Manfred Tschabitscher

Università degli Studi di Brescia, Brescia, Lombardy, Italy

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Publications (127)272.62 Total impact

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    ABSTRACT: The digastric muscle is an important surgical landmark. Several anatomical variants of the digastric muscle are reported in literature and, in particular, the presence of accessory anterior bellies of the muscle are not uncommon. Here, an unreported symmentrical variant of the digastric muscle was found during a dissection of the suprahyoid region. The dissection showed digastric muscles with an accessory anterior belly, which originated from the anterior belly of muscles in proximity and anteriorly to the intermediate tendon. The accessory bellies were fused together on the midline and were attached with a unique tendon to the inner surface of the mental symphysis. These muscles completely filled the submental triangle. This unreported anatomical variant could be considered an additional contribute in the description of the anatomical variants of the digastric muscle, with several implications in head and neck pathology, diagnosis and surgery.
    Folia morphologica 09/2015; DOI:10.5603/FM.a2015.0077 · 0.34 Impact Factor
  • Marco Ferrari · Manfred Tschabitscher · Rita Rezzani · Luigi Fabrizio Rodella ·

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    ABSTRACT: Variations in the number of renal vessels represent the most common anatomical variations in renal vasculature. Here, a rare case of multiple anatomical variations of renal vessels was found in a 70-year-old female cadaveric dissection. Three renal arteries and two renal veins were observed to supply the right kidney, which was malrotated and ectopic; on the left side, the kidney was unrotated and presented two renal arteries and normal renal vein. In particular, we paid attention to the pattern of the three renal arteries that originated from the lateral side of the aorta and passed anteriorly to the inferior vena cava. A rare case of ovarian vein that drained into the right renal vein was also reported. The descriptions of these multiple anatomical variations should be considered by clinicians for performing correct surgical and radiological procedures.
    Surgical and Radiologic Anatomy 02/2015; DOI:10.1007/s00276-015-1446-3 · 1.05 Impact Factor
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    ABSTRACT: Different surgical approaches have been used over the years in order to access skull base. The endoscopic endonasal approach represents a direct and minimally invasive approach to the suprasellar, retrosellar, and retroclival space, with the advantage of avoid brain retraction and visualize safely and effectively the surgical target. The present contribution aims to provide anatomical details of the skull base as seen from below (i.e., via an endoscopic endonasal approach). Five human cadaver heads were dissected. The anatomical neurovascular structures within the skull base were visualized and carefully described from an endoscopic endonasal view. The advantages and limitations of the endoscopic endonasal route were discussed as well. The entire skull base region, as seen from the endoscopic endonasal viewpoint, has been divided in 4 main regions: anterior skull base, middle skull base, posterior skull base and parasellar area. The development of endoscopic techniques has opened different perspectives over the skull base surgery. Endonasal surgery provides access to a wide range of skull base lesions via a natural surgical corridor (i.e., the nasal cavities). Copyright © 2014 Elsevier Inc. All rights reserved.
    World Neurosurgery 12/2014; 82(6S):S164-S170. DOI:10.1016/j.wneu.2014.08.005 · 2.88 Impact Factor
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    ABSTRACT: The lateral limit of endoscopic endonasal surgery has yet to be defined. The aim of this study was to investigate the lateral limit of endoscopic endonasal surgery at the level of the sphenoid sinus. Access from the sphenoid sinus to the middle cranial fossa through the cavernous sinus triangles was evaluated by cadaver dissection. Anatomical analysis demonstrated that the medial temporal dura mater was exposed through the anterior area of the clinoidal triangle, anteromedial triangle, and superior area of the anterolateral triangle, indicating potential corridors to the middle cranial fossa. This study suggests that the cavernous sinus triangles are applicable in selected cases to manage middle cranial fossa lesions by endoscopic endonasal surgery.
    Neurologia medico-chirurgica 11/2014; 54 Suppl 3(12). DOI:10.2176/nmc.oa.2014-0092 · 0.72 Impact Factor
  • Andrea Nicali · Luigi F. Rodella · Mauro Labanca · Rita Rezzani · Manfred Tschabitscher ·

