In this article, we are sharing with our audience the genuine PDF download of Operative Cranial Neurosurgical Anatomy 1st Edition PDF using. and is well-known for his color images of live neurosurgical anatomy as viewed through the operating microscope. Historic techniques, instrumentation and. OPERATIVE NEUROSURGICAL ANATOMY echecs16.info OPERATIVE NEUROSURGICAL ANATOMY operative neurosurgical anatomy pdf. Surgery.
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During the past 15 years, several publications on neurosurgical techniques, often with special emphasis on surgical anatomy. have appeared in the literature. Atlas of Morphology and Functional Anatomy of the Brain Анатомический атлас . Neurosurgical operative echecs16.info МБ. 1. Нравится. This book presents neurosurgical anatomy by detailing approaches on cadavers in the same position patients would be placed in during a real operative.
Fox today's instrume nts, the ne u rosu rgeon finds that the pterional approach to skull-base lesions is a more natural and easier procedure than earl ier-day operations. Yet, there is a fascinating hiSlOrica l background over the last years, that form s the basis o f the present-day pterional approach. There are several pioneers who made mo numental contributions to the development of this access to deep-seated cran ial-base lesions. Wilhelm Wagner and His Osteoplastic Method followin g studies on human cadavers for several years, Wilhelm Wagner became the first su rgeon in the world to raise a I. HislOry of the Pterional Ap proach bone flap temporal in site out of the cranial vault in a living person , kee p it attached to the overlying soft tissue perioste um, tempora l muscle, and scalp , a nd then replace the fla p after evacuation of a la rge epidu ral hematoma [4, 44].
Neurosurgery , Neurology , Neurosurgery, General , Anatomy. Rate this product. Please log In to rate. Also Recommended. Modern Management of Spinal Deformities. Comprehensive Management of Vestibular Schwannoma. Skull Base Surgery: Get NEWS! Product Search. Tardy, Jr. Select Year As a bo ' de Martel dered from the Hermann HarLel Compa ny in was alread y very inquisitive and enjoyed taking Breslau at the price of 3 German marks plus mechanical things apart to learn how the , op40 pfe nnig for shipping com to an ' forei gn erated .
Frequently he dissected the fowl country. He also added that chiefs of clinics being pre pared in the kitchen, and he bought could obta in free samples by just sending in a a skeleton that he displayed as an amiable comrequest. At fi rst he was under the government of Vienna had in- enrolled in a school for the training of entended to describe the use of the Gigli saw for gi neers and later was trained by several French cranial trepanations at the Imernational Con- master surgeons.
He beca me especially ingress in Moscow in August However, he terested in neurosurgical instrumentation. At was prevemed from going and instead pub- the age of 33 he published an article  delished his innovative a pplication in the Cen- scri bing two new neurosu rgical instruments. In his Today, 80 ,ears later, both are in dail y use by paper Obalinski stated that it had occurred to many thousands of neurosurgeons all over the him that by using a slightly bcnded cannu la as world.
In his milestone paper the two instruan inserter, the fl ex ible Gigli saw was ideal for ments he described were a a motor-driven introduction between burr holes. He em- tre phine equipped with an automatic disenphasized that the use o f the Gigli saw permits gaging gear that stopped the trephine as soon the safest method of dividing the skull bone as it has penetrated the skull and b the metal from the inside to the outside without th e type gu ide for the introduClion of the Gigli saw beof trauma usually seen from the use o f ham- tween separate burr holes.
In Moscow, Emile Doyen When in Paris, de Martel presented his new from Paris demonstrated his own method for automatic trephine, but it was received with deperforming a cra niectomy in front of many rision.
He then performed a demonstration prominent professors of surger " including lI sing a dried skull with a balloon 0 11 the inside von Bergmann fro m Berli n, Czerny from as an im itaLion of the dura mater. With his au- I. History of the Pterional Approach Fig. The " hypop hyseal 0' a pproach of Heuer and Dand y. LOmatic trephine he drilled a hole in this sk ull without puncturing the balloon a nd commented [31 ], "Well, as yo u call see, this treph ine can be operated by a n imbecile" "ct bien comme valis voycz, Messieurs, cc trepan pellt manie meme par un imbecile".
American neurosurgeons were even more reluctant to accept de Mart. Yet in Boston in its lise was rejected even at the Massachuseus General Hospital. The burr holes were done ma nuall y and laboriously!
