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    Graftless Primary Dural Closure Following Retrosigmoid Approach: Doing More With less
    (Elsevier Inc., 2024) Çavuşoğlu, Neslihan; Erol, Gökberk; Sevgi, Umut Tan; Bulgur, Feride; Doğruel, Yücel; Luzzi, Sabino; Gadol, Aaron A.Cohen; Güngor, Abuzer
    Introduction: Achieving watertight dural closure without grafts via the retrosigmoid approach can be challenging, contributing to a significant rate of postoperative cerebrospinal fluid (CSF) leaks. This study describes a dural incision technique for achieving primary dural closure without grafts following the retrosigmoid approach and presents clinical data from the authors' experience. Methods: Clinical and surgical data of 227 patients who underwent the dural incision technique following the retrosigmoid approach for various pathologies were retrospectively reviewed. To achieve no-graft watertight dural closure, the dural incision involves 2 critical steps: a 1 cm transverse incision of the dura parallel to the foramen magnum to drain CSF from the cisterna magna, and a vertical linear opening of the retrosigmoid dura. Dural incisions were closed watertight with vicryl 4/0 running sutures, without the use of grafts, fibrin glue, hemostatic overlays, or dural substitutes. Pre- or postoperative lumbar drainage was not employed. Results: Primary watertight dural closure was successfully achieved in all patients without the use of grafts or duraplasty. The average duration of dura closure was 17.7 minutes. During an average follow-up period of 49.3 months, there were no instances of CSF leaks or meningitis. Conclusions: In the authors' preliminary experience, the linear dural incision described herein was effective for achieving a no-graft, watertight primary dural closure in the retrosigmoid approach, with no CSF leaks or meningitis in our series. Validation of these preliminary data in a larger patient cohort is necessary. © 2024 Elsevier Inc.
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    Virtual anatomical atlas of the deep brain nuclei
    (Springer science and business media deutschland GmbH, 2024) Sevgi, Umut Tan; Güngör, Abuzer; Erol, Gökberk; Canbolat, Çağrı; Middlebrooks, Erik H.; Sönmez, Osman Fikret; Doğruel, Yücel; Türe, Uğur
    This study aims to improve understanding of the anatomy of the deep brain nuclei relevant to deep brain stimulation as well as stereotactic lesioning procedures, including radio frequency, high-focused ultrasound, and radiosurgery. We created interactive, three-dimensional virtual models from cadaveric dissections and radiological segmentation. We used five brain specimens (ten hemispheres) obtained from routine autopsies, prepared according to Klingler's method. Dissections were done from lateral to medial, medial to lateral, and superior to inferior to expose deep brain stimulation targets and adjacent structures. Using photogrammetry, we scanned the specimens to create detailed three-dimensional models. These models were uploaded to an online platform for free global access. Radiological models were also generated from atlas-based regions using the Montreal Neurological Institute template. We produced 16 high-quality cadaveric models at various stages of dissection. These and the radiological models were examined and interacted with through augmented reality and virtual reality headsets. This approach allowed comprehensive visual access to the anatomical structures and delineated their spatial relationships. These three-dimensional models provide detailed anatomical representations that can enhance anatomical orientiation, improve spatial perception, and serve as valuable educational tools for clinicians and students.