    Dental Cadmos 10/2014; 82(8):530. DOI:10.1016/S0011-8524(14)70213-2
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    Antonio Di Ieva · Mallorie Tam · Manfred Tschabitscher · Michael D. Cusimano ·
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    ABSTRACT: Neuroendoscopy has become a well-accepted technique in the field of neurosurgery. After the introduction of the endoscope in medical practice by Phillip Bozzini in 1806, influential individuals such as Harold Hopkins and Karl Storz paved the way for its current success. With the present pace of technological advancements, the instrumentation will greatly improve along with the status of neuroendoscopy in the neurosurgical field. Specific attention is given to the history of the instrument’s development in this paper while also discussing more recent advances dating from 1990 onward. The importance of each development for the purpose of the instrument is explained and gaps in the literature are also addressed regarding the technical portion of neuroendoscopy such as commenting on the optical physics in the endoscope, three-dimensional endoscopy, as well as clinical applications of neuroendoscopy and robotics.
    World Neurosurgery 09/2014; 82(6). DOI:10.1016/j.wneu.2014.09.005 · 2.88 Impact Factor
  • Naoki Wakuta · Tetsuya Ueba · Hiroshi Abe · Tooru Inoue · Manfred Tschabitscher ·
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    ABSTRACT: Knowledge of anatomy visualized endoscopically is necessary to perform endoscopic surgical procedures safely. The cavernous sinuses are complicated structures with major blood vessels and nerves seated deeply in the center of the skull base. Anatomical orientation during surgery is essential for deep and narrow skull base surgery. While performing surgery involving the cavernous sinuses, understanding of the structures identifiable via a transsphenoidal view can allow comprehension of the relationship between a lesion and the surrounding structures, thus preventing intraoperative complications. The objective of this study was to dissect the neurovascular structures in the cavernous sinus deeply inside the oculomotor trigone through a transsphenoidal view, and to determine the relationships among anatomical landmarks in the path of surgery. Ten fresh silicone-injected cadaveric heads were evaluated. Four millimeter-diameter rigid endoscopes with 0° and 30° rod-lenses were utilized to perform an endonasal transsphenoidal approach. The detailed position and course of the major components in each cavernous sinus were assessed under panoramic view. We also validated the utility of this approach by successfully excising a huge pituitary adenoma.
    Neurologia medico-chirurgica 07/2014; 54(8). DOI:10.2176/nmc.oa.2013-0237 · 0.72 Impact Factor
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    Antonio Di Ieva · Hussein Fathalla · Michael D. Cusimano · Manfred Tschabitscher ·
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    ABSTRACT: In the eighteenth century, Lancisi described the indusium griseum and the longitudinal striae of the corpus callosum. The indusium griseum is a thin neuronal lamina above the corpus callosum, covered on each side of the midline by the medial and lateral longitudinal striae. The medial longitudinal striae (nerves of Lancisi) and lateral longitudinal striae are two pairs of myelinated fiber bands found in the gray matter of the indusium griseum on the dorsal aspect of the corpus callosum. Embryologically, the indusium griseum and longitudinal striae are dorsal remnants of the archicortex of the hippocampus and fornix and thus they are considered components of the limbic system. Recent studies using immunohistochemistry reported that acetylcholine, dopamine, noradrenaline, 5-hydroxytryptamine and GABA neurons innervate the indusium griseum. Newer imaging techniques, such as high-field MRI and diffusion tensor imaging, provide new tools for studying these structures, whose true function remains still unclear. The present paper reviews the history of the discovery of the indusium griseum and longitudinal striae of the corpus callosum, with a holistic overview on these interesting structures from the anatomical, embryological, neurochemical, radiological and clinical perspective.
    Cortex 07/2014; 62. DOI:10.1016/j.cortex.2014.06.016 · 5.13 Impact Factor
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    ABSTRACT: The skull base represents a central and complex bone structure of the skull and forms the floor of the cranial cavity on which the brain lies. Anatomical knowledge of this particular region is important for understanding several pathologic conditions as well as for planning surgical procedures. Embryology of the cranial base is of great interest due to its pronounced impact on the development of adjacent regions including the brain, neck, and craniofacial skeleton. Information from human and comparative anatomy, anthropology, embryology, surgery, and computed modelling was integrated to provide a perspective to interpret skull base formation and variability within the cranial functional and structural system. The skull base undergoes an elaborate sequence of development stages and represents a key player in skull, face and brain development. Furthering our holistic understanding of the embryology of the skull base promises to expand our knowledge and enhance our ability to treat associated anomalies.
    Child s Nervous System 04/2014; 30(6). DOI:10.1007/s00381-014-2411-x · 1.11 Impact Factor