It was said that electric drills were not used because Cushing had once stated that such drills caused too much vibration transmitted to the brain Bakay L, personal communication, He was the pioneer neurosurgeon in France who fou ght a nd overcame the difficulties of blood loss and inadequate posterior Fossa visualization common to neurosu r ger y during the first qua rter of this centu ry.
He had lost his only son in World War I. Ographic cameras. Overhead Table In our experie nce. The table height is easily adjusted.
Items I through 10 also increasc brightness for the surgeon. The cranial e nd of the table should bejustcaudal to the patien t's shoulder more caudal if the cervical carotid a rtery needs 1. Television As memioned above. Phelan Manufactllring Corporation.
The hooks a re used to retract the froillolemporal scalp flap tlIrned over the patient's forehead as follows Fig. This is a moment 1O reflect on the use of magnification. Use greater magnification in e 'cpicces. Avoid zoom! Operating room physicians and nurses alter their anesthetic techniques a nd ongoing activities as wel l as morc efficiently prepare for anticipated operative CVClllS based on information received from the television monitor.
Minneapolis and the patient's head are -held firml y downward and caudall y by standard rubber suction tubing of appropriate length.
Usc add-on light sources. I ntraoperative Instrumentation Fishhooks The use of improvised tissue-retraction hooks. Discard bulbs ". Many of the newer television cameras can operate at a lowe r light level.
The sterile drapes between the overhead table neu rosurgical instrume ll t table. Table 2. Turn off bright lights in opcr. From Fox et al [ Yct it is still advantageous to obtai n good lighting to allow a smaller diaphragm ope ning and consequently a greater de pth of fie ld and sharper focus.
This lube a firmly holds the drapes in place and b allows a convenient site of allachmem fo r the rubber bands that retract both the scalp hooks and the bone flap. More recently a fi shh ook retractor device using springs Aesculap Instrumelll Co. Instrumentation and Positioning Gillingham cautioned. Color television systems see Fig. I n this way the drapes of the pcrioperalive field are. I ncrease voltage in transformer s hortcns bulb life.
OllCn diaphragm to camera with loss of sharpness and depth of focus. Close-up view of ru bber tube holding drapes firm ly sec Fig. Fr size is 3 mm. A SUClion system with a mechanism to controlthe negative pressure at ve ry low levels is essential. Fr size has an oLlterdiameter of 1 mm. The rig ht fromolateral bonc nap is attachcd to the lcm poralis musclc at cemcr of figure.
The suction should be finel yadjusled to eliminate the ha7. Standard sizes for aneurysm surgery are 3. In addition to keeping tissues from drying and the aneu rysm wall from becom ing briule. Dural lack-up sutures and boncnap sutures are in place in the cranium before the dura is opened. Many neurosurgica l suction tubes are con-. Here the samc tubi ng is used to attach the rubber b.
I n place of wa ll sllction. T he trap bottles ca n have pressure-regu lating gauges. There are a multitude of types of suction lubes with variation s in length. T hese fis hhooks retract thc oxrccllu lose-co-. When dissecting delicate SlnlClUres. T hese ho lcs ca n be enlarged [5.
We routinely put 1. Fr size rathe r than smaller suction tubes because of its usc as a dissector and retractor as well as a suction device. The scrub nu rse applies a small bit of account of cra niotomy methods. Instrumentation and Positioning We commonl y use the Le ksell. When using lightweight drills or burrs.
The surgeon technique of bone flap removal made a signifi. This tonoid against the wax. We use oxycellulose rather than cotton sponges to cover the nearby galea.
Charlo tte. When using bonewax under the microBone-Removal Instruments scope. North Carol ina or small cottonoids for suction protection and retraction.
He noted that bonewax to one side of a small. Diamond burrs are sa fer close to the du ra or vital structures. We usuall y use a n angulatcd Frazier suction tube of varyi ng lengths.
This "resting fi nger" serves more to provide proprioceptive feedback rather than comfol" to the su rgeon. A constantsuctioll-irrigation system with physiological saline ca n be used to cool the drill. Dangero us skiddi ng may OCClll" at slow speed s or with dull drill bits because of the greater pressure needed to cut bone. Usually we use this especially in elderly patients where the dura tech nique on the sphenoid wing a fter drilling may be stuck to the inner table of the skull.
The neurosurgeon needs a small. Rubber tubing is preferred to plastic tubing. The on ly time we use a suction-irrigation apparatus House-Radpour unit is during bone sphenoid wing or clinoid process drilling. The suction lube is held in the su rgeon's left hand. Constant bathing with CSF has the same effect.
