By John M. Tew, Harry R. Van Loveren
Sensible atlas of microscopic neurosurgery, for citizens and starting neurologic surgeons at the pathoanatomy of neurologic problems and their surgical operation. third-dimensional line drawings, a few with colour highlighting.
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Extra resources for Atlas of operative microneurosurgery
83 Removal of the sigmoid plate exposes the superior petrosal sinus. The superior semicircular canal can be exposed by following the posterior semicircular canal superiorly. Further removal of mastoid air cells exposes the fallopian canal, which runs from the digastric ridge to the antrum at approximately the same depth as the posterior semicircular canal. 83. 85 The dura between the sigmoid sinus and the petrous apex is exposed. A dural incision is made in the posterior fossa dura (inferior to the petrosal sinus) and in the middle fossa dura (superior to the sinus).
When the patient is firmly restrained on the table, liberal movements of the operating table during the procedure are permissible. 95 The patient's head is maintained in 0 degrees rotation. 96 A special operating room setup is used for the right suboccipital approach. The scrub nurse stands opposite the surgeon; the anesthesiologist is at the foot of the table; and the surgeon and the assistant are positioned at the side of the patient's dependent shoulder. 97 Some variations in the operating room setup are required for a left occipital approach when the patient is in the lateral oblique position.
Stainless steel wires are placed through the drill holes to secure the bone flap. The ends of the stainless steel wires are tucked into the drill holes. 90 A free fat graft from the abdominal wall closes the middle ear cavity and fills the defect in the mastoid bone. The temporalis muscle is split to cover the mastoid defect and then firmly reattached to the superior fascial cuff. 91 A subgaleal drain is inserted and connected to continuous aspiration. The galea is closed with absorbable sutures and the skin is closed with metal clips.