The Craniotomy Atlas by Raabe Andreas;Meyer Bernhard;Schaller Karl;Vajkoczy Peter;Winkler Peter A.;

Author:Raabe, Andreas;Meyer, Bernhard;Schaller, Karl;Vajkoczy, Peter;Winkler, Peter A.; [Неизв.]
Language: eng
Format: epub
Publisher: Thieme Medical Publishing Inc.
Published: 2019-10-21T20:00:00+00:00

Fig. 4.39 (a, b) Subgaleal flap preparation. If a subgaleal flap is desired, the periosteum is incised in a circumferential way after placement of a skin retractor.

Fig. 4.40 (a, b) Subgaleal flap preparation. The flap is carefully dissected from the bone using a rasp. The assistant retracts the flap with anatomical forceps. The flap has to be preserved in wet surgical cottonoids. During this stage of surgery, the identification of the sutures help to orientate.

Fig. 4.41 (a, b) Craniotomy planning. The cranial sutures indicate midline structures and intracranial localization of a target lesion (distance inferior/superior to the lambda). The planning of burr hole placement and craniotomy depends on various considerations including target lesion, age of the patient, and previous surgery, among others. For basic principles of the craniotomy, see Chapter 4.1, Sinus-Crossing Craniotomies. In this scenario, two burr holes were made on the sinus. Another may be placed laterally. If the craniotomy extends to the transverse sinus, an additional burr hole should be made on the sinus (inferolateral corner of craniotomy).

Several craniometric points are helpful for orientation. The lambda usually corresponds to the meeting point of the external occipital fissure/parieto-occipital sulcus, indicating the borders of precuneus (parietal) and cuneus (occipital) in the midline. The opisthocranion (approximately 2 cm superior to the inion, 2–4 cm inferior to the lambda) is related to the superior aspect of the calcarine fissure. It divides the occipital cuneus and the occipital lingual gyrus. When interhemispheric approaches are desirable, it is helpful to be aware that fewer bridging veins are encountered inferior to the lambda.

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