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    ABSTRACT: Identification of the internal carotid artery (ICA) is essential for successful endoscopic endonasal cavernous sinus tumor surgery. This study aimed to develop a method for identifying the ICA in cavernous sinus tumors at the superior part of the cavernous sinus. Ten fresh cadavers were studied with a 4-mm 0° and 30° endoscope to identify surgical landmarks of the ICA in the cavernous sinus. Clinical cases of cavernous sinus tumors were surgically treated using an endoscopic transpterygoid approach. Anatomical study indicated the ICA at the superior part of the cavernous sinus can be identified using three steps: 1) exposure of the optic nerve sheath by drilling the optic canal; 2) identification of the proximal orifice of the optic nerve sheath at the transition of the optic nerve sheath and dura mater of the tuberculum sellae; and 3) identification of the clinoid segment of the ICA at the distal dural ring just below the proximal orifice of the optic nerve sheath. Although the ICA was encased and transposed by tumors in preliminary surgical cases, the clinoid segment of the ICA was safely exposed at the superior part of the cavernous sinus using this method. Dural structures around the cavernous sinus are key to identifying the ICA at the superior part of the cavernous sinus. This method is expected to reduce the risk of ICA injury during endoscopic endonasal surgery for cavernous sinus tumors.
    Acta Neurochirurgica 01/2014; 156(3). DOI:10.1007/s00701-013-1986-4 · 1.77 Impact Factor
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    ABSTRACT: : An endoscopic approach through the transnasal corridor is currently the treatment of choice in the management of benign sinonasal tumors, cerebrospinal fluid leaks, and pituitary lesions. Moreover, this approach can be considered a valid option in the management of selected sinonasal malignancies extending to the skull base, midline meningiomas, parasellar lesions such as craniopharyngioma and Rathke cleft cyst, and clival lesions such as chordoma and ecchordosis. : Over the past decade, strict cooperation between otorhinolaryngologists and neurosurgeons and acquired surgical skills, together with high-definition cameras, dedicated instrumentation, and navigation systems, have made it possible to broaden the indications of endoscopic surgery. Despite these improvements, depth perception, as provided by the use of a microscope, was still lacking with this technology. : The aim of the present project is to reveal new perspectives in the endoscopic perception of the sinonasal complex and skull base thanks to 3-dimensional endoscopes, which are well suited to access and explore the endonasal corridor. In the anatomic dissection herein, this innovative device came across with sophisticated and long-established fresh cadaver preparation provided by one of the most prestigious universities of Europe. The final product is a 3-dimensional journey starting from the nasal cavity, reaching the anterior, middle, and posterior cranial fossae, passing through the ethmoidal complex, paranasal sinuses, and skull base. Anatomic landmarks, critical areas, and tips and tricks to safely dissect delicate anatomic structures are addressed through audio comments, figures, and their captions. CS, cavernous sinusET, eustachian tubeICA, internal carotid arteryMMA, middle meningeal arteryMN, mandibular nerve.
    Neurosurgery 09/2013; 10(1). DOI:10.1227/NEU.0000000000000172 · 3.62 Impact Factor
  • Sonja Vulcu · Manfred Tschabitscher · Wibke Mueller-Forell · Joachim Oertel ·
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    ABSTRACT: Background Recently, the authors demonstrated the technical feasibility of a transventricular translaminar terminalis ventriculostomy with a rigid endoscope. A major problem with this technique remains the contusion of the fornix at the foramen of Monro. Here, the authors evaluated alternative approaches and techniques, including the use of a flexible endoscope. Material and Methods Feasibility of two approachesanterior and posterior of the coronal suturewas evaluated on magnetic resonance images and in cadaveric brains. Two different trajectories were selected. Lamina terminalis (LT) fenestration was performed with a rigid and a flexible endoscope using two approaches in 10 fixed cadaver brains. ResultsUsing the posterior approach 2 cm behind the coronal suture with the two endoscopes caused moderate to severe damage to foramen and fornix. Using the standard approach (Kocher point) with the flexible endoscope avoided damage of these structures. After completion of the anatomical investigation, the authors successfully performed a transventricular fenestration of the LT with the flexible endoscope in one clinical case. Conclusion Rigid scopes provide brilliant optics and safe manipulation with the instruments. However, with the rigid scope, a transventricular opening of the LT is only possible with acceptance of structural damage to the foramen of Monro and the fornix. In contrast, opening of the LT via a transventricular route with preservation of the anatomical structures can be achieved with a flexible steerable endoscope even via a standard burr hole. Thus, if a standard third ventriculostomy is not feasible, endoscopic opening of the LT might represent an alternative, particularly with a flexible scope in experienced hands.
    Journal of Neurological Surgery. Part A: Central European Neurosurgery 08/2013; 75(3). DOI:10.1055/s-0033-1345684 · 0.61 Impact Factor
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    ABSTRACT: Introduction: Progress in cranial suture research is shaping our current understanding of the topic; however, emphasis has been placed on individual contributing components rather than the cranial sutural system as a whole. Improving our holistic view helps further guide clinicians who treat cranial sutural abnormalities as well as researchers who study them. Materials and methods: Information from anatomy, anthropology, surgery, and computed modeling was integrated to provide a perspective to interpret suture formation and variability within the cranial functional and structural system. Results: Evidence from experimental settings, simulations, and evolution suggest a multifactorial morphogenetic process associated with functions and morphology of the sutures. Despite molecular influences, the biomechanical cranial environment has a main role in both the ontogenetic and phylogenetic suture dynamics. Conclusions: Furthering our holistic understanding of the intricate cranial sutural system promises to expand our knowledge and enhance our ability to treat associated anomalies.
    Child s Nervous System 03/2013; 29(6). DOI:10.1007/s00381-013-2061-4 · 1.11 Impact Factor
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    I Dallan · V Seccia · P Battaglia · F Montevecchi · M Tschabitscher · C Vicini ·

