By John M. Tew, Harry R. Van Loveren

Useful atlas of microscopic neurosurgery, for citizens and starting neurologic surgeons at the pathoanatomy of neurologic problems and their surgery. three-d line drawings, a few with colour highlighting.

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The bone flap ( 4 x 4 cm) is cut with a craniotome. 39 The dura is opened to reflect over the sagittal sinus. 40 Preoperative evaluation of the venous anatomy of the right hemisphere allows the surgeon to select a corridor along the midline that will obviate sacrifice of critical bridging veins. The surgeon can gain additional exposure by dissecting the arachnoid overlying the vein and by freeing the vein from the underlying cortex and the dural flap. 41 The self-retaining retractor is attached to the skull-fixation device.

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. 89 The dura is closed with a continuous absorbable suture. A dural retention suture is placed in the center of the bone flap. Stainless steel wires are placed through the drill holes to secure the bone flap. The ends of the stainless steel wires are tucked into the drill holes.

The surgeon can gain additional exposure by dissecting the arachnoid overlying the vein and by freeing the vein from the underlying cortex and the dural flap. 41 The self-retaining retractor is attached to the skull-fixation device. A single retractor is placed on the medial aspect of the frontal gyrus; a second retractor is positioned to retract the falx medially. 42 Following dural closure, the bone flap is secured with titanium microplates and screws. All bone defects are filled with methyl methacrylate to enhance the cosmetic result.

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