Operative Technique

Abstract

Pre- and postoperative care of the patient as well as anesthesia are performed according to general practice in neurosurgery and need not be treated specifically in this study. The operation itself requires the use of some special instruments (Fig. 46) and the operating microscope. The exposure of the superficial temporal artery is sometimes possible without the operating microscope and is a technique preferred by some neurosurgeons. For the exposure of the cortical vessels, however, sufficient magnification (25 to 40 times) is absolutely necessary. The suturing of a satisfactory anastomosis is also not feasible without an operating microscope. The prerequisites for acquiring the microsurgical technique, particularly microsurgical exposure of small vessels and suturing of microanastomoses, are discussed in Chapter 5. The operative technique employed worldwide was introduced by Ya§argil and Donaghy in 1967. Although some modifications have been developed, the principle remains the same: establishment of an artificial collateral circulation between the branches of the external carotid artery and the internal carotid artery (Fig.47, page 63).