bluuebunny/crossref_metadata_2025_split huggingface dataset:
Open-door extended endoscopic transorbital technique to the paramedian anterior and middle cranial fossae: technical notes, anatomomorphometric quantitative analysis, and illustrative case
Authors: Corvino Sergio , Kassam Amin , Piazza Amedeo , Corrivetti Francesco , Spiriev Toma , Colamaria Antonio , Cirrottola Giovanni , Cavaliere Carlo , Esposito Felice , Cavallo Luigi Maria , Iaconetta Giorgio , de Notaris Matteo 
Published: April 2024

OBJECTIVE
The superior eyelid endoscopic transorbital approach (SETOA) provides a direct and short minimally invasive route to the anterior and middle skull base. Nevertheless, it uses a narrow corridor that limits its angles of attack. The aim of this study was to evaluate the feasibility and potential benefits of an "extended" conservative variant of the "standard" endoscopic transorbital approach—termed "open-door"—to enhance the exposure of lesions affecting the paramedian aspect of the anterior and middle cranial fossae.

METHODS
First, the authors described the technical nuances of the open-door extended transorbital approach (ODETA). Next, they documented its morphometric advantages over standard SETOA. Finally, they provided a clinical-anatomical application to demonstrate enhanced exposure and better angles of attack to treat lesions occupying the paramedian anterior and middle cranial fossae. Five adult cadaveric specimens (10 sides) initially underwent standard SETOA and then extended open-door SETOA (ODETA to the paramedian anterior and middle fossae). The adjunct of hinge-orbitotomy, through three surgical steps and straddling the frontozygomatic suture, converted conventional SETOA to its extended open-door variant. CT scans were performed before dissection and uploaded to the neuronavigation system for quantitative analysis. The angles of attack on the axial plane that addressed four key landmarks, namely the tip of the anterior clinoid process (ACP), foramen rotundum (FR), foramen ovale (FO), and trigeminal impression (TI), were calculated for both operative techniques and compared.

RESULTS
Hinge-orbitotomy of the extended open-door SETOA resulted in several surgical, functional, and esthetic advantages: it provided wider axial angles of attack for each of the target points, with a gain angle of 26.68° ± 1.31° for addressing the ACP (p < 0.001), 29.50° ± 2.46° for addressing the FR (p < 0.001), 19.86° ± 1.98° for addressing the FO (p < 0.001), and 17.44° ± 2.21° for addressing the lateral aspect of the TI (p < 0.001), while hiding the skin scar, avoiding temporalis muscle dissection, preserving flap vascularization, and decreasing the rate of bone infection and degree of orbital content retraction.

CONCLUSIONS
The extended open-door technique may be specifically suited for selected patients affected by paramedian anterior and middle fossae lesions, with prevalent anteromedial extension toward the anterior clinoid, the foremost compartment of the cavernous sinus and FR and not completely controlled with the pure endoscopic transorbital approach.
Transorbital neuroendoscopic surgery for treatment of sphenoid wing meningiomas extending to the cavernous sinus: clinical implications and a technical illustration
Authors: Karımzada Gardashkhan , Evleksiz Karımzada Demet , Erol Gökberk , Gülsuna Beste , Kuzucu Pelin , Güngör Abuzer , Kutlay Ahmet Murat , Şahin Muammer Melih , Çeltikçi Emrah 
Published: April 2024

OBJECTIVE
The aim of this study was to evaluate the efficacy and safety of transorbital neuroendoscopic surgery (TONES) in the management of sphenoid wing meningiomas (SWMs) with cavernous sinus and orbital invasion.

METHODS
The authors conducted a retrospective review of 32 patients with SWMs treated at Gazi University using TONES from October 2019 to May 2023. The study includes clinical applications to elucidate the endoscopic transorbital approach. Surgical techniques focused on safe subtotal resection, aiming to minimize residual tumor volume for subsequent radiosurgery. Data were collected on patient demographics, tumor characteristics, surgical procedures, complications, and postoperative outcomes, including radiological imaging and ophthalmological evaluations.

