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Additional resources for Approaches in Neurosurgery: Central and Peripheral Nervous System
In the anterior position, portions of the posterior border of the sellar tubercle may have to be removed with a burr in order to achieve the necessary approach. After completion of the intradural procedure, the dural incision is closed; interrupted or continuous sutures may be employed for this purpose. If tension has developed in the dural plane, or if a fragment of the dura has been resected, or if several small gaps remain in the dura, implantation or coverage with a plastic material is required; this in turn is then sutured or glued, or both.
One burr hole may be used, trom which to cut the cranium, Otherwise, several burr holes are connected by incision with the Gigli wire saw Fig. 32 Opening of the orbital roof after a right-frontal osteoplastic craniotomy and retraction of the dura-invested frontal lobe pole. Use may be made either of a watercooled microburr or of fine punches 1 Midline 2 Frontal bone (squama) 3 Frontal bone (orbital part) 4 Frontal pole (covered with dura) 23 2 Approaches for Operations in the Orbita Region It is important to pay careful attention to the obliq ue course of the optic canal between the posterior wall of the eye and the optic chiasm (Fig.
This generally applies to a lateral sphenoid wing meningioma growing en plaque, and to injuries. If the dura, too, has been invaded by the tumor, it is divided at a sufficient distance from the tumor margin, and is later reconstructed. A tumor growing en plaque extends to varying degrees across the orbital and sloping portions of the lateral sphenoid wing; it may have eroded or penetrated the periosteum and reached adjacent portions of various paranasal sinuses. On the basis of anatomic preparations and computed tomograms, Figure 54 shows the sometimes very wide-ranging frontal sinuses, which can be reached by the tumor as well as by sur-gical dissection, and from which tumors may also originate.