AANS Neurosurgeon | Volume 28, Number 4, 2019


Cautery: Hot Tips

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Hot Tip from Michael Link, MD, FAANS

CP Angle Surgery: Tricks of the Trade

For many, removing tumors in the CP angle represented the pinnacle of training and achieving surgical expertise. With the rise of stereotactic radiosurgery, this procedure is much less common. It always helps to hear insider tricks that facilitate this surgical approach.

Localization of the:

  • Transverse sinus trace by drawing an imaginary line between the zygoma and the inion.
  • Sigmoid sinus by following the posterior aspect of the mastoid at the mastoid notch towards the transverse sinus. 

Cerebellopontine Angle Tumor Surgery

  • Make the inferior border of the craniotomy low, close to the flat part of the occipital bone squama.
  • Use a 1.5 cm horizontal dural opening close to the inferior border of the craniotomy.
  • Under the microscope, through this dural opening, gently retract the cerebellum superomedially with a cottonoid and follow the inferior petrous dura down tothe outer arachnoid of the inferior cerebellopontine angle and open it with an arachnoid knife.
    • Avoids cerebellar herniation through a wider dural opening.
    • Relaxes the cerebellum by releasing abundant CSF avoiding placement of a lumbar drain.
    • Readily identifies the XI CN that can be stimulated to check appropriate neuromonitoring signal at the beginning of the case. 

 Vestibular Schwannoma Surgery

  • Release the arachnoid between the flocculus and CN IX, X and XI to find the choroid plexus coming from foramen of Luschka.
  • The CN VII-VIII complex at the brainstem can be found just superior and deep to the choroid plexus. The CN VII will be ventral to CN VIII.

Read More of AANS Neurosurgeon’s Columns

Code Red: Essential Coding for Every Neurosurgeon
Exercise for the Surgeon: Part 3

 Past Cautery Tips

Hot Tip from Bob Carter, MD, PhD, FAANS

Certainly, one of the great privileges we have as neurosurgeons is to serve in our communities as respected medical professionals. However, there is also great benefit to taking opportunities for community service outside of our usual professional capacity. In the hospital setting, the neurosurgeon is often a focal point of attention as a high acuity caregiver.  There is a documented risk of work-life imbalance that can occur when professional responsibilities become all consuming.

One antidote to this is to get out in to the community and roll up our sleeves at a food bank, participate in community project, or mentor as coach, as a few examples. We soon become part of something larger than our personal practice or academic career through this community service, ultimately to the great benefit of our communities, our families, and … our personal well-being.

Hot Tip from Stan Pelofsky, MD, FAANS(L)

Find a great opening line that works for you, then use it every time! Remember, the opening line only works if you let the patient answer.

Getting the Right Diagnosis and Establishing Rapport

My opening line when I first encounter a new patient is, “What’s a nice person like you doing in a place like this?” Yes, this is an unorthodox approach but it helps relax the patient and makes them smile. The key to this approach, and likely most challenging for most of us, is then keeping your mouth shut and letting them talk. I have found it takes just 2-3 minutes of uninterrupted talk by the patient to help me arrive at a correct diagnosis and insure great patient-physician rapport.

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