RESULTS
Surgical dissections delineated a three-phase endoscopic transorbital approach: extraorbital, intraorbital, and intracranial. In the clinical application, gross-total resection was not achieved in any patient because of planned postoperative Gamma Knife radiosurgery. The mean follow-up period was 16.3 months. Of 30 patients with preoperative proptosis, 25 experienced postoperative improvement. No new-onset extraocular muscle paresis or visual loss occurred postoperatively. The average hospital stay was 1.15 days, with minimal complications and no significant morbidity or mortality.

CONCLUSIONS
Total resection of SWMs invading the cavernous sinus and orbit is associated with substantial risks, particularly cranial nerve deficits. TONES offers a minimally invasive alternative, reducing morbidity compared with transcranial approaches, and represents a significant advancement in the surgical management of SWMs, especially those extending into the cavernous sinus and orbit. The approach provides a safe, effective, and patient-centric approach, prioritizing subtotal resection to minimize neurological deficits while preparing patients for adjunctive radiosurgery. This study positions TONES as a transformative surgical technique, aligning therapeutic efficacy with neurovascular preservation and postoperative recovery.
Endoscopic precaruncular medial transorbital and endonasal multiport approaches to the contralateral skull base: a clinicoanatomical study
Authors: Bhuskute Govind S. , Gosal Jaskaran Singh , Alsavaf Mohammad Bilal , Manjila Sunil , Wu Kyle C. , Alwabili Mohammed , Abouammo Moataz D. , Manogaran Ravi Sankar , Lubbe Darlene E. , Carrau Ricardo L. , Prevedello Daniel M. 
Published: April 2024

OBJECTIVE
Minimally invasive endoscopic endonasal multiport approaches create additional visualization angles to treat skull base pathologies. The sublabial contralateral transmaxillary (CTM) approach and superior eyelid lateral transorbital approach, frequently used nowadays, have been referred to as the "third port" when used alongside the endoscopic endonasal approach (EEA). The endoscopic precaruncular contralateral medial transorbital (cMTO) corridor, on the other hand, is an underrecognized but unique port that has been used to repair CSF rhinorrhea originating from the lateral sphenoid sinus recess. However, no anatomical feasibility studies or clinical experience exists to assess its benefits and demonstrate its potential role in multiport endoscopic access to the other contralateral skull base areas. In this study, the authors explored the application and potential utility of multiport EEA combined with the endoscopic cMTO approach (EEA/cMTO) to three target areas of the contralateral skull base: lateral recess of sphenoid sinus (LRSS), petrous apex (PA) and petroclival region, and retrocarotid clinoidocavernous space (CCS).

METHODS
Ten cadaveric specimens (20 sides) were dissected bilaterally under stereotactic navigation guidance to access contralateral LRSS via EEA/cMTO. The PA and petroclival region and retrocarotid CCS were exposed via EEA alone, EEA/cMTO, and EEA combined with the sublabial CTM approach (EEA/CTM). Qualitative and quantitative assessments, including working distance and visualization angle to the PA, were recorded. Clinical application of EEA/cMTO is demonstrated in a lateral sphenoid sinus CSF leak repair.

RESULTS
During the qualitative assessment, multiport EEA/cMTO provides superior visualization from a high vantage point and better instrument maneuverability than multiport EEA/CTM for the PA and retrocarotid CCS, while maintaining a similar lateral trajectory. The cMTO approach has significantly shorter working distances to all three target areas compared with the CTM approach and EEA. The mean distances to the LRSS, PA, and retrocarotid CCS were 50.69 ± 4.28 mm (p < 0.05), 67.11 ± 5.05 mm (p < 0.001), and 50.32 ± 3.6 mm (p < 0.001), respectively. The mean visualization angles to the PA obtained by multiport EEA/cMTO and EEA/CTM were 28.4° ± 3.27° and 24.42° ± 5.02° (p < 0.005), respectively.

