOS: No presente artigo, apresentamos sete casos divididos em três grupos, de acordo com o mecanismo de produção das DDC: 1) anormalidades da proliferação e diferenciação de neurônios da glia; 2) anormalidades de migração neuronal; 3) anormalidades na organização neuronal. A investigação consistiu em história mais exame neurológico, avaliação neuropsicológica, ressonância magnética e eletrencefalograma. RESULTADOS E CONCLUSÕES: Três pacientes apresentaram displasia cortical focal, dois apresentaram heterotopia em banda, um paciente apresentava lisencefalia e uma apresentava esquizencefalia. Todos os pacientes apresentavam epilepsia de difícil controle. Malformações corticais constituem um grupo heterogêneo de causas de epilepsia de difícil controle. É importante para o manejo médico que as diversas formas de malformações corticais sejam conhecidas e diagnosticadas, o que foi facilitado pelo advento da ressonância magnética.

OBJECTIVES: Cortical development disorders (CDD) are the second cause of refratary epilepsy. Various patologies are included in the CDD. The diagnosis was easy with the continuous development of the neuroimaging. METHODS: In the present paper we show seven cases divided in three groups, accourding with the mecanism of production of the CDD: 1) proliferation and diferentiation abnormalities of the glial cells; 2) abnormalities of the neuronal migration; 3) abnormalities of the neuronal organization. The investigation consisted in story and neurological examination, neuropsicological avaliation, magnetic ressonance imaging and eletroencephalogram. RESULTS AND CONCLUSION: Three patients had focal cortical dysplasia; two had heterotopic band, one patient had lissecephaly and another had schizencephaly. All the patients had refractory epilepsy. Cortical malformations are a heterogeneous group of refractory epilepsy. Knowing and diagnosing these different types of cortical malformations are important steps for their treatment, and were facilitated by de advent of magnetic resonance imaging.

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