Atlas of operative microneurosurgery by John M. Tew, Harry R. Van Loveren PDF

By John M. Tew, Harry R. Van Loveren

Sensible atlas of microscopic neurosurgery, for citizens and starting neurologic surgeons at the pathoanatomy of neurologic problems and their surgical operation. third-dimensional line drawings, a few with colour highlighting.

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The dural incision follows the margin of the craniotomy. 48 The dural flap is hinged on the edge of the sagittal sinus and reflected medially. A corridor is selected between the bridging veins. Additional exposure can be obtained by dissecting the arachnoid overlying the vein; minor veins are sacrificed. Preoperative evaluation of the venous anatomy of the right hemisphere will allow the surgeon to select a corridor along the midline that will obviate sacrifice of critical bridging veins. The surgeon can obtain additional exposure by dissecting the arachnoid overlying the vein and by freeing the vein from the underlying cortex and the dural flap.

The dura is elevated from the middle fossa floor and petrous bone. The middle meningeal artery is sacrificed at the foramen spinosum. Several structures are visible on the middle fossa floor, including the mandibular division of the trigeminal nerve at the foramen ovale; the lesser and greater superficial petrosai nerves; occasionally the internal carotid artery through a small dehiscence in the bony floor; and the arcuate eminence, which overlies the superior semicircular canal. Critical structures usually obscured by bone include the petrous carotid artery and its posterior loop, head of the malleus in the epitympanum, geniculate ganglion, facial nerve, superior vestibular nerve, cochlear nerve and cochlea, and semicircular canals.

This maneuver provides a corridor for approaching the petroclival region of the upper posterior fossa from the middle fossa. This approach improves exposure for infraclinoidal basilar tip and upper midbasilar tip aneurysms as well as for petroclival tumors that are located superior to and anterior to the internal auditory meatus. The anterior petrosectomy can be performed with hearing preservation. 66 A standard subtemporal craniotomy is performed (see previous section). The dura is elevated from the middle fossa floor and petrous bone.

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Atlas of operative microneurosurgery by John M. Tew, Harry R. Van Loveren

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