CONCLUSIONS
Multiport EEA/cMTO to the contralateral LRSS offers the advantage of preserving the pterygopalatine fossa contents and the vidian nerve, which are frequently sacrificed during a transpterygoid approach. This approach also offers superior visualization and better instrument maneuverability compared with EEA/CTM for targeting the petroclival region and retrocarotid CCS.
360° around the orbit: key surgical anatomy of the microsurgical and endoscopic cranio-orbital and orbitocranial approaches
Authors: Agosti Edoardo , Alexander A. Yohan , Plou Pedro , Leonel Luciano C. P. C. , De Bonis Alessandro , Bauman Megan M. J. , García-Lliberós Ainhoa , Piazza Amedeo , Torregrossa Fabio , Pinheiro Neto Carlos D. , Peris Celda Maria 
Published: April 2024

OBJECTIVE
Several pathologies either invade or arise within the orbit. These include meningiomas, schwannomas, and cavernous hemangiomas among others. Although several studies describing various approaches to the orbit are available, no study describes all cranio-orbital and orbitocranial approaches with clear, surgically oriented anatomical descriptions. As such, this study aimed to provide a comprehensive guide to the microsurgical and endoscopic approaches to and through the orbit.

METHODS
Six formalin-fixed, latex-injected cadaveric head specimens were dissected in the surgical anatomy laboratory at the authors’ institution. In each specimen, the following approaches were modularly performed: endoscopic transorbital approaches (ETOAs), including a lateral transorbital approach and a superior eyelid crease approach; endoscopic endonasal approaches (EEAs), including those to the medial orbit and optic canal; and transcranial approaches, including a supraorbital approach, a fronto-orbital approach, and a 3-piece orbito-zygomatic approach. Each pertinent step was 3D photograph–documented with macroscopic and endoscopic techniques as previously described.

RESULTS
Endoscopic endonasal approaches to the orbit afforded excellent access to the medial orbit and medial optic canal. Regarding ETOAs, the lateral transorbital approach afforded excellent access to the floor of the middle fossa and, once the lateral orbital rim was removed, the cavernous sinus could be dissected and the petrous apex drilled. The superior eyelid approach provides excellent access to the anterior cranial fossa just superior to the orbit, as well as the dura of the lesser wing of the sphenoid. Craniotomy-based approaches provided excellent access to the anterior and middle cranial fossa and the cavernous sinus, except the supraorbital approach had limited access to the middle fossa.

CONCLUSIONS
This study outlines the essential surgical steps for major cranio-orbital and orbitocranial approaches. Endoscopic endonasal approaches offer direct medial access, potentially providing bilateral exposure to optic canals. ETOAs serve as both orbital access and as a corridor to surrounding regions. Cranio-orbital approaches follow a lateral-to-medial, superior-to-inferior trajectory, progressively allowing removal of protective bony structures for proportional orbit access.
Posterior-only 2-level vertebrectomy and fusion in a medically complex patient with lumbar metastasis: illustrative case
Authors: Johnson Ryan , Shaffer Annabelle , Tang Ashley , Tsai Kathryn , Guglielmi Gina , Arnold Paul M 
Published: April 2024

BACKGROUND
Spinal metastases are commonly seen in patients with cancer and often indicate a poor prognosis. Treatment can include curative or palliative surgery, chemotherapy, and radiation therapy. The surgical approach varies widely on the basis of the affected region of the spine, the location of the tumor (anterior versus posterior), the goal of surgery, the health of the patient, and surgeon preference.

OBSERVATIONS
The authors present a case of a 68-year-old male with intractable lower-back pain and substantially diminished ambulation. Diagnostic imaging revealed a lumbar metastasis from a cholangiocarcinoma primary at L2–3 (4.5 cm anteroposterior × 5.7 cm transverse × 7.0 cm craniocaudal). The patient underwent a 2-level vertebrectomy with expandable cage placement and T10 to S2 fusion via a posterior-only approach. The patient regained much of his mobility and quality of life after the surgery.

LESSONS
Although this was a high-risk surgery, the authors show that a posterior-only approach can be used for lumbar vertebrectomies and fusion when necessary. Palliative surgeries carrying a high risk, especially in the setting of a limited prognosis, should include multidisciplinary deliberations and a thorough discussion of the risks and outcome expectations with the patient.
Cervicothoracic ventral-dorsal rhizotomy for bilateral upper-extremity hypertonia in cerebral palsy: illustrative case
Authors: Kelly Ryan , Kemeny Hanna R , Abdelmageed Sunny , Trierweiler Robin , Krater Tim , LoPresti Melissa A , Raskin Jeffrey S 
Published: April 2024

BACKGROUND
Management of medically refractory limb-specific hypertonia is challenging. Neurosurgical options include deep brain stimulation, intrathecal baclofen, thalamotomy, pallidotomy, or rhizotomy. Cervical dorsal rhizotomy has been successful in the treatment of upper-extremity spasticity. Cervical ventral and cervical ventral-dorsal rhizotomy (VDR) has been used in the treatment or torticollis and traumatic hypertonia; however, the use of cervicothoracic VDR for the treatment of upper-extremity mixed hypertonia is not well described.

