Microscopic versus endoscopic approach to the sellar and supprasellar space, a cadaveric study

Skull base endoscopic endorasal approaches are used more and more liberally to expose the skull base transnasally. However the surgical microscope is still used by some surgeons for sellar exposure transnasally. To provide a qualitative and quantitative anatomical evaluation of the surgical exposure and maneuverability afforded by the endoscope versus that of the surgical microscope in exploring the sellar / suprasellar areas. We used seven embalmed cadaver heads whose vascular system had been injected with colored silicon material. Sublabial trans-septal exploration of the sellar/suprasellar areas was conducted using the endoscope and then microscope. The exposure and maneuverability associated with each mode were evaluated. The endoscope exposed the sellar/superasellar compartment better than the microscope in terms of maneuverability and surgical field exposure. In our model, use of the endoscope provided a better maneuverability advantage over microscope mode in the exploration of the suprasellar compartment

Spinal neurofibroma masquerading as a herniated disc. A case report

We present the only case in English medical literature of a spinal neurofibroma misdiagnosed as a herniated disc using magnetic resonance imaging [MRI]. This case presented with typical symptoms and radiological findings of a herniated disc. Intraoperatively, an abnormality was noted at the S1 nerve root sleeve. Further exploration revealed a spinal neurofibroma which was completely resected, resulting in an improvement in the patient's symptoms. Currently, there is heavy reliance on MRI as a highly sensitive and specific tool used in the diagnosis of herniated lumbar discs. Although there have been occasional reports of misdiagnoses using MRI, there are no reported cases of a spinal neurofibroma being misdiagnosed as a herniated lumbar disc. Despite great advances in radiological diagnostic imaging, surgical surprises do still occur. Ultimately, instinct is still essential in intraoperative surgical decisions