Pterional Approach

Aug 6, 2016 by in NEUROSURGERY Comments Off on Pterional Approach

10 Pterional Approach Position The patient is positioned supine with a bolster under the shoulder ipsilateral to the aneurysm. The head is rotated 15 to 20 degrees away from the…

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Orbitozygomatic Approach

Aug 6, 2016 by in NEUROSURGERY Comments Off on Orbitozygomatic Approach

11 Orbitozygomatic Approach Rationale and Indications The orbitozygomatic approach dramatically enhances the standard pterional craniotomy. When a patient’s head is rotated away from the aneurysm and extended, the superior and…

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Anterior Interhemispheric Approach

Aug 6, 2016 by in NEUROSURGERY Comments Off on Anterior Interhemispheric Approach

12 Anterior Interhemispheric Approach Position, Incision, and Extracranial Dissection Pericallosal artery (PcaA) aneurysms originate from a right-or left-sided bifurcation of the anterior cerebral artery (ACA), but are midline aneurysms deep…

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Brain Transgression

Aug 6, 2016 by in NEUROSURGERY Comments Off on Brain Transgression

8 Brain Transgression Violation Vascular neurosurgery is a refined art. The dexterity, grace, and precision of a master neurosurgeon are awe-inspiring; the movement of microsurgical instruments among arteries and nerves…

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Under the Microscope

Aug 6, 2016 by in NEUROSURGERY Comments Off on Under the Microscope

1 Under the Microscope The Microscope The operating microscope is the neurosurgeon’s most important tool. It illuminates the operative field, magnifies anatomy, and gives constant visual feedback. Skillful dissection depends…

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Vascular Control

Aug 6, 2016 by in NEUROSURGERY Comments Off on Vascular Control

4 Vascular Control Contingency Planning A reality of aneurysm surgery is that the technical skill and surgical experience do not eliminate the risk of intraoperative aneurysmal rupture. The dangerous combination…

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Intraoperative Rupture

Aug 6, 2016 by in NEUROSURGERY Comments Off on Intraoperative Rupture

9 Intraoperative Rupture Ever-Present Danger Uncontrolled intraoperative bleeding is one of the most feared complications in neurosurgery. It has been said that uncontrolled bleeding is the one factor above all…

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Temporary Clipping

Aug 6, 2016 by in NEUROSURGERY Comments Off on Temporary Clipping

5 Temporary Clipping Final Dissection Temporary clips are used occasionally to control an intraoperative aneurysm rupture, but more often to finish aneurysm dissection and prepare it for permanent clipping. Aneurysm…

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Brain Retraction

Aug 6, 2016 by in NEUROSURGERY Comments Off on Brain Retraction

3 Brain Retraction Retraction Without Retractors Brain retraction is bad. It can raise brain tissue pressure, reduce cerebral perfusion locally, hide critical anatomy, and injure neurovascular structures. However, subarachnoid corridors…

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Conclusion

Aug 6, 2016 by in NEUROSURGERY Comments Off on Conclusion

21 Conclusion Technical development does not come from reading a book; it comes from operating. Neurosurgeons develop microsurgical skills through a combination of repetition, technical mistakes, outside learning, and high…

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