The fl at-j awed Lempert rongeur is especiall y helpful for removing that portion of the sphenoid wing sticki ng Out as a ridge toward the sylvian fissue. Electrocautery for coagulation of vessels and Ro ngeu rs for biting away the base of the vascular tissues has been an in1. T he it under magnification. Some surgeons prefer a combination suctio n-irrigation unit. The metal suction tube can also be used for resting microscissors or other instruments to reduce tremor when making a delicate d issection.
One obmins a more accurate a nd controlled use of the drill when it is operated at high speeds. We use the 7. A drill that ca n reve rse its direction is pre fe rred by some to one that cuts in only one di rection. The the surgeon's operative field. Sugita et al One pole is the "ground plate" and the other is the hand-hcld electrode.
Light  gave a good historical ove rview of the subject in Fox bipolar electrocautery forceps in three lengths: In Malis  reviewed the de.. Mueller Compau '.
Malis  improved th e power supply 0 provid e a damped wave spark un it that was electricall y bener isolated. It is important nOl to sterilize titanium and stain less-steel instruments in the same package. Titan ium or stai nless steel are commonly used metals. This un it Cod man and Shurtleff Company has bee n one of the more popular and reliable un its for neurosurgery and is preferred by us.
For microvascular and intracran ial aneurysm surgery and ford issection of tumors fro m the bra instclll. The greater safety of bipolar coagulation compat'ed with monopolar coagulation around brain stem structures was demonstrated by Gestring et al [ 18]. Other popu lar bipolar forceps fo r surge ry include the Rhoton round-handled forceps and the Malis forceps with the blades slightly angled downward rather than parallel lO the hand le.
O-mm tip diametcrs. Of course. There have been many mod ifica tions in both the fo rceps and the po"crsupply [8. Mu eller Company. Accordin gly. Chicago Fig. Each of the straight forceps cOl11es in 0.
The unit was designed specificall y to provide the best coagulation at the lowest voltage with the least muscle stimulation.
Oth ers developed a suction  or irrigation [ Bi pola r electrocoagulation of the type whcre both poles arc in the forceps was developed by Grcenwood  to cauterize small blood vessels on the spinal cord. T hesc forccps come in Some tried to provide a single unit for both mono polar and bipolar electrocoagulation [ At the same time.
Del ong and Fox  described an automalic cyclin g on-off bipolar electrocautery power supply. We prefer the heavier weight of the stainless-steel for ceps for bettcr balance. Bovie" electrosurgical un it. Various t 'pes. Self-reta inin g retractors also have become indispensablc to aneurys m surgery because they allow th e surgeon to work in a relativel y. On tcrms of frequenc. I n this positio n 3.
Apply t he currCIll in shon bursts to allow heat dissipation. Instrurnentation and Positioning electrical potcmial conductive to rusting a nd pOOl. For the same reason. Clowa rd. He wa rned that thi s wou ld be aggravated by excess or prolonged brain retraction. We set the power supd oth not with the sca lpe!! Wc usc the bipola r forccps as the principal d isscCling a nd tissuc-separating instrument intracranially. We use a foot I.
T hey must not rotatc inappropriately in the surgcon's hand. Longer cord s may cause de fecti ve electri2. In terms of timc. A number o f authors have described the use of self-rel.
Avoid high current settings. It is uscd to place a nd remove cotlonoids. Clea n the lips frequemly only with a damp ca l o utput at the forceps. I f induced hypote nsio n is used. Polish the lips periodically or obtain new it does not add to th e instrument cluneI' near force ps when the tips become pitted a nd the surgeon.
The 6. If higher settin gs are required. In Gi llin gham  warned that bleedin g from an a neurysm at surgery causing reve rsal of blood now from vital brain tissues a nd a drop in blood pressure may result in ischem ia of nearby brain tissuc. Such retraction was often inconsistcnt.
Add itionall y. Fo r this reason the blades o f the fo rceps must have proper spreading tcnsion. On cerebral cOrtcx wc use the Malis bipolar power supply d ial al the 25 to 30 seuings: Dohn-Ca rton. Thcre fore. With faulty spark gap distances or other electrical proble ms. Do not short-circuit the electric curre nt by cord between the power supply and the fortouching the forceps lips together.
