Neurosurgical atlas. ), with complete text, is published by CRC Press, 2006.

The differential diagnosis for NTLE is similar to MTLE, with the exception of MTS. Outcomes were suggestive of increased survival but similar to some of the previous trials, improvement in functional outcome was demonstrated. Objective: The Neurosurgical Atlas is a popular world-wide multimedia website in neurosurgery with informative chapters and videos to promote excellence and safety in neurosurgical techniques. The distal resistance of VP and ventriculoatrial shunts is assumed to be close to zero in most patients. M. Learn from the European Association of Neurosurgical Societies 2022 Research Fund project. Other factors that play a role in selection of the approach include The pterional or frontotemporal craniotomy is the workhorse of the supratentorial approaches. Its mission is to push the boundaries This collection includes more than 160 operative videos categorized based on topics. Right posterior lateral view into the posterior cranial fossa. Medial sphenoid wing meningiomas are a heterogeneous group of tumors originating from the anterior clinoid and the medial third of the lesser sphenoid wing. Once an AVM is identified, all patients receive a thorough preoperative evaluation including history and neurologic exam. Hendelman (M. The entrance into the cyst is decided through inspection, neuronavigation, and neuromonitoring. Ventricular Shunt Reference. Melkersson-Rosenthal syndrome. This force can lead to shunt overdrainage The following series of articles from the Neurosurgical Atlas in the upcoming issues of the Operative Neurosurgery will introduce interactive 3D models that provide an immersive third dimension of both normal and pathological neurosurgical anatomy. Upper cervical spine meningiomas can extend cranially and are commonly called spinocranial FMMs. The occipital craniotomy is designed to provide operative exposure of the occipital lobe, tentorium and posterior incisural space, splenium of the corpus callosum, medial and posterior temporal lobe, posterior thalamus, atrium of the lateral ventricle, and parieto-occipital area. The most common indications for an anterior petrosectomy include: Intrapetrous lesions, with or without epidural extension, including: Anterior petrosal cysts ( epidermoid or cholesteatomas) Chordomas and chondrosarcomas (endoscopic transnasal route preferred) Upper petroclival and Meckel’s cave tumors, including: Meningiomas. Rachel's vision in life was focused on improving the Join us in the historic city of Boston from April 25-28, 2025, for the 2025 American Association of Neurological Surgeons Annual Scientific Meeting, where this year’s theme, Power of One, Impact of Many, celebrates the individual contributions that collectively advance the field of neurosurgery. For purposes of surgical planning, FMMs are classified in relation to the dentate ligament, which separates the anterior The Neurosurgical Atlas ( ATLAS ) is the largest nonprofit (501c3) organization for neurosurgical education and research in the world. Benign recurrent cranial nerve paralyses. Progressive supranuclear palsy. A number of potential drawbacks to using a ventriculoatrial (VA) shunt exist. Some surgeons advocate premedicating the patient with atropine to counter the vasovagal response elicited by glycerol injection or puncture of the foramen ovale. Share your videos with friends, family, and the world Anaplastic oligodendrogliomas are WHO grade III. The project was created with the extensive help and collaboration of Kaare Fugleholm, MD PhD, Department of Neurosurgery, Rigshospitalet Copenhagen, University of Copenhagen, Denmark and Mr Mike Fox MD Consultant Surgeon in Peripheral Nerve Injury The Royal National Orthopaedic Hospital Stanmore UK & Cleveland Clinic Apr 14, 2024 · Dr. A recent survey demonstrated that the ATLAS is considered internationally as the Figure 1: The corpus callosum is the largest anatomic interface with the lateral ventricle. Table 2: Frequency table showing the best neuroanatomy websites and YouTube channels according to the neurosurgeons’ preference. On average, patients suffer from HFS for about 8 years before definitive treatment is found. These last steps of bone removal are performed using a diamond burr. Images showing the various shunt settings are also available for reference. Figure 1: This right frontal meningioma demonstrates low T2 signal intensity and is inciting hyperostosis along the inner table of the right frontal calvarium and along the anterior falx. Pituitary tumors were among the first tumors explored by the pioneer neurosurgeons. This injury to the medium and large fibers is responsible for disruption of the ephaptic transmission of pain. Figure 1: The location of the coronal sutures in relation to the underlying frontal lobe is demonstrated. Table 7: Glossopharyngeal, Vagus, and Accessory Nerve Pathology. #anatomy #neurosurgery #neuro #surgery #NeurosurgicalAtlas #medinsta #medinstagram #mededucation #neurosurgeryresident #neurosurgeryinfocus #neuroscience #medicine #medstudent #MedicalAnimation #science The Neurosurgical Atlas remains the largest nonprofit (501c3) organization for neurosurgical education and research in the world. The cyst wall is not lined with neoplastic tissue; the goal is resection of the enhancing nodule, similar to surgery for cerebellar pilocytic astrocytomas. Aaron Cohen-Gadol at (neurosurgicalatlas. Traumatic neuropathy. Carotid endarterectomy (CEA) is one of the most scrutinized surgical procedures in neurosurgery. ADVERTISEMENT. Neoplastic. Here, we present our analysis of the viewing data of this website. Atlas network: https://linktr. (Bottom) No diffusion restriction is present that would suggest this lesion to be an epidermoid cyst. In 1948, Sugar and Tinsley described this aneurysm subtype as a relatively rare entity The Atlas of Functional Neuroanatomy, 2nd edition, by Walter J. Majority occur within the cerebral hemispheres (80%), with the cerebellum (15%) and basal ganglia (3%) less commonly involved. Increasingly, AVMs are found incidentally on imaging obtained for other unrelated reasons. These models are the result of 5 years of intense computerized sculpting work by The Neurosurgical Atlas is the most comprehensive collection of surgical techniques. It has over 70,000 members and 1. The cerebellum has Neurological System. Medical imaging, in all its forms, is the most powerful tool for noninvasive diagnosis and characterization of preoperative and postoperative neurosurgical diseases. 9% (n = 47) of the participants [Table 2]. Figure 3: Relative distribution of the most common intracranial meningiomas is illustrated. Philadelphia: Saunders, 1994-2001. A thorough preoperative evaluation includes a complete assessment of neurologic function. This structure is divided into four segments. The far-lateral transcondylar approach entails a suboccipital craniotomy posterior to the sigmoid sinus and C1 hemilaminectomy followed by partial or complete resection of the ipsilateral occipital condyle. The Neurosurgical Atlas | 24,573 followers on LinkedIn. Pieper D. Very small ACoA aneurysms can present as “blister” pseudoaneurysms. It features detailed surgical volumes, extensive operative videos, interactive neuroanatomy, and 3D models. This phenomenon is related to cross filling of an ACoA aneurysm from bilateral A1 arteries, leading to very rare instances when the contrast fails to fill a small ACoA aneurysm. Externally, this core is covered by the insula and surrounded by the fornix, choroid plexus, and lateral ventricle. Figure 1: (Top Left) CT demonstrates a typical permeative lucent appearance of this glomus jugulare tumor in the left petrous apex. Rolling Meadows, IL: Thieme Medical Publishers and the American Association of Neurological Surgeons, 2007. The veins in the posterior are divided into three groups: a galenic group (green) that drains into the vein of Galen; a petrosal group (blue) that drains into the petrosal sinuses; and a tentorial group (brown) that drains into the sinuses near the torcula. Let's review the techniques for resection of a simple frontal convexity meningioma. 30-day mortality predictor for ICH. The vertical plane in which the single pin is located should bisect the two-pin arm, which can be achieved by adhering to the second key principle above. The parasagittal veins anterior to this suture are relatively dispensable. Boston, a hub of medical innovation and The external ventricular drain (EVD) is one of the most basic and essential procedures that the junior resident must master but even the most experienced can face difficulties if the technical principles are not respected. This craniotomy is situated around the coronal suture (when using a frontal interhemispheric route) or behind the central lobule (when using the superior parietal interhemispheric route) to protect the sensorimotor cortices and dominant numerous parasagittal veins, which are typically 3-4 cm posterior to the coronal suture. Whether for rapid assessment of intracranial hemorrhage with computed tomography (CT) or delineating operability of tumors with magnetic resonance imaging (MRI), a An ASDH is defined as a bleed occurring within the subdural space that occurred within 72 hours prior to the patient’s presentation. Resection of a Pineal Region Tumor via the Paramedian Supracerebellar Approach. Due to their unique location in close proximity to the cerebral aqueduct, falcotentorial menigiomas can impair cerebrospinal fluid circulation and present with symptoms of elevated intracranial pressure. Figure 1: Harvey Cushing demonstrates creation of a trephine craniotomy at the upper edge of frontal bone work. Although nearly always angiographically occult, these lesions may be dynamic in their behavior over time, with evidence of hemorrhagic products of mixed stages, and may present with Trigeminal neuralgia is considered one of the worst pains that can affect a human being. +1. The experience of the surgeon plays an important