By I. Mohsenipour

Universitatsklinik fur Neurochirurgie, Innsbruck, Austria. Atlas for neurosurgeons and citizens of methods common within the authors' neurosurgical practices. Descriptions comprise positioning, wound closure, strength error, and risks. strange colour illustrations.

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Additional resources for Approaches in Neurosurgery: Central and Peripheral Nervous System

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The third hole (C) lies in the parietal bone behind the coronal suture on the temporal line, and the fourth hole (D) 50 Dissection of the fascia and transverse incision of the temporal Fig. 65 muscle 1 Galea aponeurotica 2 Frontal bone (squama) 3 Temporal muscle with dividec and coagulated local artery and vein is placed in the squama of the temporal bone behind the sphenosquamous suture. To avoid dural injuries, the dura is retracted as far as possible with Braatz probes before drilling, particularly so between burr holes A and B.

This operative step may involve considerable bleeding and effort, particularly in the presence of sphenoid wing tumors, because these tumors are supplied with blood from the often massively dilated branches of the middle meningeal artery and the superficial temporal artery. Therefore, in preparing for this operation, it is necessary to consider preoperative embolization of these vessels, or of the tumor portions being supplied, as well as possible ligation in the area of the external carotid artery.

The posterior position naturally facilitates this approach. In the anterior position, portions of the posterior border of the sellar tubercle may have to be removed with a burr in order to achieve the necessary approach. After completion of the intradural procedure, the dural incision is closed; interrupted or continuous sutures may be employed for this purpose. If tension has developed in the dural plane, or if a fragment of the dura has been resected, or if several small gaps remain in the dura, implantation or coverage with a plastic material is required; this in turn is then sutured or glued, or both.

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