Bauman, Megan

Abstract Neuroanatomy remains a core competency in neurosurgical training, particularly in skull base education, where learners must integrate three‐dimensional spatial understanding, radiologic correlation, and stepwise procedural knowledge. Cadaveric dissection remains foundational, but adjunctive digital tools may strengthen repeated visualization and anatomical review. We describe the educational rationale and implementation of integrating stereoscopic teaching, a stepwise digital application, photogrammetry, and virtual reality within an established neurosurgical skull base curriculum. Within the Mayo Clinic cranial base course embedded in a broader longitudinal curriculum, four postgraduate year 4 neurosurgery residents participated in transcranial and endoscopic cadaveric dissections supported by stereoscopic lectures, workstation‐based tablet guidance, and immersive review using photogrammetry, virtual reality, and computed tomography/magnetic resonance imaging correlation. The integrated design aligned these modalities with course objectives in anatomical landmark recognition, operative corridor planning, radiologic‐anatomic translation, and stepwise procedural rehearsal. The educational contribution of this model lies in the intentional integration of digital adjuncts around cadaveric dissection rather than in a single technology alone. This multimodal sequence may support spatial understanding, procedural preparation, and competency‐oriented skull base training while extending review beyond the laboratory. Current evaluation is best interpreted as preliminary program evaluation rather than definitive learner‐outcome evidence. This model may offer a transferable approach for programs seeking to complement cadaveric education with emerging digital tools and provides a basis for future prospective evaluations using multiple low‐stakes assessment data points across the broader curriculum.

BACKGROUND AND OBJECTIVES: Endoscopic transnasal surgery offers a minimally invasive alternative to transcranial approaches for accessing midline skull base lesions involving the petrous apex and petroclival region. However, lateral access, particularly behind the petrous internal carotid artery (ICA), remains limited. The contralateral transmaxillary (CTM) approach provides a more direct surgical trajectory, more parallel to the petrous ICA. Yet, lateral access through this approach can be restricted by anatomic barriers, including the pterygoid process and lateral buttress of the maxillary sinus. We aimed to evaluate the contralateral transmaxillary-transpterygoid (CTMP) approach, with and without the lateral buttress removal (CTMP-LBR), to determine whether these modifications could enhance surgical access to the petroclival region. METHODS: Ten sides from 5 formalin-fixed, latex-injected cadaveric specimens were dissected to compare CTM, CTMP, and CTMP-LBR approaches. Petrous bone drilling was directed posterolaterally behind the petrous ICA toward the region medial to the cochlea. In addition, 30 sides from computed tomography angiography scans were analyzed to obtain radiographic measurements for each approach. RESULTS: Compared with CTM, both CTMP and CTMP-LBR significantly increased access for retrocarotid petrous bone drilling ( P < .001) and yielded a wider surgical angle relative to midline ( P < .001), in both cadaveric and radiographic analyses. In dissections, 20% of sides required CTM only, 50% benefited from CTMP, and 30% required CTMP-LBR to achieve adequate lateral access. Radiographic analysis revealed that CTMP required a median of 4 mm of pterygoid drilling, whereas CTMP-LBR required 9 mm and enabled a trajectory parallel to the petrous ICA with only 11 mm of soft tissue displacement. Patients with smaller angles between the petrous ICA and the horizontal plane were significantly more likely to benefit from CTMP over CTM ( P = .005). CONCLUSION: Modification of the CTM approach with pterygoid drilling and optional LBR improves retrocarotid access. Preoperative evaluation of the petrous ICA angle may help optimize patient-specific planning in endoscopic petroclival surgery.

BACKGROUND Glossopharyngeal neuralgia (GPN) is a rare disorder characterized by severe, episodic pain along the sensory distribution of cranial nerve (CN) IX. Bilateral GPN presents unique challenges for consideration of microsurgical treatment due to potential risks of postoperative dysphagia and cardiac arrhythmias associated with resection of bilateral CN IX/X. Here, the authors describe successful staged bilateral microsurgical rhizotomy of CN IX and upper CN X rootlets to treat bilateral GPN. OBSERVATIONS A 54-year-old female presented with right GPN and underwent a right retrosigmoid craniotomy with rhizotomy, resulting in complete resolution of pain. During the following year, the patient developed left GPN and was considered for the same surgical intervention. However, prior to pursuing surgical intervention, evaluation of her swallowing function was conducted to stratify her risk of pharyngeal sensory denervation or dysphagia, and to confirm her suitability for left-sided rhizotomy. Given the patient’s normal oropharyngeal swallowing function on videofluoroscopic swallow study, she underwent left retrosigmoid craniotomy with rhizotomy. At the 3-month follow-up, the patient described complete resolution of pain and normal swallowing function. LESSONS With the use of comprehensive patient evaluation between surgical stages, staged bilateral microsurgical rhizotomy is a feasible and safe treatment option for carefully selected patients with bilateral GPN. https://thejns.org/doi/10.3171/CASE25359

