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Significance of Arachnoid Dissection to Obtain Optimal Exposure of Lower Cranial Nerves and the Facial Nerve Root Exit Zone during Microvascular Decompression Surgery.

Kim BT - J Korean Neurosurg Soc (2014)

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea.

No MeSH data available.


The outside of cortical anterior inferior cerebellar artery arachnoid membrane is dissected using microscissors.
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Figure 1: The outside of cortical anterior inferior cerebellar artery arachnoid membrane is dissected using microscissors.

Mentions: The retromastoid approach is most commonly conducted in the lateral decubitus position. The dura mater is incised along the sigmoid sinus, and the Cisterna magna is opened to drain the cerebrospinal fluid after careful retraction of the cerebellum from the lower to the upper side. The cerebellar cortical branches of the anterior inferior cerebellar artery (AICA), which is covered with an arachnoid membrane exterior to the lower cranial nerves, are exposed. Under the microscope, the outside of the arachnoid membrane is attached to the pia mater of the cerebellar cortical braches of AICA, which is dissected using an arachnoid knife and microscissors. At this point, the inner side of the arachnoid membrane of the cerebellar cortical braches of AICA should be preserved (Fig. 1). Next, the space between the cerebellar cortical braches of AICA and the cerebellar cortex is separated, and the sharp continuous arachnoid membrane dissection is extended towards the anterior and inferior end of lower cranial nerves modified by author's technique (Fig. 2)1). The cerebellar cortical branches of AICA are then retracted naturally towards the tentorium, and the choroid plexus, located in the lateral recess of the 4th ventricle, can be visualized. The offending artery and entire set of lower cranial nerves, facial nerves, including the FNREZ, can then be widely exposed (Fig. 3).


Significance of Arachnoid Dissection to Obtain Optimal Exposure of Lower Cranial Nerves and the Facial Nerve Root Exit Zone during Microvascular Decompression Surgery.

Kim BT - J Korean Neurosurg Soc (2014)

The outside of cortical anterior inferior cerebellar artery arachnoid membrane is dissected using microscissors.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3928355&req=5

Figure 1: The outside of cortical anterior inferior cerebellar artery arachnoid membrane is dissected using microscissors.
Mentions: The retromastoid approach is most commonly conducted in the lateral decubitus position. The dura mater is incised along the sigmoid sinus, and the Cisterna magna is opened to drain the cerebrospinal fluid after careful retraction of the cerebellum from the lower to the upper side. The cerebellar cortical branches of the anterior inferior cerebellar artery (AICA), which is covered with an arachnoid membrane exterior to the lower cranial nerves, are exposed. Under the microscope, the outside of the arachnoid membrane is attached to the pia mater of the cerebellar cortical braches of AICA, which is dissected using an arachnoid knife and microscissors. At this point, the inner side of the arachnoid membrane of the cerebellar cortical braches of AICA should be preserved (Fig. 1). Next, the space between the cerebellar cortical braches of AICA and the cerebellar cortex is separated, and the sharp continuous arachnoid membrane dissection is extended towards the anterior and inferior end of lower cranial nerves modified by author's technique (Fig. 2)1). The cerebellar cortical branches of AICA are then retracted naturally towards the tentorium, and the choroid plexus, located in the lateral recess of the 4th ventricle, can be visualized. The offending artery and entire set of lower cranial nerves, facial nerves, including the FNREZ, can then be widely exposed (Fig. 3).

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea.

No MeSH data available.