Microsurgical dissection of Sylvian fissure—short technical videos of third generation cerebrovascular neurosurgeons

Document Type

Article

Abstract

Background: Multiple intracranial pathologies, including aneurysms of the middle cerebral artery, distal basilar artery, and suprasellar pathologies require the microsurgical opening of the Sylvian fissure. Delicate splitting of the arachnoid and safe microdissection of the veins, arteries, and brain parenchyma is the key to successful surgery through the Sylvian fissure corridor. We hypothesize that the geographical and historical environment in which neurosurgeons learn their operative skills is subject to a number of extrinsic influences, including cultural nuances of surgical techniques. Here we try to illustrate some cultural differences and technical aspects of the opening of the Sylvian fissure by four “third generation” cerebrovascular neurosurgeons from three different continents. Methods: In the video analysis, various microsurgical aspects, including the opening style of the Sylvian fissure, handedness, use of sharp or blunt microinstruments, use of retractors, use of high magnification, and handling of bridging veins are presented. Results: The video illustrates the two distinct Sylvian fissure opening styles, namely sharp and blunt microdissection, as well as the extent of the opening namely a wide and focal splitting. Conclusion: The edited video underlines nuances and differences of a few major technical aspects that are perhaps typical to certain surgical environments and cultures. These microsurgical nuances and styles are useful pearls that can be mastered with training by any novice neurosurgeon.

Publication Date

9-1-2019

Publication Title

Acta Neurochirurgica

ISSN

00016268

E-ISSN

09420940

Volume

161

Issue

9

First Page

1743

Last Page

1746

PubMed ID

31281944

Digital Object Identifier (DOI)

10.1007/s00701-019-03999-x

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