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By John P. Girvin

This publication describes the categorical surgical ideas presently hired in sufferers with intractable epilepsy; it additionally covers the suitable technical features of basic neurosurgery. all the ways linked to a few of the foci of epilepsy in the cerebral hemispheres are thought of, together with temporal and frontal lobectomies and corticectomies, parietal and occipital lobe resections, corpus callosotomy, hemispherectomy, and a number of subpial incisions. additionally, somebody bankruptcy is dedicated to electrocortical stimulation and sensible localization of the so-called eloquent cortex. The extra common subject matters on which advice is supplied contain bipolar coagulation (with insurance of the actual rules, energy of the coagulating present, use of coagulation forceps, the benefits of right irrigation, and use of cottonoid patties) and all the measures required through the functionality of operations less than neighborhood anesthesia. The publication is designed to fulfill the necessity for a virtually orientated resource of specific details at the operative approaches hired in epilepsy sufferers and should be of exact worth for neurosurgical citizens and fellows.

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By John P. Girvin

This publication describes the categorical surgical ideas presently hired in sufferers with intractable epilepsy; it additionally covers the suitable technical features of basic neurosurgery. all the ways linked to a few of the foci of epilepsy in the cerebral hemispheres are thought of, together with temporal and frontal lobectomies and corticectomies, parietal and occipital lobe resections, corpus callosotomy, hemispherectomy, and a number of subpial incisions. additionally, somebody bankruptcy is dedicated to electrocortical stimulation and sensible localization of the so-called eloquent cortex. The extra common subject matters on which advice is supplied contain bipolar coagulation (with insurance of the actual rules, energy of the coagulating present, use of coagulation forceps, the benefits of right irrigation, and use of cottonoid patties) and all the measures required through the functionality of operations less than neighborhood anesthesia. The publication is designed to fulfill the necessity for a virtually orientated resource of specific details at the operative approaches hired in epilepsy sufferers and should be of exact worth for neurosurgical citizens and fellows.

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This situation of what tissue to which the traction should be directed during the course of surgery is commonly encountered in epileptic operations. This is especially the case when completing the isolation of the neocortex of the temporal lobe in an anterior temporal lobectomy (aTLY) and even more so in the case of a radical frontal lobectomy and in corticectomies of all sizes. 3 Anatomical Measurements of Functional Areas of the Cortex 31 being removed. However, it is evidence of carelessness and unsatisfactory retraction when bruising of parenchyma, which is being left behind, is seen following the removal of the retractor at the termination of an operation!

4 Retraction with Normal-Sized Retractors This has been relegated to a separate section, not because of any complexity, but because of its importance in protecting the health of cerebral parenchyma being left behind following any surgical procedure involving retraction of that parenchyma. When retraction of large segments of cerebral parenchyma is required in order to achieve satisfactory vision of the operative field, the retraction should always be applied to the tissue that is being removed, not to that which is to remain.

Suc(thick arrow) tion cannula, sul sulcus, tr. p. Sub Cortical tr V Fig. 7 (continued) a point where it cannot safely be applied directly onto the pial membrane. 7b is the reverse of Fig. 7a in that the cottonoid patty combination is used for counter-traction, opposing the traction of the forceps. Perhaps the greatest concern about not providing reliable traction and counter-traction in the sulci is that not only is the pial membrane delicate and fragile, but also there is fragile vasculature in the subarachnoid space between the two pial membranes within the sulcus supplying the cortex on either side of the sulcus, which can also be compromised (see Sects.

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