By I. Mohsenipour
Universitatsklinik fur Neurochirurgie, Innsbruck, Austria. Atlas for neurosurgeons and citizens of ways common within the authors' neurosurgical practices. Descriptions comprise positioning, wound closure, strength error, and risks. strange colour illustrations.
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Extra resources for Approaches in Neurosurgery: Central and Peripheral Nervous System
And the craniolome is used to cut around the bone flap; -in osteoclastic enlargement is required in the direction of :he base. he easier the development of the tentorial border. (Fig. 73) \Vrth the S-shaped skin incision, burr holes are placed at the "evel of the ear, and at the same level lemporofrontally at :he border of the temporal muscle, and an oblique cut with ;he craniolome is made around the bone flap. inastomotic vein (Labbe's vein). at. the break lines are straightened and, as far as necessary, •feeding from the edges and the inside of the bone flap is topped with bone wax.
56) Placement of dural elevation sutures, which are passed through the bone margin, is recommended to minimize the possibility of a postoperative epidural hematoma. This operative step can easily be added immediately after the craniotomy; it is then merely necessary to tie the sutures at the end of the operation. For fixation of the reimplanted bone flap, dural sutures passed through the bone, which are likewise tied over the flap and which additionally secure the epidural space, are recommended.
Overlooked loss of blood due to deficient hemostasis in the cutaneous region — Injury to superior branches of the facial nerve due to excessive temporo basal extension of the skin incision — Dural injury due to craniolomy instruments — Brain lesions due to unduly vigorous application of the brain spatula — Injuries to the eye muscles and nerves — Postoperative epidural hematoma due to inadequate or slack dural elevation sutures — Soft-tissue hematoma (subaponeurotic, to the upper eyelid) due to inadequate hemostasis in the cutaneous region.