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Henry Troupp

lobectomy (130 gm) on August 20, 1968. The operation was complicated by troublesome “swelling” of the frontal lobe from the start, even before the lobectomy was started. When eventually the dura had been closed, a large extradural hematoma extending backward over the whole parietal area was found. The hematoma was removed through the frontal craniotomy; on August 23, more hematoma was removed and hemostasis secured through an enlarged parietal burr hole. The patient then recovered uneventfully. Case 4 A 39-year-old man was operated on on May 9, 1972, for a left

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Guilherme Carvalhal Ribas and Aldo Junqueira Rodrigues Jr.

A lthough placement of basal bur holes for frontotemporal craniotomies is usually performed in a standard fashion, 13 , 32 , 33 for more posterior supratentorial temporooccipital craniotomies the selection of sites for bur holes is more variable and usually left to the discretion of the individual surgeon. The main objective of this study was to establish locations of basal temporooccipital bur holes that have important and constant anatomical relationships with the skull base and intracranial structures and can easily serve as standard initial bur hole

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Phillip E. Williams Jr. and Kemp Clark

S everal problems exist in preparing the head with a razor. The risk of scalp infection caused by inadvertent or excessive nicking of the scalp is the major one. A certain amount of discomfort and apprehension is associated with clipping and shaving of the head. Preparation after induction of anesthesia merely prolongs anesthesia time. Surgex * is a mixture of calcium thioglycovate, calcium hydroxide, and strontium hydroxide. It is a commercially available depilatory agent. We have used it routinely in the preparation of the head for craniotomy over the

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Rachid Assina, Christina E. Sarris, and Antonios Mammis

eras have contributed greatly to our modern-day understanding of the classification, pathophysiology, and treatment of headaches. Although the first descriptions of headaches, migraines, and neuralgias were recorded by the ancient Egyptians in the Ebers Papyrus, it was not until Hippocrates that headaches were classified as different types and attributed to real physical pathological states. 20 Just as headache has been described for thousands of years, the history of trepanation (earlier) and then of craniotomy (later) can be traced back to prehistoric man. It is

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John H. Schmidt III, Bernardo J. Reyes, Roopan Fischer, and Sarah K. Flaherty

replacement using titanium bone plates in a hinged fashion such as the one we describe. The aim of this report was to describe our experience in patients who have undergone a posttraumatic cerebral decompression craniotomy utilizing a hinge to create a mobile bone flap secured to the skull. We used titanium bone plates in a hinged manner to allow decompression while maintaining cerebral protection and reducing postoperative complications. This technique also eliminates the need for subsequent surgery for cranioplasty or bone flap replacement. Materials and Methods

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Karolyn Au, Suparna Bharadwaj, Lashmi Venkatraghavan, and Mark Bernstein

T echnological advances in neurosurgery and neuroanesthesia have markedly reduced the morbidity and mortality of craniotomy for tumor resection. 10 , 15 The timing and frequency of hemorrhagic complications are recognized, allowing for optimal clinical and imaging surveillance. 17 The safety and efficacy of outpatient craniotomy, whereby the patient is admitted the morning of surgery and is discharged home after the procedure without spending the night in the hospital, has been established. 1 , 7 , 13 Compared with an inpatient admission, same

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Eric L. Zager, Daniel A. Del Vecchio, and Scott P. Bartlett

A lthough not a major concern in most pterional craniotomies, temporal muscle asymmetry is a common sequela of this procedure. It could represent atrophy of distally transected muscle, malposition of the muscle origin, or a combination of both. A number of techniques have been described in the past to preserve the anatomy of the temporal muscle and to reconstruct its origin, but these have not gained widespread popularity, probably due to either the demand for excessive operating time or the risk of injury to the frontal branch of the facial nerve

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Vincent C. Hinck and Guy L. Clifton

potentially imprecise), or they require elaborate radiographic procedures and equipment for exact determination. 1, 4, 6, 7 We are presenting a simple, direct method of preoperative CT craniotomy localization that obviates the need for skull radiographs, calculations, and corrections for magnification. The principles upon which this technique is based were first applied to spinal CT. 2 Materials and Methods To make the localizing device required for this technique, one needs a piece of x-ray film (or other flexible material) measuring about 9 × 13 cm, and 12 lengths

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Göran C. Blomstedt and Juha Kyttä

I n craniotomies, the bone flap is cut off from its blood flow and is therefore comparable to a foreign body, such as a ventricular shunt. Its resistance to infection is reduced, and it may become infected, usually by opportunistic skin bacteria. 4 Prophylactic antimicrobial agents have been found beneficial in shunt surgery, 5 so the aim of this study was to test the usefulness of antimicrobial prophylaxis in patients undergoing craniotomy, with special reference to bone-flap infection. Clinical Material and Methods This trial started on September 1

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Robert F. Spetzler and K. Stuart Lee

zygomatic process of the frontal bone ( Fig. 1B ). The muscle is dissected from the temporal fossa and is retracted along with the scalp with multiple fishhooks connected to rubber bands attached to a Leyla retractor bar. A cuff of fascia and muscle remains attached to the skull at the superior temporal line ( Fig. 1C ). The standard frontotemporal craniotomy is performed with a free bone flap. At closure, after the bone flap has been well secured, the temporalis muscle and fascia which are still attached to the scalp are reattached to the superior cuff of muscle and