role in successful foraminal cannulation. With 56,000 members and over 1. Most arise from the branching point between the callosomarginal artery and the main ACA trunk. The ICH score is an excellent parameter designed by Hemphill and colleagues at UCSF to predict 30-day mortality and can therefore be a stratification tool when deciding whether the patient’s condition warrants surgical intervention. This patient also has significant midline shift Intramedullary spinal cord tumors are rare and challenging entities, comprising 16% to 58% of all primary spinal cord and 2% to 8. Figure 1: This patient was arguably one of Harvey Cushing’s most favorite patients. Glioma. Figure 1: Harvey Cushing illustrated an epidural hematoma with an associated skull fracture (circa 1906). It is through the efforts of many surgeons, anatomists, fellows, residents, and students that this resource has been constructed. To learn more, sign in with your Neurosurgical Atlas subscription, or sign up for your free 30-day trial if you're not a subscriber. This maneuver is less selective and more inclusive for some pathologies. The Neurosurgical Atlas collection presents the nuances of technique for complex cranial and spinal cord operations. (1) A limited amount of catheter can be placed in the atrium, and growing children often need future revisions to lengthen the catheter. Images of each shunt valve on standard radiography are provided. Parenchymal metastases typically located at the gray–white junction. Its mission is to push the boundaries of surgical excellence, education, and innovation to achieve the best possible patient outcomes. The interview is one of the most important phases of the neurosurgical residency application process. Click on any structure to see related images, videos, cases, and articles from the Atlas. Olfactory groove meningiomas (OGMs) constitute 9–18% of all intracranial meningiomas. In almost all cases, an EDH is caused by blunt trauma leading to a skull fracture. These tumors arise in the midline of the anterior cranial fossa at the junction of the cribriform plate and planum sphenoidale. Although many trials have been conducted The Neurosurgical Atlas is an essential resource for neurosurgeons, providing expert guidance on advanced microneurosurgical techniques. Hemifacial spasm has an estimated prevalence of 11 cases per 100000 individuals and is twice as common in females as males. Glomus Jugulare Paraganglioma. 5-inch spinal needle is used for injection of glycerol. Arises from malignant transformation of mature oligodendrocytes or glial precursor cells. With its illumination, magnification, and stereoscopic imaging, this device expands the operator’s vision and allows microsurgery without the need for fixed retractors. Placement of the needle within the foramen can be challenging because of variations of the foraminal anatomy and the presence of intraforaminal ridges. Headaches, ataxia, and incontinence are the most common presenting symptoms. 5% of all primary central nervous system tumors in the adult and pediatric populations. The shunting that is confined to the dura is supplied by branches of the external carotid artery, tentorial branches of the internal The Neurosurgical Atlas is an essential resource for neurosurgeons, providing expert guidance on advanced microneurosurgical techniques. Proficiency with the microscope will dramatically advance one’s operative skill. Carotid Endarterectomy: Principles of Exposure, Arteriotomy and Patch Grafting. ee Pituitary Adenoma: Diagnosis and Operative Considerations. The endonasal transsphenoidal approach has evolved during the past century. 0. Genetics by WHO 2016 classification: IDH mutant, ATRX wild type, and 1p/19q . Approximately ~15-20% of all meningiomas arise from the sphenoid wing, with about half of these arising from the medial portion of the wing. Operative Anatomy. Early pioneers of pineal surgery included Sir Victor Horsley, Brunner, and Schloffer, all with minimal or no success until Oppenheim and Nerve compression, manually or by balloon, injures medium and large myelinated fibers while sparing small myelinated and unmyelinated fibers. After removal of the labyrinth to the level of the vestibule, the IAC is identified and skeletonized. This collection represents the nuances of techniques for complex cranial and spinal cord operations. With Grand Rounds and a Patient Resource Center, the Atlas supports both surgeons and patients Pericallosal cerebral aneurysms arise from the anterior cerebral arteries (ACA) and its branches distal to the anterior communicating artery (ACoA) complex. , C. Most medical students interested in neurosurgery will pursue significant research in medical school Giant pituitary adenomas are usually described as tumors larger than 4 cm that generally extend within 6 mm of the foramen of Monro. Even though a component of this hematoma has a convex-medial appearance, the other characteristics (crossing the sutures and wrapping around the parenchyma) are define this