By H. Krayenbühl, J. Brihaye, F. Loew, V. Logue, S. Mingrino, B. Pertuiset, L. Symon, H. Troupp, M. G. Yasargil
As an addition to the ecu postgraduate education process for younger neurosurgeons we started to put up in 1974 this sequence dedicated to Advances and Technical criteria in Neurosurgery which was once later backed via the Euro pean organization of Neurosurgical Societies. the truth that the English language is definitely so that it will changing into the foreign medium at ecu clinical meetings is a brilliant asset when it comes to mutual realizing. hence we've got determined to post all contributions in English, whatever the local language of the authors. All contributions are submitted to the complete editorial board earlier than book of any quantity. Our sequence isn't really meant to compete with the guides of unique clinical papers in different neurosurgical journals. Our purpose is, really, to give fields of neurosurgery and comparable components during which vital contemporary advances were made. The contributions are written by means of experts within the given fields and represent the 1st a part of every one quantity. within the moment a part of each one quantity, we post certain descriptions of normal operative tactics, supplied through skilled clinicians; in those articles the authors describe the concepts they hire and clarify the benefits, problems and dangers taken with a number of the approaches. This half is meant basically to help younger neurosurgeons of their postgraduate education. although, we're confident that it'll even be worthy to skilled, absolutely knowledgeable neurosurgeons.
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Extra resources for Advances and Technical Standards in Neurosurgery
1 Internal camtid artery: la lateral meningeal branches to the clivus from the intracavernous portion, 1 b medial branches to the clivus. 2 Middle meningeal artery: 2 a petrosal meningeal branch . ,) Ascending pha1'yngeal artery: 3 a petrosal branches, 3b clivus branches. 4 Occipital artery: 4a petrosal branches. , II \ " '\ \ \\ / \ \ \ \\ \ \ I 1 I " \ II " f..! I . '- ------- / ,;-- / / / / I / / / / b Fig . 17b. Axial projection 3* M. G. : 36 Tumor Vascular Supply The vascular supply of the dura of the posterior fossa, and consequently of meningiomas based on that dura, has received an excellent recent study (Salamon et al.
Initial Approach to the Tumor The basal frontal lobe may be elevated and the carotid cistern reaehed inferior to it, but this is done without the benefit of a removed sphenoid wing. The temporal lobe may be elevated and if no tumor is in the way, the ambient cistern may be rapidly reaehed and opened. The middle fossa is explored by suceessive retraetion of the temporal lobe from its pole to its posterior 1/3. The temporal lobe is not retraeted more than 10 -15 mm, and every effort is made to avoid saerifieing veins at the base of the temporal lobe.
The dura of the middle fossa floor and tentorium are often hemorrhagic and require similar coagulation. Once the tumor is internally decompressed, adhesions between the tumor and the temporal lobe are separated with bipolar coagulation and cotton pledgets. The tumor is separated from the basal dura with small elevators and coagulation. The middle fossa portion of the operation may be remarkably bloody, and induced hypotension to 80 mm Hg may help the surgeon keep control of the field. Only intrathecal tumor is removed, although epidural meningioma may be clearly present.
Advances and Technical Standards in Neurosurgery by H. Krayenbühl, J. Brihaye, F. Loew, V. Logue, S. Mingrino, B. Pertuiset, L. Symon, H. Troupp, M. G. Yasargil