the lateral surface of the leg at the head of the fibula ( Fig. 21 ). For the exposure of the common peroneal nerve alone, the lower third of the incision alone may be used. To omit the modified Z across the popliteal fossa produces the result pictured in Fig. 22 . Fig. 20, Fig. 21 ( left ). Retraction of skin flaps in the region of the popliteal space to show the operative exposure obtained by use of the Z-shaped incision. ( right ). Exposure of the sciatic nerve with its division into the tibial and peroneal in the region of the popliteal fossa. (A
Christopher S. Ogilvy and Robert G. Ojemann
✓ A safe technique is described for performing a lateral posterior fossa craniotomy to gain access to the cerebellopontine angle. The method makes use of currently available high-speed air drills. Thus, it is possible to replace the removed bone at the conclusion of the procedure and to re-establish normal tissue planes while providing rigid protection to the posterior fossa.
John A. Persing, John A. Jane, Paul A. Levine and Robert W. Cantrell
contamination of the dura during the subsequent osteotomy of the anterior cranial base into the nasoethmoid region. Fig. 2. Intraoperative drawings. a: Olfactory fibers and dura are severed and cerebrospinal fluid is allowed to drain freely, until all of the fibers to be transected have been released. The dura is closed with two parallel continuous sutures incorporating all of the openings in the dura (inset) . b: The opening into the frontal sinus may be expanded superiorly (A) or laterally (B), if additional operative exposure is required. c: Osteotomy of the
Masato Shibuya, Masakazu Takayasu, Yoshio Suzuki, Kiyoshi Saito and Kenichiro Sugita
superoposteriorly and the artery usually does not affect the operative approach. On the other hand, in cases of retrochiasmatic tumors, the ACoA is located anterior to the tumor and often limits operative exposure. Division of the ACoAs may be necessary for the removal of the latter type of tumor. The lamina terminalis is opened in the midline. Internal decompression is the next step toward removal of the tumor. The cyst is punctured and intracapsular removal of the tumor is done using a smooth or serrated suction tube to extract the solid part of the tumor. 13 The two
Servet Inci and Tuncalp Özgen
Case 2, we surgically confirmed that the largest aneurysm, located on the right side of the ACoA, had ruptured. After this lesion had been clipped, the operative exposure was narrowed because of the clip head. Therefore, the second and third aneurysms were occluded with some difficulty. Beginning the clipping procedure at the farthest (or deepest) aneurysm may be an alternative to decrease this difficulty in some cases. Regardless, the sequence of clipping must be modified to the particular anatomy of the individual patient. In addition, the necks of the other
Eric L. Zager, Daniel A. Del Vecchio and Scott P. Bartlett
✓ Temporal muscle asymmetry is a common sequela of pterional craniotomies. The authors describe a simple technique of restoring the temporal muscle to its origin by microscrew fixation. This technique provides reliable preservation of temporal muscle bulk and function with little additional operating time and no compromise of operative exposure.
Federica Beretta, Norberto Andaluz, Chiraz Chalaala, Claudio Bernucci, Leo Salud and Mario Zuccarello
the provision of a tailored exposure through a minimal opening, obviating the need for retraction and unnecessary brain dissection. 1–4 , 7–14 , 16–19 , 21–26 , 28 , 30–35 , 37 However, few morphometric data exist to support such benefits. 4 , 10 , 11 , 38 Therefore, in this cadaveric morphometric study, we systematically quantified and compared the operative exposures afforded by the pterional, supraorbital keyhole, and transorbital keyhole surgical approaches to the perisellar region. Methods The heads of 5 embalmed adult cadavers with no known brain
Gregory J. Przybylski and Ashwini D. Sharan
later by internal fixation. 2, 3, 16, 21, 32 The purpose of this study was to determine the efficacy of combining single-stage VB and intervertebral disc debridement, arthrodesis in which autologous iliac autograft is used, and segmental internal fixation in patients in whom nonoperative management of PDVO failed. Other hypotheses investigated included the efficacy of a 6-week postoperative course of intravenous antibiotics alone in patients with few risk factors, the safety of obtaining graft material via the same operative exposure, and the effect of discontinuing
Gary G. Ferguson
✓ Mean and pulsatile intra-aneurysmal blood pressures were recorded from four cases of human intracranial saccular aneurysms at the time of operative exposure. In each case the mean intra-aneurysmal pressure equalled the mean systemic arterial pressure, and the intra-aneurysmal pressure was pulsatile. The results demonstrate that, contrary to the findings of another report, intracranial aneurysms are subjected to the full force of systemic blood pressure.
Nicholas C. Bambakidis, L. Fernando Gonzalez, Sepideh Amin-Hanjani, Vivek R. Deshmukh, Randall W. Porter, Philip C. Daspit and Robert F. Spetzler
Combined approaches to the skull base provide maximal exposure of the complex and eloquent anatomical structures contained within the posterior fossa. Common to these combined exposures are variable degrees of petrous bone removal. Understanding the advantages of each approach is critical when attempting to balance increases in operative exposure against the risk of potential complications. Despite their risks, aggressive combined exposures to the posterior fossa enable the greatest degree of visualization of the anatomy. Consequently, surgeons can approach lesions with maximal margins of safety, which cannot otherwise be realized. To minimize morbidity in all cases, the approach chosen must be applied individually, depending on the lesion and the patient's characteristics.