By John M. Tew, Harry R. Van Loveren
Useful atlas of microscopic neurosurgery, for citizens and starting neurologic surgeons at the pathoanatomy of neurologic problems and their surgical operation. 3-dimensional line drawings, a few with colour highlighting.
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Extra info for Atlas of operative microneurosurgery
Several structures are visible on the middle fossa floor, including the mandibular division of the trigeminal nerve at the foramen ovale; the lesser and greater superficial petrosai nerves; occasionally the internal carotid artery through a small dehiscence in the bony floor; and the arcuate eminence, which overlies the superior semicircular canal. Critical structures usually obscured by bone include the petrous carotid artery and its posterior loop, head of the malleus in the epitympanum, geniculate ganglion, facial nerve, superior vestibular nerve, cochlear nerve and cochlea, and semicircular canals.
The surgeon can gain additional exposure by dissecting the arachnoid overlying the vein and by freeing the vein from the underlying cortex and the dural flap. 41 The self-retaining retractor is attached to the skull-fixation device. A single retractor is placed on the medial aspect of the frontal gyrus; a second retractor is positioned to retract the falx medially. 42 Following dural closure, the bone flap is secured with titanium microplates and screws. All bone defects are filled with methyl methacrylate to enhance the cosmetic result.
A skin flap is centered on the coronal suture, crosses the midline, and is based laterally. 45 The patient is placed in a supine position with the thorax elevated 15 degrees. The patient's head is flexed so that the surgeon sites the target through the bone flap. 46 Two entry burr holes are made adjacent to the superior sagittal sinus. The edge of the sagittal sinus is dissected from the bone. A bone flap ( 4 x 6 cm) centered on the coronal suture is cut with a craniotome. 47 The surgeon drills holes in the cranial edge and bone flap for placing dural retention sutures and later placement of stainless steel wires for bone flap fixation.