Dolt Edinburgh. For most of o ur extracra nial cauterization we usecither the monopolarorthe bipolar unit with the Malis powcr supply dial set at 30 or Kee p the tissue moist with CSF or saline. Fi rst. Sel f-reta ining brain retractors arc of two basic types [ 17]. CSF drainage: O the r Microsu rgical Instrume nts T here are now a large number of microsurgica l instruments in the fie ld of neu rosu rgery.
T he otherconsislS of a series of ball-and-socket un its resembling a cha in of peads with an internal cable that when tightened. We auach the bar to the left Table 2. We ca nnot review all of them in this rapidly changi ng field. Other Microsurgical Instruments confined space unhinde red by the presence of' an assistant's hands.
T here is also a cm scissor. Figures 2. I'crmincd by: Vascular compression by retractoror stretched arachnoidal bands 6. Many prefer systems that attach on ly to the sku ll. The bipolar forceps have been described in the earl ier section on electrocautery. Neumanest hetic techniques Avoids: Of greatest impon a nce in intracranial surge ry is the minimal brain retraction necessary Table 2. T hen tighte n the flex ible bar by turning [he screw.
Drift is minimal or absent if done properly. T he Aescu lap bayonet scissors cu rved and stra ight come in three lengths 16 cm for surface work. Self-retaining br. The j ewelers' fo rceps is used to pick up the arachnoid over the sylvian fiss ure to in itiate opening of this fissure.
T his ma neuver gives better in tracranial exposure wi thout the ends of the fl exible retractor arms being in the way. Secondary brain contusion o r edema. Removal of significant brain for exposurc of lesion 2. Usc of microS ope. All joi nts must be firmly tightened to avoid drift. T he Rhoton. Minimal brain retraction. T hey are concerned that table-mounted retractors may move relative to the brain even if the skull is immobilized by three-point fixa tion .
Low oosal. Although these retractors a re usually ap plied against brai n tissue or its coverings. T he selection of a self-retaining retraClor system is up to the ind ividual surgeon's preferellce and habit.
This requires auaching the flexible arm ncar the end of the retractor blade and bending the blade at its proper poi nt for descent into the cranial cavi ty. One is composed of a series of stra ight shafts attached by small clamps to give the co rrect arm length and con fi guration requ ired for holding the brain spatula in place.
Always have the poi lll of connection between the retractor blade and flexible bar away from the cra nial opening. Retractor h. Above is the draped scalp with an outline of a righl froruolateral cran iotomy incision.. Close-u p view of connector bell. Instrumemation and Positioning. Close-up view of auachmCIlt head between the bar left and retractor a rm connector right.. TUlli ingen. Sugi ta et al  a 5-mm mirror.
I nstruments and sutu re for reanastomosing or repairing blood vessels and nerves should be available along with the expertise to do so.
The "Iong flat instrument" a. T he technology. There now are many types. On occasion a mirror a t the tip of a probe can be useful for seei ng behind and around va riou s structu res. One instrument can also be rested on the suction tube of the surgeon's left hand to red uce tremor in critical moments.. These are detailed in many articles on microvascular anastomosis.
Often the surgeon rests only his fifth finger as a point of proprioceptive feedback. These are in a continual state of evol Ulion. These microsurgical instruments require some trai ning and ex perience in their use and manipulation through a small openi ng and insid e a deep narrow cavi ty. This allows sensory orientation a nd reduces tremor. Olher Microsurgical Instruments 29 D fig. The "short fl at instrument" is ideal for se parating adhesions between an aneurysm and adjacent tissues because the edges of its angled.
Wilson and Spelzler ] used a denta l mirmr. A ball-tipped hook also is helpful. Bayonet sha ped microscissors Aesculap Instrume nts. Be n nclt MH et 31 19i7 Clin ical and experimemal brai n retraction pres- sure monito ring.
Albin MS. Acta Ncurol Scand supp! From Fox ]. Buncgin L. Bo ndu ra nt C P Alte ration or suctio n lip prcssure. Enlarged view of microsurgical dissecti ng instruments Rhoton ty pe: J Neu ros urg Nu rs 7: Instrume ntation and Positio ning fi g. Bibliograp hy I. III aid to the rc moval or im rac ra nial tu mors. J Neuros u rg Ltft nld: Colley PS. Bunegin L. Albi n MS. Cushing H. BO" ie WT Electro-su rgery as.
Vcrlag der JJ Lentnc r'sche n Buch handlung. Arch Phys T her Tech nical note. Ann Med Hist 2: CV Mosby Co Hocrenz P Ann R Coli Surg Kurze T Microtechniques in neurological surgery. Cerebrqvascular Disease.
