Differential Approaches in Microsurgery of the Brain by Wolfgang Seeger

By Wolfgang Seeger

Preface within the current quantity a variety of methods to a similar when it comes to the encircling mind buildings and aim sector within the deep areas of the mind are cerebral vessels. the following it truly is to be famous that the so defined. within the earlier volumes this element used to be referred to as "quadrigeminal" quarter is composed not just of the taken little under consideration. the writer endeavored to Cisterna tecti, however the within reach fissures (Fissura trans describe relatively the common operative techniques versa cerebri and Fissura horizontalis cere belli) and their rules to make it more uncomplicated for the newbie must also be incorporated. The pathological approaches to benefit the microsurgical strategies in interventions don't as a rule confine themselves to the Cisterna within the important apprehensive process. tecti, yet expand over the neighboring fissures. The Now tricky approaches within the speedy vicini Cisterna tecti extends with no limits into the neigh ty of the brainstem zone were solely dull fissures and into the Cisterna ambiens. chosen. they've been separated into dorsal, later As formerly, in addition to own operational experi ences (which usually are not marked as such) additionally interven al and ventral tactics with destinations regularly within the dorsal, lateral or ventral cisternal components. every one of tions are awarded that have been performed by way of those 3 teams has been separated back into co-workers."

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16. Preoperative planning of operation via the midline approach A Preoperative problems: 1. Presupposition for the operation: no blocking of the approach by fronto-polar draining veins 2. Determination of the landmarks for orientation during the operation 3. Determination of the situation of the angioma in the brain tissue (Corpus callosum and frontal horn structures) and in relation to the anterior cerebral artery. The relations to the anterior cerebral artery allows the assessment of how far the A VM infiltrates essential structures (Lamina terminalis, 3rd ventricle) located behind the anterior cerebral artery.

20 A 1m m microsurgical topography ® ® rachnoidea -cut- (wall of ("I~ternac ocp. ,,11,,;) Arachnoidea of Co15terna corp. _ _ _ _ _ _ _ _ _---1144 Fig. 21. 2nd step: exposure of the anterior cerebral artery, Al and A2 sections both sides and the anterior communicating artery from proximal to distal. The anatomical normal variations - prefixed chiasma make the orientation easier. Microsurgical site - A with anatomical positioning sketch 451~__ FIG. 21 1===1 1mm microsurgical topography 2 nd step (HEUBNERI) of AVM?

ProblemsJ landmarks distance A. cerebri ant....... In angiogram of AV M AVM penetrating f Genu corp. callosi 0-10 mm Cornu location approach l Genu corporis callosi Caput nuclei caudat i Cornu ant. ant. lat. distance. midline 20 m m / o'0 ------. teeding branches from Acerebri ant I not from A. cerebri media) o o 00 o 8 8o o Sulcus longi tudinalis Gyri orbitales DORSAL CISTERNS AND FISSURES, ANTERIOR SEGMENTL-I_ _ _ _ _ _ _ _ _--11 52 Fig. 25. The most important advantage of the pterional approach as compared to the midline approach: a large part of the lateral surface of the angioma with its feeding arteries from the cerebral artery may be clearly exposed.

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