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This is the first such case, to our knowledge, of a bupivacaine precipitate mimicking a spinal cord tumor.

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This anatomic study evaluated the extent that a fronto-orbital osteotomy (FOO) added to a bilateral frontal craniotomy widened the exposure to the midline compartment of the anterior, middle, and posterior cranial fossae. The goal was to determine if osteotomy would significantly increase angles for two targets: the foramen magnum (FM) and anterior clinoid process (ACP). Stepwise dissections were performed on five cadaveric heads. A bilateral frontal craniotomy was made, followed by FOO. After the ethmoids were removed, the planum sphenoidale was drilled to enter the sphenoid sinus. Further drilling exposed the anterior clivus, which was drilled down to FM. Excellent exposure of the basilar artery, vertebral artery, and brain stem was achieved. With and without FOO, angles of exposure were measured for two targets: the ACP and FM. The angle of exposure after FOO increased markedly with an average gain of 76% for the ACP and of 80% for FM. Compared with a conventional bifrontal craniotomy, the addition of FOO increased the surgical exposure and minimized frontal lobe retraction for accessing lesions of the anterior, middle, and posterior cranial fossae.KEYWORDS: Brain tumor, extended frontal approach, operative approach, skull base, skull base tumor Large skull base tumors have always been a formidable challenge to neurosurgeons and maxillofacial surgeons. Cushing, Dandy, and others proposed skull base operations, 1 but their enthusiastic attempts were often hampered by the absence of antibiotics and adequate instruments. Technical advances (operating microscopes, micro-instrumentation, bipolar coagulation, and development of neuro-anesthesia); an improved understanding of skull base anatomy 2,3 ; and collaborative efforts of neurosurgeons, otolaryngologists, and plastic surgeons have led to the development of more

The radial artery appears to be a suitable route for access to the intracranial vessels when the femoral artery is not available.

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Intracranial cavernous malformations are vascular anomalies consisting of endothelium-lined caverns filled with blood at various stages of thrombosis and organized and separated by a collagenous stroma devoid of mature vessel wall elements. They represent a clinical challenge both in diagnosis and management due to the variety of presenting symptoms and neuroradiological features. This study analyzes the clinical manifestations and surgical outcomes in 16 patients with cavernous malformations who were treated surgically at the Louisiana State University Health Sciences Center in Shreveport. The most common presenting features were headache, seizure, and focal neurologic deficits. Three patients had deep lesions (two in the brainstem and one in the basal ganglion), and 13 patients had superficial lesions. All patients underwent surgery and had complete excision of the lesion. The overall outcome was satisfactory for all patients with significant symptom relief over a mean follow-up period of 60 months. The optimal management of cavernous malformations should be determined on a case-by-case basis and, when indicated, surgery provides good outcome.