By Wolfgang Seeger
Preface within the current quantity numerous techniques to an analogous on the subject of the encompassing mind constructions and aim sector within the deep areas of the mind are cerebral vessels. the following it really is to be famous that the so defined. within the earlier volumes this element used to be known as "quadrigeminal" sector is composed not just of the taken little into consideration. the writer endeavored to Cisterna tecti, however the close by fissures (Fissura trans describe fairly the common operative techniques versa cerebri and Fissura horizontalis cere belli) and their rules to make it more uncomplicated for the newbie also needs to be integrated. The pathological techniques to profit the microsurgical strategies in interventions don't commonly confine themselves to the Cisterna within the principal worried procedure. tecti, yet expand over the neighboring fissures. The Now complicated procedures within the speedy vicini Cisterna tecti extends with out limits into the neigh ty of the brainstem sector 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 aren't marked as such) additionally interven al and ventral strategies with destinations often within the dorsal, lateral or ventral cisternal components. each one of tions are offered which were conducted by means of those 3 teams has been separated back into co-workers."
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Extra resources for Differential Approaches in Microsurgery of the Brain
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. The Gyrus rectus belonging to the limbic 'system remains intact 53 I~ ________________________________________________________ , I "'.
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. Operational strategy: 1. Begin in the middle fissure. There is the approach easiest. lst step: exposure of the anterior cerebral artery from distal to proximal. Via the pterional approach B this step is the most difficult and possibly not feasible, so that reoperation may be required 2nd step: exposure of both A1, the A.
Removal of intraventricular part of the angioma. Microsurgical site - A with anatomical positioning sketch 47Ll______________________________________________ ~ FIG. 22 V thalamostriatn-"""+'-t-+-t- Stria terminalis For. interventricul I MONROI) microsurg ical topography \\ Y \' \ ~ DORSAL CISTERNS AND FISSURES, ANTERIOR SEGMENT ...... 1 48 Fig. 23. 5th step: after clipping of the lateral draining vein inflation of the A VM and rupture of several A VM vessels. Correction of mistake: 1. Use of a temporary clip which can be removed immediately.