  • Paolo Castelnuovo · Iacopo Dallan · Manfred Tschabitscher ·
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    ABSTRACT: This chapter illustrates the surgical anatomy of the cervical portion of the internal carotid artery. This tract of the vessel starts from the common carotid artery bifurcation and ends at the level of the skull base; therefore, it is identifiable as the extracranial portion of the internal carotid artery. A careful description of the anatomic relationship between the artery and all the neural, muscular, and vascular structures of the neck is provided. The exposition is really surgically oriented and can be of valuable help for many surgeons, especially for those who perform advanced endoscopic endonasal surgery.
    Surgical Anatomy of the Internal Carotid Artery, 01/2013: pages 1-57; , ISBN: 978-3-642-29663-5
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    ABSTRACT: Tumor-specific gene products such as cancer-testis (CT) antigens are promising targets for the development of T cell vaccines. CT antigens are frequently found in several tumors, but their expression in pituitary adenomas has not been investigated. Here, we immunohistochemically studied the expression of the human Sperm protein 17 (Sp17) CT antigen in disease-free pituitary glands (n = 6) and clinically functioning (n = 22) and non-functioning pituitary adenomas (n = 38). The normal pituitary tissues contained only a few scattered Sp17-immunopositive cells, whereas 30 (79%) non-functioning adenomas and 11 (50%) functioning (p = 0.02) were highly immunopositive. The patients from whom the Sp17-immunopositive samples were taken were older than those whose samples were immunonegative (p= 0.007). The high frequency of Sp17 expression in pituitary adenomas suggests that it might be a potential histopathological biomarker of such tumors and a helpful tool in disease management. Moreover, the results of this study stimulate experimental models for exploring the role of Sp17-immunopositive cells in the pathogenesis of human pituitary adenoma, and evaluating the usefulness of Sp17 as an immunotherapeutic target.
    Procedia in Vaccinology 12/2012; 6:39–46. DOI:10.1016/j.provac.2012.04.007
  • Fuminari Komatsu · Mika Komatsu · Antonio Di Ieva · Manfred Tschabitscher ·
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    ABSTRACT: Objective: Endoscopy has provided a less invasive approach to skull base surgery, mainly through endonasal routes, but has been limited in its applications due to potential complications. The aims of this study were to evaluate the feasibility of the purely endoscopic extradural transcranial approach to lateral and central skull base through a subtemporal keyhole and to better understand potential distortions of the related anatomy via endoscopy. Methods: Ten fresh cadaver heads were studied with 4-mm 0° and 30° endoscopes to develop the surgical approach and to identify surgical landmarks. Results: The endoscopic extradural subtemporal approach was divided into 3 sections after exposure of the extradural space in the middle cranial fossa: 1) exposure of the lateral wall of the cavernous sinus and the preauricular infratemporal fossa; 2) anterior petrosectomy and posterior cranial fossa exploration; and 3) unroofing of the tympanic cavity and exposure of the facial nerve. This keyhole endoscopic technique clearly visualized anatomical landmarks of the lateral and central skull base via an extradural subtemporal route. Conclusions: The endoscopic extradural subtemporal approach was feasible. This approach could display a wide range of lateral and central skull base structures with minimal invasiveness. The use of extradural space would be key to performing safe and effective endoscopic skull base surgery.
    World Neurosurgery 12/2012; 80(5). DOI:10.1016/j.wneu.2012.12.018 · 2.88 Impact Factor
  • Fuminari Komatsu · Mika Komatsu · Antonio Di Ieva · Manfred Tschabitscher ·
