New PDF release: Atlas of operative microneurosurgery

By John M. Tew, Harry R. Van Loveren

Useful atlas of microscopic neurosurgery, for citizens and starting neurologic surgeons at the pathoanatomy of neurologic issues and their surgical procedure. 3-dimensional line drawings, a few with colour highlighting.

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83. 85 The dura between the sigmoid sinus and the petrous apex is exposed. A dural incision is made in the posterior fossa dura (inferior to the petrosal sinus) and in the middle fossa dura (superior to the sinus). 86 Clips are applied to the superior petrosal sinus. 87 The superior petrosal sinus and tentorium are incised ventrally toward the incisura in a course directed posterior to the trochlear nerve. 88 The surgeon gently applies 10-mm self-retaining retractors to the posterior temporal lobe and lateral cerebellar hemisphere to expose the medial temporal lobe, lateral pons, basilar artery, and cranial nerves V through VIII.

The head is rotated until the sagittal suture is oriented parallel to the floor. 75 The lateral oblique position is an option when extensive exposure of posterior fossa structures is required or if the patient poorly tolerates neck rotation. 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.

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. 60 Bridging veins to the sphenoparietal sinus are coagulated as the tentorium is approached. The anterior temporal vein and the anastomotic vein of Labbe are preserved. 61 The tentorial margin is retracted laterally with a suture. 62 A dural retention suture is placed in the center of the craniotomy to prevent an epidural hematoma.

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