By I. Mohsenipour
Universitatsklinik fur Neurochirurgie, Innsbruck, Austria. Atlas for neurosurgeons and citizens of ways familiar within the authors' neurosurgical practices. Descriptions comprise positioning, wound closure, strength mistakes, and hazards. strange colour illustrations.
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Additional resources for Approaches in Neurosurgery: Central and Peripheral Nervous System
51 Unilateral extradura! approach to the froniotemporal region: positioning and incisions. Yellow: frontal sinus 40 special care has to be taken to avoid injury to the temporal and zygomatic branches of the facial nerve and to the auriculotemporal nerve. Division of branches of the superficial and middle temporal vein and artery can be limited, but is not avoidable; only bipolar coagulation should be used in this area. Dissection of Soft Tissues Once the skin Rap has been retracted laterally or toward the eyebrows, and the transected cutaneous vessel branches have been securely closed by coagulation and clamps as well as Cologne clips, an arcuate incision can be made in the galea aponeurotica to permit closure by suture at the end of the operation.
In keeping with the cosmetic conditions, the skin is closed with fine interrupted sutures. , using the surgical microscope On leaving the depth of the operative site, another meticulous search is made for small sources of bleeding. Such Fig. 38 Clarification of tumor in ihe area of posterior superior orbil 1 Eyebrow 2 Orbicular muscle o1 the eye 3 Superior border of the orbit, wilh the supraorbital artery and nerve 4 Orbital roof from below 5 Periorbita 6 Tumor 28 Anterior Extracranial Median Approach to the Orbit Typical Indications for Surgery — Tumors of the median orbital wall — Mucoceles penetrating the median orbit Principal Anatomical Structures Angular artery and vein, dorsal artery of the nose, supratrochlear artery, supraorbital artery, infratrochlear nerve, supratrochlear nerve, supraorbital branch of the trigeminal nerve, orbicular muscle of the eye, occipitofrontal muscle (venter frontalis), corrugator supercilii muscle, orbital septum, adipose body of the orbit, trochlea, superior oblique muscle, frontal bone (pars nasalis and pars orbitalis), nasal bone, supraorbital incisure (foramen), anterior ethmoidal foramen, anterior and posterior ethmoidal cells, ethmoid bulia; superior, middle and common meatus of the nose; perpendicular lamina of the ethmoid bone, sphenoid sinus.
This generally applies to a lateral sphenoid wing meningioma growing en plaque, and to injuries. If the dura, too, has been invaded by the tumor, it is divided at a sufficient distance from the tumor margin, and is later reconstructed. A tumor growing en plaque extends to varying degrees across the orbital and sloping portions of the lateral sphenoid wing; it may have eroded or penetrated the periosteum and reached adjacent portions of various paranasal sinuses. On the basis of anatomic preparations and computed tomograms, Figure 54 shows the sometimes very wide-ranging frontal sinuses, which can be reached by the tumor as well as by sur-gical dissection, and from which tumors may also originate.
Approaches in Neurosurgery: Central and Peripheral Nervous System by I. Mohsenipour