By Prof. Dr. med. Wolfgang Seeger (auth.)
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Extra resources for Microsurgery of the Brain: Anatomical and Technical Principles
Tumor now borders on white matter. Arachnoidal layers preserved as in A C Especially if preformed gaps of inner arachnoidal layer exist, an increasing defect in the two arachnoidal layers is possible D Increasing herniation of tumor through arachnoidal layers (e. g. in meningiomas, less typical for acoustic neurinomas) E Loosening of tumor surface from Arachnoidea (arrows) after hollowing. Dissection between tumor Arachnoidea and inner arachnoidal layers covering brain. In depth there may be a defect in arachnoidal layers: Surface of brain and tumor are in direct contact without protective arachnoidal layer F Preparation in wrong direction.
Corresponding structures of skull X-ray should be transferred from ap. to lateral view at corresponding levels (can be reached by positioning of lateral roentgenogram), in order to facilitate comparison 1 to 5 Samples of auxiliary projection lines. Transfer of a' and b and Cf calculated distance c of to roentgenograms results in localization of the tumor in ap. and lateral roentgenograms 51 r-I- - - - - - - - - - - - - - - - - - - - - - - - - - , 1 FIG. 26~1 ________________________________________________________ ~152 Fig.
I§argil for his operative demonstrations, the technique of which we have adapted. 1 Arachnoidea of Cisterna cerebellopont. is pushed off tumor surface with forceps (and tiny cotton wool swabs) 2 Intracapsular loosening of tumor after incision of tumor surface 3 Retention of Arachnoidea, here with sucker Situation as in A, schematic transection 1a and 1b Arachnoidea of Cisterna cerebellopont. is opened and pushed back over the tumor surface. Preparation within tumor near surface with 2a forceps or 2b dissector 1 A section of tumor surface is excised, after partial evacuation of tumor, and 2 also removed 3a and 3b Further pushing of Arachnoidea from tumor surface with forceps (and cotton wool) with coagulation of small vascular connections of tumor 4 Retention of Lobulus quadrangularis, here with sucker Situation as in B, schematic transection 1 and 2 Excision and removal of tumor portions 3 Arachnoidea pushed away 4 Sucker 5 Further hollowing of tumor After further evacuation, tumor is pressed in lateral direction by impinging brain structures.