By I. Mohsenipour
Universitatsklinik fur Neurochirurgie, Innsbruck, Austria. Atlas for neurosurgeons and citizens of methods conventional within the authors' neurosurgical practices. Descriptions contain positioning, wound closure, capability blunders, and risks. strange colour illustrations.
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Extra resources for Approaches in Neurosurgery: Central and Peripheral Nervous System
For aneurysms of the iniernal carotid artery and its adjacent branches, the pterional approach, described in the following chapter, is preferred. The same applies to retrosellar processes. The individual anatomical situation of the optic chiasm, that is, its anterior or posterior position, influences any procedure in the anterior chiasmatic angle. 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.
The temporal muscle is divided about 2-3 cm basal to its attachment at the cranial bone; it is divided transversely to secure its final suture. Occasionally, vertical division of the temporal muscle proves sufficient; the pressure of the retractor blades on the muscular tissue then has to be kept within limits. Tn the S-shaped incision, which runs in a curve to a point behind the ear and as far as the zygomatic bone, it is generally possible to reflect the bone flap together with the muscle, so that the muscle is dissected along the course of the craniolomy line.
A thin cottonoid strip can be placed under the spatula; natural protection is also afforded by leaving the circumcised dural flap in place. The other adjacent structures are brought into the field of vision by modified spatula maneuvers in conjunction with adjusted viewing angles. A semidiagrammatic representation of a typical viewing angle is provided in Figure 61, without, however, showing the overlying brain and with the anterior cerebral arteries and the anterior communicating artery displaced posteriorly.