By John M. Tew, Harry R. Van Loveren
Functional atlas of microscopic neurosurgery, for citizens and starting neurologic surgeons at the pathoanatomy of neurologic issues and their surgery. three-d line drawings, a few with colour highlighting.
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Extra resources for Atlas of operative microneurosurgery
To avoid compressing the brachial plexus and obstructing venous return from the arm, a gelatin pad is placed in the axilla. All pressure points are securely padded. 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.
Prior to positioning the patient, an angiographic sheath is placed in the right groin for subsequent angiography and is maintained with a pressurized heparin solution. 94 The patient's thorax is elevated 15 degrees and the head is maintained in neutral flexion for most vascular procedures. To avoid compressing the brachial plexus and obstructing venous return from the arm, a gelatin pad is placed in the axilla. All pressure points are securely padded. When the patient is firmly restrained on the table, liberal movements of the operating table during the procedure are permissible.
The pins are placed in the unshaved scalp at the midpoint of the cranium (above the external auditory meatus) and at the level of the superior temporal line. The surgeon must ascertain that the clamp does not contact any area of the face and is firmly secured to avoid slippage. When the pressure-sensitive gauge shows three tension rings (60 lb/in2), pressure is adequate to secure the head in the clamp. A radiolucent head-fixation device is used if imaging or angiographic studies are anticipated.