OBSERVATIONS
A 9-year-old girl with severe quadriplegic mixed hypertonia secondary to cerebral palsy (CP) underwent cervicothoracic VDR. Modified Ashworth Scale scores, provision of caregiving, and examination improved. Treatment was well tolerated.

LESSONS
Cervicothoracic VDR can afford symptomatic and quality of life improvement in patients with medically refractory limb hypertonia. Intraoperative positioning and nuances in surgical techniques are particularly important based on spinal cord position as modified by scoliosis. Here, the first successful use of cervicothoracic VDR for the treatment of medically refractory upper-limb hypertonia in a pediatric patient with CP is described.
Aortogenic calcified cerebral embolism diagnosed with an embolus retrieved by thrombectomy: illustrative case
Authors: Yokochi Yasunori , Ikeda Hiroyuki , Tanimura Mai , Osuki Takuya , Uezato Minami , Kinosada Masanori , Kurosaki Yoshitaka , Chin Masaki 
Published: April 2024

BACKGROUND
Calcified cerebral embolism has been reported as a cause of acute cerebral infarction, but an aortogenic origin has rarely been identified as the embolic source. The authors describe a case of aortogenic calcified cerebral embolism in a patient with other embolic sources.

OBSERVATIONS
In a patient with cerebral infarction and atrial fibrillation, a white hard embolus was retrieved by mechanical thrombectomy. Pathological analysis of the embolus revealed that it was mostly calcified, with some foam cells and giant cells. The macroscopic and pathological findings allowed the authors to finally diagnose an aortogenic calcified cerebral embolism.

LESSONS
Even in patients with cardiogenic embolic sources, it is possible to identify a complex aortic atheroma with calcification as the embolic source, based on the macroscopic and pathological findings of the embolus retrieved by mechanical thrombectomy.
Antioxidant Effects of Selenium Nanoparticles Prepared from Eruca Sativa Extract on Ketoconazole –Induced Testicular Oxidative Damage in Male Rats
Authors: Q. Shareef Basman , I. Al Qadhi Huda , A. Jamal Shayma'a 
Published: April 2024

Background: Recent studies have shown that the anti-fertility effects of Ketoconazole can be minimized by taking an antioxidant nanoparticles based-plant extract in combination with the medication or by taking it after medication. One of the effective methods to improve its medicinal properties and decrease the toxicities of Selenium is by formulating it as nanoparticles. However, this is still a challenging strategy.
Objectives: The aim of this study was to analyze the impact of nano selenium, which was prepared from Eruca Sativa extract, on testicular oxidative stress parameters in rats that were treated with ketoconazole. The study will focus on the evaluation of glutathione peroxidase, superoxide dismutase, and malondialdehyde as indicators of oxidative stress.
Methods: In this study, a 1% w/v solution of plant extract was added to a solution of 10mM sodium selenite in different ratios, and placed on a magnetic stirrer in the dark for 12 hours at a temperature 50Cº and pH9. The solution was then left for 48 hours, and the optimal fabricated selenium nanoparticles were selected for further characterization. forty-eight rats were divided into six groups with eight animals in each. Group A was the negative control, while Group B was given oral Ketoconazole at a dose of 50mg/kg for fourteen days. Group BC, BD, BE1 and BE2 were given oral Ketoconazole at a dose of 50 mg/kg for fourteen days, followed by 200mg/kg Eruca Sativa, 0.5mg/kg oral sodium selenite, 0.25mg/kg oral nano selenium and 0.5mg/kg oral nano selenium for 28 days, respectively. Finally, the animals were euthanized and their testicle anti-oxidant parameters were evaluated.
Results: Significant increases in glutathione peroxidase and superoxide dismutase ( p value < 0.001), and a decrease in malondialdehyde levels ( p value < 0.001) were observed in groups treated with nanoparticles compared to control group.
Conclusion: Nano forms of prepared by Eruca sativa extract exhibit significant antioxidant effects on testicular tissues, while being available for several metabolic, biological, and physiological functions.
The Impact of Selenium and Levothyroxine on the Immune System of Hypothyroid Rats
Authors: Sabea Aryaf M. , Al-Qaiym Majida A. 
Published: April 2024

