The surgical procedures applied during the endoscopic endonasal approach for anterior skull base and parasellar lesions, which include transsphenoidal and transplanum transtuberculum approaches, can be divided into four phases : the nasal/paranasal sinus phase, skull base bone resection, tumor resection, and cranial base reconstruction. In the nasal and paranasal phases, the key anatomies are the olfactory mucosa, posterior branch of the sphenopalatine artery, palatovaginal canal, and vidian canal. In the skull base bone resection phase, the key anatomies are the optic canal, carotid prominence, posterior clinoid process, medial/lateral opticocarotid recess, tuberculum sellae, planum sphenoidale, and anterior intercavernous sinus. During tumor resection, the pituitary gland, cavernous sinus, diaphragma sellae, intradural structures, pituitary stalk, optic nerve, internal carotid artery, and superior hypophyseal artery are involved. In each surgical phase, these anatomical structures should be accurately confirmed, and normal structures should be preserved.

  Amygdalohippocampectomy for mesial temporal lobe epilepsy and corpus callosotomy for generalized seizures are well-established epilepsy surgeries. To perform these surgeries safely and completely, sufficient anatomical knowledge regarding the structures, vessels, functional localization, and white matter tracts is mandatory for surgeons. Herein, we describe these two surgeries in detail, focusing on the surgical anatomy with the aid of illustrations and intraoperative photographs.

  In addition, we provide an introduction to endoscopic surgery for epilepsy surgery. We illustrate the anatomical structures in the deep part of the brain by comparing the microscopic and endoscopic views during surgery.

  In surgeries for spinal cord tumors, it is extremely important for surgeons to achieve the best balance between medium- and long-term tumor control and postoperative functional recovery. To achieve this surgical objective, surgeons must determine the best surgical strategy, resolve technical issues, and contribute to the medical care team. Surgeons also need to have thorough knowledge of the functional neuroanatomy related to surgery. This review article addresses the following three issues: (1) functional neuroanatomy related to spinal cord tumor surgery, (2) surgical concept for benign dumbbell nerve sheath tumors (NST) of the cervical spine, and (3) selection of surgical myelotomy for the successful surgical removal of intramedullary tumors. In the first category, functional neuroanatomy related to surgery for spinal cord tumors, five important membrane structures surrounding the spinal cord and the surface anatomy of the spinal cord were examined. In the second category, several surgical issues, such as selection of the surgical approach in the surgery of dumbbell-shaped cervical nerve sheath tumors, were discussed with the illustration of a representative case. In the third category, the importance of selecting surgical myelotomy was emphasized for the successful removal of intramedullary tumors. Although the posterior median sulcus approach is standard in most cases, the posterolateral sulcus approach, equivalent to dorsal root entry zone myelotomy, may be suitable in carefully selected cases. A direct transpiration approach should be indicated for subpial tumors, such as hemangioblastomas. This review article focuses on the microsurgical anatomy necessary for the successful surgery of spinal cord tumors.

  The field of view in endovascular therapy is presented as 2D images displayed on a monitor. Creating an appropriate field of view is relatively easy if the overlapping vessels can be separated and visualized. However, it is important to recognize the function of vessels, as the surrounding structures, such as the brain and nerves, cannot be visualized. Careful observation of slab maximum intensity projection images using 3D-rotational angiography or cone-beam CT can be useful for understanding the microvascular anatomy of complex vascular diseases, such as dural arteriovenous fistulas, prior to the procedure. It is also important to imagine a 3D architecture from 2D images during this procedure. This article provides an overview of the functional microvascular anatomy and imaging techniques required for safe and effective endovascular therapy.

  Mechanical thrombectomy (MT) has been firmly established as the standard therapeutic modality for acute cerebral infarction attributable to large vessel occlusion in the adult population. However, its applications in pediatric stroke cases have been rarely reported. We successfully performed the MT procedure on a one-year-old patient by employing balloon protection to address a large amount of thrombus extending from the origin of the left vertebral artery to the left subclavian artery. Despite encountering limitations imposed by the 4Fr sheath, we achieved success through the utilization of a suction catheter in conjunction with a stent retriever. We utilized a combined technique due to the substantial volume of thrombotic material and the constrained dimensions of the suction catheter.