as a subdural rather than epidural hemorrhage. Bleeds in patients who present after 72 hours of injury are considered either subacute or chronic, depending on their timing and the computed tomography (CT) findings. The SC is 45 cm in length and is shorter Colloid Cyst. Balloon compression is particularly useful in patients with V1 TN because of the ability of Preface. At its branch point, the PCoA provides a natural demarcation between the proximal ICA’s ophthalmic segment and its distal communicating segment. Large trials have demonstrated definitive benefit in select patients with both symptomatic and asymptomatic carotid stenosis. Overview. Arachnoid Cyst (AC) Figure 1: (Top Left and Right) This left middle crania fossa extra-axial lesion follows CSF on all sequences and is in a very common location for arachnoid cyst. Other causes of TLE include tumors, infections, vascular malformations, cortical dysplasia, and trauma. The central core of a hemisphere consists of extreme, external, and internal capsules; claustrum; lentiform and caudate nuclei; and thalamus. This technique is lifesaving for patients suffering from life-threatening hydrocephalus and intraventricular hemorrhage. 3 million website users (as of March 2021,) the ATLAS affects the care of many patients daily. The Neurosurgical Atlas is the most comprehensive collection of microneurosurgical techniques in the world. Bell’s palsy. The lower edge of the craniotomy must be at the level Figure 4: Principles of the telovelar approach to the fourth ventricle. These lesions tend to be low signal intensity on T1WI (top right) and hyperintense with a salt-and-pepper appearance on T2WI (bottom). Cohen-Gadol, the founder of the Neurosurgical Atlas, lost his treasured niece to a rare malignant brain tumor. She was the quintessential essence of faith in G-d and innocence whose unprecedented giving and kind nature changed the world for many around her. This etiology owes its prevalence to two The current neuroanatomy collection of The Neurosurgical Atlas provides one of the most comprehensive and user-friendly collections of neuroanatomical knowledge in the world. The layout of this chapter is broken down by the manufacturer of the shunt, listed in alphabetical order. The histologic characteristics of giant pituitary adenomas do not correlate with their size or invasive nature; most of these tumors contain The microscope is an integral part of microsurgery. The posterior wall of the communicating segment gives rise to the AChA, a key artery to identify and preserve during PCoA surgery. Clip ligation of such aneurysms is treacherous because an authentic aneurysm neck is often not Vestibular schwannomas (VSs) have been resected via the translabyrinthine (TL), middle cranial fossa (MCF), or retrosigmoid (RS) approaches, based on their size/location of the bulk of the tumor, status of the patient’s hearing, and the preference of the operating surgeon. This versatile approach may be extended via or combined with the Mar 1, 2020 · The Atlas app was officially launched in May 2019, largely via promotion on the Atlas social media platforms, and has since recorded more than 60,000 viewing sessions, 80% of which were from users outside the United States. Analogous to their extramedullary counterparts, three major histologic subtypes predominate. (Bottom) Colloid cysts should have no internal enhancement on T1-weighted postcontrast imaging. suboccipital surface, posterior view. The trigeminal nerve (CN V) passes Pathologically, this is characterized by segmental loss of pyramidal cells, dispersion of granule cells, and reactive gliosis. These tumors typically originate near the fourth ventricle in the cerebellar hemispheres, vermis, or even the A 1-way shunt valve should be chosen. I rarely extend the condylectomy only to the point of adequate exposure because excessive condylar resection (>30%) increases the risk of Glycerol rhizotomy can be performed with the patient under conscious sedation. The spinal cord (SC) is a longitudinal neural structure within the spinal canal, which acts mostly as a conduit for information reaching or leaving the periphery of the body. Rachel was only 12 years old. The right tonsil and the medial part of the Foramen magnum meningiomas originate from the dura of the lower third of the clivus and any portion of the FM circumferentially. The entire lateral ventricle is unroofed. During the infancy of cranial surgery, transsphenoidal surgery literally placed Cushing on the brink of The Neurosurgical Atlas (ATLAS) is a comprehensive platform for advancing neurosurgical techniques and research. Free. Parietal craniotomy is designed to provide an operative exposure of the mid to posterior hemisphere while sparing the highly functional anteriorly located sensorimotor cortices and the posteriorly located visual cortex. Diagnosis. Introduced into formal scientific parlance in the 1990s, 1 EI was popularized by the publication of Daniel Goleman’s best-selling book on the topic, entitled Emotional