Background: The immune system and thyroid hormones have an inverse relationship, but both thyroid hormones and selenium play a crucial role in the immune system. However, when the levels of thyroid hormones decrease (known as hypothyroidism), their effect on immune system cells and their relationship with selenium supplements in the body are not well understood.
Objectives: The aim of this study was to investigate the impact of Se-nanoparticles on thyroid hormones and the blastogenic response of lymphocytes in various lymphoid tissues in rats with hypothyroidism.
Methods: A group of female Wister rats aged three to four months were randomly placed into five groups (each group has 6 rats) and were given a basal diet on a daily basis. However, the daily water supply given to each group was different. The first group was the control group and received normal water, while the other four groups were given 0.02% methimazole in their drinking water every day for four weeks to induce hypothyroidism. Once the hypothyroidism was confirmed, the 3rd, 4th, and 5th experimental groups were given one of the following three treatments for four weeks, respectively: SC-SeNPs (0.1mg selenium per kg per day) as T1, Levothyroxine (0.9μg per 100g per day) as T2, or SC-SeNPs (0.1 mg selenium per kg per day) and Levothyroxine (0.9μg per 100g per day) as T3. In the end, blood samples were collected from euthanized animals using a high dose of anesthesia, and lymphoid tissue samples (spleen, Peyer’s patches and mesenteric lymph node) were preserved in 10% formalin.
Results: Our research has revealed that IgG, a humoral immunity marker, was found to be significantly decreased in hypothyroidism. However, when treated with levothyroxine alone or in combination with Sc-SeNPs, the level of cellular immunity marker, IL-6, was found to be significantly increased in hypothyroidism when compared to the control group. Additionally, we observed histopathological changes in the lymphoid tissue of hypothyroidism rats, which included depletion of the white pulp of spleen with congestion in the blood vessels, a decrease in the lymphoid follicle of Peyer’s patches, and a decrease in the primary and secondary follicles of the mesenteric lymph nodes .
Conclusion: Thyroid hormones play a role in regulating innate and adaptive immunity. The combination of selenium with levothyroxine is the most effective treatment for hypothyroidism and improving the activity of the immune system cells .
&ldquo;En remuneraci&oacute;n de sus servicios&rdquo; en 1823-1856: El servicio dom&eacute;stico en Chile a trav&eacute;s de testamentos
Authors: Valenzuela Pedro 
Published: April 2024

“In payment for its services” in 1823-1856: Domestic service in Chile through wills
This article studies domestic service in Chile, particularly in the province of Concepción, during the first half of the nineteenth century. The main objective is to characterize the social and labour dynamics involved in domestic service during the first years of the Republic focusing on the study of the testamentary practices of the local elite evidenced through the review and analysis of wills notarized in the city of Concepción between 1823 and 1856. Methodologically, the selection of wills was carried out in a universe of 315 wills, 73 of which contained bequests to domestic service, and their analysis was carried out both quantitatively and qualitatively. The main conclusions are related to the characterization of the objects bequeathed and to the materialization or agency in the delivery of the bequests.
Resumen
El presente artículo estudia el servicio doméstico en Chile, particu-larmente en la provincia de Concepción, durante la primera mitad del siglo XIX. Se pretende caracterizar las dinámicas sociales y laborales que envuelven al servicio doméstico durante los primeros años de la República por medio del estudio de las prácticas testamentarias de la elite local, evidenciadas a través de la revisión y análisis de testamentos notariados en la ciudad de Concepción entre 1823 y 1856. Metodológicamente, la selección de testamentos se realizó en un universo de 315 testamentos, de los cuáles 73 contenían legados al servicio doméstico y su análisis se realizó tanto de manera cuantitativa como cualitativa. Las principales conclusiones se extraen en relación con la caracterización de los objetos legados y con la materialización u agencialidad en la entrega de los mismos.