By John M. Tew, Harry R. Van Loveren
Functional atlas of microscopic neurosurgery, for citizens and starting neurologic surgeons at the pathoanatomy of neurologic problems and their surgical operation. three-d line drawings, a few with colour highlighting.
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Extra resources for Atlas of operative microneurosurgery
A free bone flap is cut with a pneumatic-powered craniotome. 57 A rongeur is used to remove bone flush with the floor of the middle fossa. 58 The dura is secured to the bone edge at multiple sites with absorbable sutures. Stainless steel wires are placed for subsequent stabilization of the bone flap. The dura is opened near the skull base. 59 The inferiorly based dural flap is sutured to the muscle flap. After the halo retractor system is attached to the skull-fixation device, gentle retraction is applied with two 10-mm retractors as cerebrospinal fluid is removed from the lumbar catheter.
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. 43 A thin sheet of Silastic placed over the bony defect in the forehead area prevents any shadow effect. 44 The patient's head is maintained at 0 degrees rotation. 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.
Hemostatic clips are placed on the skin edges. 78 The temporalis muscle is reflected anteroinferiorly, leaving a superior fascial cuff. Entry burr holes are positioned at the most anterior mastoid point and below the asterion, which are above and below the transverse sigmoid junction, respectively. A second set of burr holes are placed above and below the superior nuchal line, isolating the transverse sinus. A pneumatic craniotome is used to partially dissect a bone flap that overlies both the posterior and the middle cranial fossae.
Atlas of operative microneurosurgery by John M. Tew, Harry R. Van Loveren