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 surgery. third-dimensional line drawings, a few with colour highlighting.
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Extra resources for Atlas of operative microneurosurgery
They are the preferred approaches to most aneurysms of the anterior cerebral artery distal to the anterior communicating artery and to arteriovenous malformations of the lateral ventricle, third ventricle, basal ganglia, and thalamus. 36 The patient's head is maintained at 0 degrees rotation. 37 The patient is placed in the supine position with the thorax elevated 15 degrees; the head is extended to enhance the surgeon's trajectory to the target. 38 An 8-cm linear incision is made in a skin crease of the forehead.
76 Critical to the petrosal approach is the surgeon's ability to project the location of the petrous bone and deep venous structures onto the surface anatomy. 77 The temporal skin flap is reflected inferiorly. The frontal skin flap is reflected anteriorly. 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 single-entry burr hole, made at the superior aspect of the bone flap, is in line with the anterior border of the mastoid. 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.