microsurgical techniques

Microsurgical neurosurgery refers to the use of special microsurgical neurosurgery equipment under the microscope (magnifying glass) to separate, transplant, excise, ablate, and ablate the nerves, blood vessels and masses of the brain and spinal cord. A general term for fine operations such as connections. Operators and assistants are required to be well-trained, well-known for microscopic neuroanatomy of the brain and spinal cord, especially the skull base, the cerebral cistern and its internal vessels, nerves and position, and proficient in microscopes and microscopy equipment. Performance and operational skills. The function of normalizing the brain, spinal cord, including nerves and blood vessels, is minimized in the subject of surgical injury, and is therefore an important component in minimally in-vasive neurosurgery. It is also the most widely used basic surgical procedure in neurosurgery. Curing disease: Indication 1. Tumor. Applicable to benign tumors in the skull base area, brain functional area and adjacent areas, and high neck area; gliomas of the brain and spinal cord, such as pituitary tumors, craniopharyngioma, saddle nodules and sphenoid meningiomas, pine cones Germ cell tumors and teratomas in the posterior and third ventricles, neurofibroma in the cerebellopontine region of the cerebellum, occipital macropore and jugular vein, intramedullary, slope, brainstem and high cervical External tumors, etc. 2. Vascular diseases. Surgical treatment of aneurysms, arteriovenous malformations, and deep large venous tumors at various sites; extracranial-internal anastomosis for some ischemic cerebrovascular diseases; endarterectomy and embolization for internal carotid artery stenosis or thrombosis Excision; intracranial and extravascular transplantation. 3. Intracranial microvascular decompression for trigeminal neuralgia, glossopharyngeal neuralgia, hemifacial spasm and anterior lateral stenosis of the spinal cord for the treatment of various causes of pain. Surgical procedure 1. The skull needs to be fixed in the correct position for the operation with the head frame and cannot be moved during operation. 2. According to the requirements of the surgical exposure, proper removal and smoothing of the spine, ankle and cranium can provide sufficient surgical space. 3. It is necessary to have a good surgical field of vision. When operating in the vicinity of the skull base and the cerebral cistern, it is necessary to recognize the anatomical position of each cerebral cistern and the relationship with the adjacent brain structure. Open the brain pool as needed, and carefully identify the anatomical location and direction of the nerves and blood vessels contained in the brain pool. In the cavernous sinus, the skull base artery and the third ventricle, the anatomical location of the blood vessels and nerves is also required to be recognized. 4. When performing nerve and blood vessel separation, the action should be gentle, and the bleeding should be patient, and should not be impatient. After decompression and release, the tissue should be protected with a nearby tissue or with a gasket to prevent re-adhesion. 5. When the anastomosis is performed, the broken ends should be neat, the diameters of the two ends should be the same, and the length should be sufficient, and the tension-free anastomosis should be performed. The anastomosis should be observed without distortion, blood flow and no leakage. 6. In the anastomosis of the nerve, the outer membrane and the bundle must be aligned accurately; when the nerve is anastomosed, the sensory branch and the exercise branch should not be confused; the suture should be performed without tension, and the nerve nutrient vessels should be avoided as much as possible. The intracranial nerve must be protected by a spacer after separation and anastomosis; after the perineural nerve is anastomosed, it is protected by a nearby fascia, sarcolemma or shims, and the limbs are fixed in the functional and relaxed position. 7. In order to achieve a good quality of life after surgery and to minimize disability, for some benign masses of adjacent brainstem and functional areas, in principle, try to get a total resection, but never force the operation, can achieve internal decompression The blood and cerebrospinal fluid can be circulated smoothly. Small residual tumors may be treated with X-knife or gamma knife, or fractionated resection if necessary.