Difference between revisions of "Surgical Procedure"
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|[[File:Fig07.jpg|400px]] || At the bottom of burr hole, there is a very thin bone flap left. Remove the flap carefully with curette. | |[[File:Fig07.jpg|400px]] || At the bottom of burr hole, there is a very thin bone flap left. Remove the flap carefully with curette. | ||
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− | |[[File:Fig08.jpg|400px]] || Confirm no bone flap is left and dura | + | |[[File:Fig08.jpg|400px]] || Confirm no bone flap is left and dura has to be fully exposed under burr hole. Gently peel off dura from skull and make epidural space around burr hole. This has to be done in all burr hole. |
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|[[File:Fig09.jpg|400px]] || Epidural spaces between burr holes are connected. This tunnel will be a working space for Craniotome. Make sure all of epidural spaces underneath lines of bone incision are connected. | |[[File:Fig09.jpg|400px]] || Epidural spaces between burr holes are connected. This tunnel will be a working space for Craniotome. Make sure all of epidural spaces underneath lines of bone incision are connected. | ||
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|[[File:Fig12.jpg|400px]] || Removing the bone piece. The piece has to be lifted up gently from one edge and peel off dura from the piece with spurtle. This process has to be done slowly and carefully. Otherwise, it will tear dura easily. | |[[File:Fig12.jpg|400px]] || Removing the bone piece. The piece has to be lifted up gently from one edge and peel off dura from the piece with spurtle. This process has to be done slowly and carefully. Otherwise, it will tear dura easily. | ||
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− | |[[File:Fig13.jpg|400px]] || Now dura is exposed. Wash the area and remove bone tips and stop bleeding if there is. Before cutting dura, put two traction sutures with silk. The needle should not penetrate dura but scoop it at 2/3 depth of dura's thickness. | + | |[[File:Fig13.jpg|400px]] || Now dura is exposed. Wash the area and remove bone tips and stop bleeding if there is. Before cutting dura, put two traction sutures with 4-0 silk. The needle should not penetrate dura but scoop it at 2/3 depth of dura's thickness. |
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− | |[[File:Fig14.jpg|400px]] || | + | |[[File:Fig14.jpg|400px]] || Elevate dura with traction sutures. One suture is held by assistant and the other by surgeon. The traction sutures are used to enlarge subdural space to prevent damaging brain when opening dura. Touch dura with knife gently in between tractions and cut slowly layer by layer. Cutting doesn't have to be long. ~5mm will be fine. If you cut through dura, you will see transparent liquid (spinal fluid) comes out. But if you don't see the leakage, it is still on the way. |
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− | |[[File:Fig15.jpg|400px]] || | + | |[[File:Fig15.jpg|400px]] || Cut Bensheet in triangle shape and soak in saline. Inset the sheet into the dura hole gently. This will make safe working space for extending dura incision. |
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|[[File:Fig16.jpg|400px]] || (figure 16) | |[[File:Fig16.jpg|400px]] || (figure 16) |
Revision as of 08:09, 14 August 2011
Surgical illustrations courtesy of [Juna Kurihara]