King TT. Bader DCH et a1 Microsurgical treatme nt of neurovascular d isease. Sugita K. Malis LI Bipolar coagulation in microsurgery. Clin Ncurosurg Acta O[olaryngol [Suppl] Stockh Bullara LA. Drake CG On the surgical treatment of ruptured intracranial aneurysms.
Micro-vascular Surgery. Dujovny M. Stroke 7: Gurdjian ES A singlc unit for bipo lar. Ral'en Press. Am J Surg Greenwood J. J Neul"Osurg Peerless SJ The surgical approach to middle cerebra l and posterior commu nicati ng. Surg Neurol 2: Clin Neuros urg Thomas LM. Cl in Neurosurg Gurdjian ES. Scharff TB et al Expericnce with videotape monitOring of microscopic neurosurgical procedu res. J Ncurosurg Charles C Thomas Publisher New ' ork.
Fox J L Intracranial Aneurysms. Vas R. Fox J L Miu osurgical cxposure of intracranial aneurysms. Osgood CP et al Automatically irrigated bipolar forceps.
Rev Ins[ Nac Ncurol Mcx Housepian EM. I Nellrosurg Prog Neurol Surg 3: Khoton AL. A puzzo Mq. Gestri ng FG. Tenth Prineeton Conference. Kurze T. Bibliography 8. A new principle a nd instru ment for applying coagulation current in ncurosurgery. ScarffTB A nell' bipolar suction-camery forceps fo r microncurosurgical use. Sw ug. Gill ingham fJ The management of ru ptured intracranial aneurysm.
Cli n Neurosurg Malis Ll Instrumentation and techn iques in microsurgery. Koos WT. Carl Zeiss Charles C T ho mas Publisher Jacques S.
IIS first use a nd later development. Fo x J L Automatic q-cling bipola rcoagulator. Hirota T. Donaghy Rfo. Greenwood J J r Two-point or interpola r coagulation. Tsugane K Applica-. I Neurosurg 2: Nylen CO Thc microscope in aural surgery.
G T hieme II. Centralbl ChiI' Celltralbl Chir Surg Neurol8: Rogers L T he history or craniotomy: Clin Neurosurg II: Spetzler RE Operative approaches to aneurysms. I nstrumentation and Positioning lion of nasopharyngeal mirror for aneurysm operation. Vise WM. Wilson CB. University Park Press. Ray MW The operative approach to aneurysms oflhe anteriorcolllmunicating artery.
Shintani A el al fl. Kobayashi S. Tsuganc R. Tsugane R Bipolar coagulator with automatic thcrmocomrol. TakemaeT et al Direct retraction method in aneurysm surgery. Stro nger halogen o r xenon lig ht sou tcescan be used. The light inte nsity can be increased to some extent by overloading increasing the voltage the tra nsfo rmer of the In oth erwords.
Because a rteria l systolic pu lsations are quite brief compared wi th the entire duratio n of one pulse. T his results in a significant improvemen t in clarity a nd shar pness of images and in dep th of foc us reducing the flatness of image effect. The key lO improving the q uality of the colo r photographs is to na rrow the le ns a perature we use an f -StOp o f The surgical pho tographer muSl ta ke care to avoid any respiratory.
T he majority of these cases were palie nt5 with illlracranial a ne u rysms. But excess light ene rgy. Many surgical photogra phers still pho tograph through the operating microscope with these concepts in mind. Mount Sinai School of Medicine. Pho tog raph ic slides were selected for demo nstratio n o n the basis of ill ustrating clarity of features.
Chairman of the De partmen t of Neurosurgery. New Yor k City.
West Virginia. Earl y in his ex pe rie nce the a uthor VLF was under the misconception that increased lightin g. From a recent historical stand point. Saudi Arabia. The photogra phs were taken du ring actual ope rative proced ures per form ed by the author since One can. Any black-paint border around the tion. Recen t a nd more be attached LO the other side. Wi th automatic cameras the exposure time approxi mates this duration.
We have been satisfi ed with this light. T he tungsten.. I operating microscope 3. With lI'aves o peratin g microscope. Unless otherwise indito the rig ht or left side of the beam splitter we cated. Before no drapes were used. We Current Techniques use the delayed sh utter-release mode so that a ll camera and microscope movements have Except for the Zeiss camera adapte r and 2x ceased by exposure time occurring about magnification attachme nt.
The still ca mera cam.