By Charles G. Drake OC, M.D., FRCSC, Sydney J. Peerless M.D., FRCSC, Juha A. Hernesniemi M.D., Ph.D. (auth.)
ISBN-10: 3709194091
ISBN-13: 9783709194096
ISBN-10: 3709194113
ISBN-13: 9783709194119
It is a smart privilege to jot down the foreword for this classical paintings of Professor Charles Drake. there's no doubt that intracranial aneurysms have existed because the starting of time. This terrifying sickness of the mind arteries, with its dramatic results for the sufferer, has definitely been saw in all human collectives, even though transparent definition and outline within the literature begun purely three hundred years in the past. over the past century, scientific signs were conscientiously saw and analyzed, and a hundred years in the past, the 1st makes an attempt have been made for surgical procedure, corresponding to the ligature of exterior and inner carotid and vertebral arteries. With the creation of angiography, a wholly new measurement of prognosis and differential prognosis of the vascular ailments of CNS, used to be comprehensive. within the years among 1945 and 1970, the neurosurgeon used to be more and more encouraged to at once do away with intracranial aneurysms. the main revered and kept away from place, the aneurysms on the bifurcation of the basilar artery, remained as a "dark nook. " numerous pioneers of neurosurgery tried to discover the interpeduncular fossa, yet eventually retreated. no longer so Charles Drake. His imaginative and prescient should have been improved than his nervousness, after stories of preliminary fatalities, to persevere extra decisively during this determined struggle rather than to yield. Such steadfastness calls for huge, immense braveness. yet what distin guishes braveness! Surgical braveness isn't just a fearless or unscrupulous action.
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Additional info for Surgery of Vertebrobasilar Aneurysms: London, Ontario Experience on 1767 Patients
Example text
The Subtemporal Approach In 1958, the approaches to various segments of the basilar artery were worked out in the post-mortem room. Subsequently, under the fullness of the living brain at craniotomy, exposure of the same regions was found to be much more limited. The senior author had been impressed previously with the exposure of the upper basilar artery in the cavity remaining after the subfrontal or transsylvian removal of large suprasellar tumors. However, this exposure on either side of the carotid artery in cadavers seemed narrow and confining.
A. and crossing the zygomatic process of the temporal bone is necessary. The flap is fashioned from a single burr hole and high speed craniotome. Bone must be removed with the drill or rongeurs below the base of the zygoma. B The same vertical/tic' incision can be extended posteriorly to allow the original flap to be extended posteriorly to permit more exposure of the tentorium should it need to be divided to gain access to low lying aneurysms. C The pterional transsylvian approach is easily converted to the subtemporal or half and half by removal of the temporal squama Small Aneurysms at the Bifurcation of the Basilar Artery in front of the tragus and is carried to the lower border of the zygomatic arch.
II C). After passing it through the dura of the floor of the middle fossa, below the position of the Gasserian ganglion, it can be tied tightly or held so with a clip, thus reflecting the edge of the tentorium downward for 1 cm or more. Any arachnoid tethering the fourth nerve needs to be divided before tension is placed on the nerve by this maneuver. Then the fourth nerve can be tucked below the tentorial edge for safety. Introduction of this simple but effective maneuver in 1969 to open the entrance into the interpeduncular cistern has obviated the necessity of dividing the tentorium for most aneurysms at the basilar bifurcation including those arising at the origin of the SCA.
Surgery of Vertebrobasilar Aneurysms: London, Ontario Experience on 1767 Patients by Charles G. Drake OC, M.D., FRCSC, Sydney J. Peerless M.D., FRCSC, Juha A. Hernesniemi M.D., Ph.D. (auth.)
by Charles
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