Abstract Professor Albert J. Rhoton Jr., MD, is renowned for his groundbreaking dissections, marking a monumental achievement in the field of neuroanatomy. Alongside his anatomical contributions, he also passed on his knowledge and skills to numerous fellows, leaving behind a profound legacy. Despite the widespread recognition of his influence, little quantitative work has been done to characterize the scholarly impact of his alumni. Data were collected on Rhoton fellows, including fellowship years, country of origin, current institutions, and titles, practice settings, and leadership roles. Scholarly productivity was evaluated by assessing publication counts, including publications before and after the fellowship, and publications focused on surgical anatomy. Additionally, H-indices and citation counts were recorded. Other variables analyzed included ownership of a surgical anatomy laboratory, and participation in organizing hands-on courses. We analyzed 118 alumni from diverse countries. There was a significant increase in publication output following the fellowship, with publications rising from an average of 7 to 76 (p < 0.001). Fellows from high-income countries had higher research productivity than those from middle-income countries, with greater average H-index (p = 0.003), publication count (p = 0.01), and citation score (p = 0.003). Overall, 65% of fellows pursued academic practice, with 18% owning a laboratory and 30% involved in hands-on courses. Dr. Rhoton's mentorship has shaped a generation of neurosurgeons who continue his legacy. His fellows have established careers worldwide, leading in academia, professional organizations, and surgical training. Their global impact underscores the lasting value of structured mentorship in neurosurgery.

Abstract Cadaveric dissections, which are considered the most realistic model to study neuroanatomy, are expensive and not readily available in all centers. Given the surge of technological advances, incorporation of three‐dimensional (3D) scanning technologies and 3D models has gained popularity, both in the educational and clinical settings. We present our institutional experience in creating high‐fidelity neuroanatomical 3D models using three 3D scanning techniques: structured light 3D scanning, “manual” photogrammetry with a single DSLR camera, and “automatic” photogrammetry using a scanner equipped with five vertically arranged DSLR cameras and an automatic turntable within a square box. A survey study was conducted with 20 neurosurgical residents to assess the quality of the three resulting 3D models. In the study, “manual” photogrammetry was determined to be the most cost‐effective technique, while “automatic” photogrammetry was the most time‐effective and user‐friendly technique. The best visual quality was obtained using “manual” photogrammetry, as determined from survey results of 20 neurosurgical residents. While structured light 3D scanning had the lowest quality of resolution of the texture map, this technique was the most accurate to use for determining measurements, with a fixed accuracy of 0.05 mm. Overall, “manual” photogrammetry can allow for the most detailed 3D models and is the most cost‐effective strategy, while structured light 3D scanning is most suitable for obtaining clinically relevant measurements given the high degree of structural accuracy. Alternatively, “automatic” photogrammetry can serve as a hybrid between obtaining relatively high‐quality models in a time‐effective and user‐friendly manner.