Intelligence: Why It Can Matter More Than IQ. Understanding Neurosurgery as a Career Path. This Cranial Approaches volume provides a road map regarding the indications, rationale, and technical nuances for execution of common supratentorial and Place the skull clamp in the position where the opposing arms cross the vertical or sagittal plane of the cranium, as defined by the superior sagittal sinus. As part of our continued mission, we will continue to offer the last 12 months of Grand Rounds and our Patient Resource Center for free. To complete a successful percutaneous rhizotomy, the foramen ovale must be accessed using Härtel’s Neurosurgical Atlas: Pushing the Boundaries of the Art of Neurosurgery. Knowledge of the anatomy of the anterior skull base is necessary for execution of a bifrontal craniotomy. The level of consciousness may alter the need for anesthesia. This collection includes more than 625 operative videos categorized based on topics. The anatomy of the frontal lobe is relatively straightforward and familiar to most neurosurgeons. After the facial nerve has been adequately skeletonized, the superior vestibular nerve entering the vestibule can be seen. Most (80%) of these hematomas are located in the temporal lobe. In the majority of individuals, the thoracic aorta courses right to left and anterior to posterior in 4 segments, the ascending aorta, AA, aortic Emotional intelligence (EI) is the ability to perceive, understand, and regulate emotions in oneself and others. Originally developed as Adobe Flash animations and now also provided as The DEcompressive Craniectomy In MALignant middle cerebral artery infarction (DECIMAL) trial 1 included patients randomized to surgical intervention within 30 hours of symptom onset. Calcification and cystic degeneration common. 3 million website users, and is considered the Bible of neurosurgery by many. Since most applicants complete only 2-4 subinternships, the interview is your chance to put a face and a personality to your application for the majority of programs to which you apply. The cerebellomedullary fissure and uvulotonsillar space are exposed (A). Because of their location, lateral projection, and attachment of the dome to the lobe, nearly 50% of all ruptured MCA aneurysms present with intraparenchymal hematomas. The good news is that anyone invited to interview by a Middle cerebral artery (MCA) bifurcation aneurysms account for approximately 35% of all giant aneurysms. The uvulotonsillar space is expanded by retracting the tonsil laterally at the uvulotonsillar fissure. Cavernous malformations are benign vascular hamartomas consisting of dysplastic immature vascular channels with variable mass effect depending on size. This is a 52 year old male presented with a seizure and underwent MRI evaluation, which revealed alertive really large convexity right from meningioma. Figure 2: A lateral overview of a C-shaped peri-insular hemispherotomy in shown (top image). Because of its simplicity, flexibility, efficiency, and familiarity to neurosurgeons, this corridor is the most commonly used surgical route to lesions along the anterior and middle skull base. All illustrations in the book are on this website. An epidural hematoma (EDH) is one of the most widely known and definitively treatable of all neurologic conditions. This nonprofit and our flagship organization, also known as the Bible of Neurosurgery, has inspired a devoted global community with over 70,000 members. Hyperostotic tumors may present with cosmetic deformity of the skull. It contains over 500 chapters and 1200 surgical videos. The neurosurgical training path or trajectory in the United States generally consists of the steps outlined below: Medical school: 4+ years in an accredited MD or DO program (or foreign equivalent). I use the extended pterional approach, defined as a The Neurosurgical Atlas is the most comprehensive collection of microneurosurgical techniques in the world. This site has been created to enhance the text and the illustrations in the text. This colloid cyst is in the classic location at the Cystic focal tumors of the brainstem are handled similarly. … Jan 13, 2021 · The second most popular choice was “The neurosurgical atlas by Dr. The PCoA arises from the posterior wall of the supraclinoid ICA. Their surgical history defines the history of our profession. Visit The Neurosurgical Atlas ». Intracranial dural arteriovenous fistulas (dAVFs) are a group of acquired pathological vascular malformations that are defined by an abnormal connection between an artery and a vein, bypassing the capillary bed. Onset is mostly during the 4th and 5th decades of life. Note the use of tourniquet to control scalp bleeding. The Neurosurgical Atlas unveils novel and efficient techniques for brain surgery. In these circumstances, the patient may Understanding of aortic arch (AA) anatomy is important in neuroangiography for complete radiographic evaluation of the craniocervical vasculature and in vessel selection during angiography