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    ABSTRACT: Minimally invasive surgery to the posterolateral craniovertebral junction (CVJ) has not been sufficiently described. The aims of this study were to evaluate the feasibility of an endoscopic far-lateral approach to the posterolateral craniocervical junction and to better understand the related anatomy under distorted endoscopic view. Ten fresh cadavers were studied with 4-mm 0° and 30° endoscopes to develop the surgical approach and to identify surgical landmarks. After making a 3-cm straight incision behind the mastoid process, the superior oblique and rectus capitis posterior major muscles were partially exposed. An endoscope was then introduced and the two muscles were followed inferiorly until the posterior arch of the atlas appeared. The two muscles were removed to create ample working space without violating the posterior atlanto-occipital membrane. The vertebral artery was identified by the landmark of the posterior arch of the atlas, and the atlanto-occipital joint and foramen magnum were exposed. In addition to suboccipital craniectomy, transcondylar, supracondylar, and paracondylar extension by drilling were applicable through the narrow corridor under superb visualization. The intradural neurovascular structures from the acousticofacial bundle to the dorsal root of C2, anterolateral space of the foramen magnum, cerebellomedullary fissure, and fourth ventricle were clearly demonstrated. This endoscopic far-lateral approach offers excellent exposure of surgical landmarks around the posterolateral CVJ with minimal invasiveness. Endoscopic soft tissue dissection is key to creating the surgical corridor. This approach could offer an alternative to the conventional far-lateral approach in selected cases.
    Neurosurgical Review 11/2012; 36(2). DOI:10.1007/s10143-012-0433-y · 2.18 Impact Factor
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    ABSTRACT: Due to progressively expanded indications of endoscopic transnasal surgery, having different reconstructive options in the armamentarium becomes of paramount importance. We herein report our experience with the use of the temporo-parietal fascial flap after extended endoscopic procedures for malignancies of the clival and nasopharyngeal regions. We focus our report on the surgical anatomy of this flap and the technique for its intranasal transposition through an infratemporal corridor. The main steps of the procedure and anatomic landmarks were highlighted, thanks to previous cadaver dissection. Five patients underwent an extended endoscopic resection for malignant tumors: one with persistent clival chordoma, three with recurrent nasopharyngeal carcinomas, and 1 recurrent nasopharyngeal adenoid cystic carcinoma. In all patients a temporo-parietal fascial flap was harvested to protect critical structures or irradiated denuded bone. The Mean harvesting and hospitalization time were 120 min and 5 days, respectively. No major or minor complications were observed. Whenever local flaps are not available for oncologic reasons or previous surgery, the temporo-parietal fascial flap is a safe and relatively easy option to protect the residual skull base and critical structures such as the internal carotid artery and dura of the posterior cranial fossa, after extended endoscopic resections.
    Archives of Oto-Rhino-Laryngology 09/2012; 270(4). DOI:10.1007/s00405-012-2187-0 · 1.55 Impact Factor

Publication Stats

2k Citations
272.62 Total Impact Points


  • 2010-2014
    • Università degli Studi di Brescia
      • Department of Clinical and Experimental Sciences
      Brescia, Lombardy, Italy
  • 2007-2014
    • Medical University of Vienna
      • • Center for Anatomy and Cell Biology
      • • Department of Systematic Anatomy
      Wien, Vienna, Austria
    • Istituto Clinico Humanitas IRCCS
      • Department of Neurosurgery
      Milano, Lombardy, Italy
  • 1991-2013
    • University of Vienna
      • Clinic for Oral and Maxillofacial Surgery
      Wien, Vienna, Austria
  • 2011
    • Fukuoka University
      • Department of Neurosurgery
      Hukuoka, Fukuoka, Japan
  • 2003
    • Allegheny General Hospital
      Pittsburgh, Pennsylvania, United States
  • 2002
    • Vienna General Hospital
      Wien, Vienna, Austria
  • 1996
    • American Society of Ophthalmic Plastic and Reconstructive Surgery
      Vienna, Virginia, United States
  • 1989
    • Ludwig Boltzmann Institut für Experimentelle und Klinische Traumatologie
      Wien, Vienna, Austria