AbstractObjectiveNeuromodulation for pediatric refractory epilepsy (PRE) is preferred when the seizure onset zone is not amenable to surgical resection, due to multifocal onset or involvement of eloquent cortex. Given its rapidly evolving landscape, we describe our institutional experience with neurostimulation therapies including deep brain stimulation (DBS) of the anterior nucleus (DBS‐ANT), the centromedian nucleus (DBS‐CM), responsive neurostimulation (RNS), and chronic subthreshold stimulation (CSS) to treat PRE.MethodsA retrospective chart review was conducted to identify pediatric patients (≤18 years of age) who presented to our institution with PRE. Patients were included who had at least 1 year of follow‐up after neurostimulation was started. Patients with ≥50% seizure frequency reduction at last follow‐up compared to baseline were classified as responders.ResultsA total of 35 patients (21 females) were included in the series. Nine patients underwent DBS‐ANT, 9 underwent DBS‐CM (+ ANT in 7 patients), 5 underwent RNS, and 12 underwent CSS. The median age at seizure onset and surgery was 8 and 16 years, respectively. Structural lesions were the most common etiology of epilepsy (54%). Eighteen patients had prior interventions and 13 received invasive EEG. Post‐operative complications following neurostimulation implantation were noted in three patients (9%). However, no permanent deficits were noted. Median follow‐up time was 46 months (range 13–162 months). Twenty‐three patients (59%) were responders (3/9 DBS‐ANT; 7/9 DBS‐CM; 4/5 RNS; 9/12 CSS). Further, median seizure reduction was 25% (DBS‐ANT), 89% (DBS‐CM), 87% (RNS), and 88% (CSS) across the cohort. Six patients (17%) had improved subjective neurocognitive outcomes while the other 29 had stable neurocognitive outcomes.SignificanceDBS, RNS, and CSS are safe and effective options for PRE. An understanding of treatment approaches can optimize results by tailoring therapy to individual patients.Plain Language SummaryThis study investigates the use of various neurostimulation therapies for treating pediatric refractory epilepsy (PRE) including deep brain stimulation (DBS), responsive neurostimulation (RNS), and chronic subthreshold stimulation (CSS). Overall, neuromodulation was found to be effective in reducing seizures in most patients, with 59% of patients showing at least a 50% reduction in seizure frequency. Additionally, the treatments were generally safe, with few complications and no instances of permanent deficits.

Abstract Background Cadaveric dissection remains a preferred and irreplaceable learning modality among neurosurgery residents. We aimed to develop and describe a tiered, quantifiable, and practical curriculum for cranial neurosurgical anatomy education. We report the structure and evaluation of our 2-year pilot study to serve as a suggested guide for other neurosurgery programs. Methods Our Complex Cranial Dissection Program is tailored to the needs of junior-level neurosurgery residents based on their postgraduation years 1 to 4. Dissections are performed in a sequential manner, each of which emphasize a particular set of manual skills and neuroanatomical knowledge. Dissections are scored on a scale of 10 points. The grading was based on specific landmarks and anatomical structures, which need to be exposed, explored, and preserved. Results Out of 16 residents, 14 individuals (87.5%) attended the dissections in the first iteration of the program and 16 individuals (100%) attended the dissections in the second iteration. A total of 17 dissections were performed across all years. In survey feedback about the program, 100% (Year 1) and 94% (Year 2) of residents considered the assigned dissections to be appropriate for their respective training levels. Further, 100% (Year 1) and 94% (Year 2) of residents endorsed that the dissections were important and helpful for their practice prior to similar operating room experiences. Conclusion The development and implementation of structured dissection programs within residency training, along with dedicated staff, and objective feedback serve a crucial role in neurosurgical education to further develop and enhance surgical skills in the operative setting.

AbstractHemifacial spasm is a neuromuscular disorder caused by compression of the facial nerve at the nerve root entry zone, often due to ectatic or aberrant vasculature. Pathologic compression of the nerve–brainstem interface results in involuntary, paroxysmal contractions of ipsilateral facial muscles that may cause considerable impairments in quality of life. For those with severe symptoms, have positive imaging demonstrating vascular compression, or who fail other management modalities,1 2 3 4 microvascular decompression offers potential definitive treatment.5 6 Traditionally, nonabsorbable packing agent is used to pack between the nerve and offending vascular structure. However, for large and more complex arterial structures, simple nonabsorbable padding is often not sufficient.In this operative video, we demonstrate microvascular decompression for intractable hemifacial spasm in a 52-year-old female using a specialized sling tacked to the petrous dura for management of a large, ectatic vertebral artery. Following a standard left retrosigmoid craniotomy, an atheromatous ectatic vertebral artery was identified. We fashioned a bovine pericardium sling around the vessel and used a permanent aneurysm clip to secure it to an incision portion of petrous dura. We subsequently identified potential additional facial nerve root compression by anterior inferior cerebellar artery (AICA) and posterior inferior cerebellar artery (PICA) branches, which were elevated and secured using Teflon felt packing. Following elevation of all three vessels, the lateral spread response resolved. At 2 weeks postoperatively, the patient reported substantial relief in her hemifacial spasms and endorsed highly improved quality of life.