procedures. A depressed preoperative level of consciousness may lead to a delayed emergence from anesthesia and increase the risk for aspiration. Explore the neuroanatomy of the brain, spinal cord, and peripheral nerves with this comprehensive and interactive module. (2) Nephritis is a rare but particular complication that can result from a VA shunt. ), with complete text, is published by CRC Press, 2006. (Left) A hyperintense CSF cleft is also present on T2WI that characterizes this as an extra-axial mass. Figure 2: Relative distribution of the most common intracranial meningiomas is illustrated. The approach can be devised to lateral and mesial parietal lobe lesions as well as to interhemispheric median or paramedian Hemispherotomy is a technically challenging operation that requires a thorough understanding of three-dimensional cerebral anatomy to ensure a safe and thorough hemispheric disconnection. Figure 1: Because colloid cysts are typically filled with a highly proteinaceous fluid, they are often dense on CT (top left) and hyperintense on T1-weighted (top right) imaging. Typical Meningioma. However, VPL shunts are exposed to a negative, subatmospheric intrathoracic pressure with each breathing cycle, which imparts an active “sucking” force. Figure 2: The anatomy of the anterior cranial fossa with the dura removed. The mechanisms and rates of hematoma Hemangioblastomas are benign, World Health Organization (WHO) class I tumors that predominantly (>90%) occur within the posterior fossa. Surgical management of tentorial meningiomas, in Badie B (ed): Neurosurgical Operative Atlas: Neuro-oncology , 2nd ed. 2 As a construct, EI gained early traction in the field of business General. Note how the temporal lobe is displaced but is without edema. General Principles. Differential diagnosis for glossopharyngeal, vagus, or accessory nerve pathology. He underwent a right frontal craniotomy and incision was mapped over the right temporal parietal area so that Atlas of Operative Microneurosurgery. They are reported in 5% to 14% of surgical pituitary tumor series. Conclusions: The Neurosurgical Atlas has attempted to leverage the many e-learning resources at its disposal to assist in Convexity meningiomas are frequently found incidentally on unrelated imaging studies, but may present with focal neurologic findings or epileptic activity of the underlying cortex. Additional imaging is obtained as needed so each patient has a CT, an MRI, and a catheter angiogram. The SC starts at the foramen magnum and extends to the conus medullaris at approximately the level of the first lumbar vertebra. Individual Access. From anterior to posterior, these are the rostrum, genu, body, and splenium (image courtesy of AL Rhoton, Jr). They constitute only 8% of adult posterior fossa tumors and only 1% of all intracranial tumors. com),” chosen by 18. Start your 30-day free trial or subscribe to access the most comprehensive collection of advanced microneurosurgical techniques. The bifurcation of PICA is exposed and the medial and lateral trunks can be identified and Figure 1: Subdural hematomas can become quite large as on this head CT. 3D Photorealistic Atlas of Peripheral Nerve Approaches and Related Anatomy. Notice the asymmetry of the frontal sinuses (upper image), emphasizing the need to review preoperative imaging. A few primary malignancies, however, such as uterine and prostate cancer, may show predilection for the posterior fossa. D. Surgical approaches to pineal tumors tested the resolve of our early forefathers and were not reported until the early 1900s. Medial Sphenoid Wing Meningioma. “Fried-egg” microscopic appearance due to rounded nuclei and clear cytoplasm. The fornix is a significant anatomic structure to consider during intraventricular surgery. It is a tribute to the visionaries of the The Neurosurgical Atlas is the most comprehensive collection of advanced microneurosurgical techniques. Intracerebral Hemorrhage Score. A 20-22gauge 3. Right posteromedial view of the petrous portion of temporal bone. The spasms are bilateral in about 2% of the patients with this disorder. An indispensable tool for neurosurgical strategy, intelligence, and performance, Atlas Meditech The indications and advantages of an extradural clinoidectomy are: The extradural space allows a more “aggressive” osteotomy of the medial sphenoid wing and clinoid while protecting the intradural neurovascular structures during drilling. Explore photorealistic 3D models of neurosurgical anatomy and approaches with annotations and videos. Harvey Cushing played an instrumental role in popularizing the endonasal route as it was pioneered by surgeons of his time, including Schloffer and Halstead. Anatomical landmarks were used in five hemispheric deafferentations. The severity of this disabling pain and its relief through successful operative intervention have caused microvascular decompression (MVD) surgery to be recognized as one of the most satisfying operations in neurosurgery. by sk gp xc xd wy my zq hr xo