Microsurgery

Table of ContentsForewordIntroduction ReferencesChapter 1 A History of Microsurgery Microangeional or Microvascular Surgery Neurosurgery Bipolar Electric Coagulation Microinstruments Peripheral Nerves Plastic Surgery Clinical Application ReferencesChapter 2 A. The Operating Microscope The Operating Microscope and its Attachments The Binocular Operating Microscope from the Surgical Standpoint The Binocular Diploscope The Electrically Driven Binocular Monoscope (ZEISS I) The Zoom Microscope (ZEISS II) The Automatic Microscope Stand Directions for Use of the Operating Microscope The Objective The Eyepiece (ocular lens) Positioning of the Microscope at the Start of the Operation The Eyepiece Tube (ocular tube) Magnification Sterile Covering of the Microscope Attachment for Still and Cine Cameras Technical Details of the Television Camera for Operating Microscopes ReferencesB. Instruments for Microsurgery Forceps Scissors Clamps Curettes and Dissectors Forceps and Punches Scalpels and Hooks Needle Holder Probes Irrigator Counterpressor ('micro-fork') Retractors Suckers Drills Swab Material Rubber Strips (Dam) Ligature Carrier Bipolar Coagulation in Microsurgery The Author's Experience with the Bipolar Coagulator of Malis Instrumentation for Transsphenoidal Microsurgery of the Pituitary Instrumentation for Otoneurosurgery References Plastic Tubes and Plastic T-Tubes ReferencesC. Suturing Techniques Stapler References Adhesives References Microlaser and Micro-Electrocoaptation References Suture Material Size of Thread Needles Suture Technique ReferencesD. Future Developments The Microscope Combination of Microscope, Television and X-ray Image Amplifiers Instruments ReferencesChapter 3 Experimental Microsurgical Operations in Animals Special remarks Surgical Exercises on Rats Carotid Artery Half-ring bypass graft Aorta and Vena Cava Operations on the Femoral Artery (Rabbit, Cat) Longitudinal Arteriotomy Introduction of the Tube Suture Technique End-to-end Anastomosis (Termino-Terminal Anastomosis) End-to-side Anastomosis (Termino-Lateral Anastomosis) Duplication Bridge Transplantation (Interposition) Operations on the Common Carotid Artery (Rabbit, Cat) Elaboration of Work Conditions Transcervical-transclival Exploration of the Basilar Artery in the Rabbit, Cat and Do Follow-up Angiography Autopsy Operations on Rhesus Monkeys: Transoral Clivectomy Operations in the Middle Cerebral Artery (Dog) Extracranial-intracranial Anastomoses: Anastomosis between the Superficial Temporal Artery and the Middle Cerebral Artery (Dog) Bypass between the Common Carotid Artery and the Middle Cerebral Artery (Dog) Pre- and Postoperative Management and Anesthesia in Laboratory Animals Rabbits Dogs Follow-up Angiography Summary of the Surgical and Physiological Problems of Vascular Surgery ReferencesChapter 4 Reconstructive and Constructive Surgery of the Cerebral Arteries in Man A. The Cerebral Vasculature Nutrition The Relationship between Morphology and Flow References B. Diagnosis and Indications for Operations in Cerebrovascular Occlusive Disease Reconstructive Operations on the Cerebral Arteries Constructive Operations on the Cerebral Blood Vessels References C. Aneurysms, Arteriovenous Malformations and Fistulae 1. Operations on Saccular Aneurysms 2. Operations on Intracranial Arteriovenous Malformations References 3. Operations on Caroticocavernous Fistulae ReferencesChapter 5 A. Intracranial Tumors Sellar and Parasellar Tumors The Transsphenoidal Approach The Subfrontal Approach Craniopharyngioma Sphenoid-wing Meningiomas Clivus Tumors Acoustic Neurinomas Subtemporal-transpetrosal Approach Transtentorial Approach Translabyrinthine Removal of the Relatively Small Tumor Combined Translabyrinthine and Suboccipital Approach for Larger Tumors Suboccipital-transmeatal Approach Other Tumors of the Posterior Fossa ReferencesB. Cranial Nerve Lesions Trigeminal Neuralgia Transtentorial Approach Spasmodic Torticollis ReferencesChapter 6 A. Vertebral Column and Spinal Cord Lesions Spinal Arteriovenous Malformation Spinal Tumors Extradural Tumors Intradural-Extramedullary Tumors Cauda Equina Tumors Meningocele-Meningomyelocele Intramedullary Tumors References Cervical Disc Herniation B. Peripheral Nerve Lesions References Chapter 7 Transnasal-transsphenoidal Approach to the Pituitary Gland (J. Hardy) Introduction Preoperative Radiological Study The Sellar Type The Presellar Type The Conchal Type Preparation and Positioning Techniques The Subnasal Midline Transsphenoidal Approach Microsurgical Selective Removal of Intrapituitary Microadenoma Summary References Chapter 8 Oto-neurosurgical Operations: Transtemporal Extralabyrinthine Operations on the Internal Auditory Canal, the Eighth and the Seventh Cranial Nerves The transtemporal Extralabyrinthine Approach to the Internal Auditory Canal References A. Exploration of the Internal Auditory Canal in Cases of Suspected Intrameatal Acoustic Neurinoma Conclusion References B. Operations on the Vestibular Nerve 203 1. Selective Sectioning of the Vestibular Nerve (Vestibular Neurotomy) Conclusion 2. Excision of a Segment of the Vestibular Nerve, Including the Vestibular Ganglion(Vestibular Neurectomy) Conclusion References C. Operations on the Cochlear Nerve Selective Sectioning of the Cochlear Nerve Conclusion References D. Transposition of a Pedicle Flap of Temporalis Muscle over the Exposed Internal Auditory Canal (Meato-Myo-synangiosis) Conclusion References E. Operations on the Facial Nerve Exposure of the Meatal and Labyrinthine Segments of the Facial Nerve Conclusion References Chapter 9 Anesthesia in Microsurgical Operations on the Central Nervous System A. General Heart and Circulation The Prevention of Edema Preoperative Prevention of Recurrent Hemorrhage from Aneurysms and Vascular Malformations B. Anesthetic Techniques C. Special Tasks for the Anesthetist Induced Hypotension Induced Hypertension Induced Hypothermia D. Special Subjects Aneurysms Arteriovenous Malformations Acoustic Neurinomas Craniopharyngioma Occlusive Cerebrovascular Disease Spasmodic Torticollis Spinal Arteriovenous Malformations and Intramedullary Tumors References Appendix List of Drugs Manufacturers and Suppliers of Microsurgical Equipment Microsurgical Outfit Author Index Index