Far lateral approach neurosurgery: the second phase

Our brain surgery live tweet took place 16.11.12 in Astana, Kazakhstan. Neurosurgeon Dr. Evaldas Cesnulis guides us through the operation he led to remove a brain tumour from a 17-year old girl.
Dr. Evaldas Cesnulis is a world-class neurosurgeon based in Zürich, Switzerland. In November 2012, he spent a week in Astana, Kazakhstan with a team of Swiss doctors on a not-for-profit mentoring mission at the top teaching hospital in Kazakhstan. One of the operations he carried out was tweeted on a live Twitter stream: here, you can find a record of the event.

Visit Website - See Stage 1

1. Preparation of operating area

In the image above, a sterile covering is applied to the operating area, and the skin is prepared so that blood loss will be minimised.

This is done by injecting a special solution that will constrict blood vessels and minimise blood loss. It consists of a saline solution mixed with adrenaline and local anaesthetic to constrict blood vessels under the skin, and reduce blood loss and post-operative pain.

2. Preparing for a craniotomy

Surgeon Cesnulis installs a brain retractor, a tool made from soft, flexible metal. When inserted, this gently pulls the brain a little away from the area of surgery.

Then, the first skin incision is made and the surgeon double checks where the skull should be drilled with the help of neuronavigation: here, Cesnulis comments that "it‘s important to use every possible centimetre of the craniotomy area, in order to have access to the deeply seated tumour."

The bone is then drilled into with a skull perforator, an automatic mechanical tool that works on compressed air. It stops automatically as soon as the inner layer of the skull is perforated, in order to not injure the brain.

3. The craniotomy

First, the surgeon prepares the bore holes and dissects the dura mater away from the bone, so there is a corridor to go in with the craniotomy instruments.

The craniotomy is performed on the left, so the tumour can be reached on the opposite side. During this procedure, the tip of the drill is protected with a special shoe to protect the dura mater and the brain. 

Holding sutures are placed on the dura, in order to prevent blood gathering between the skull and dura after surgery. This is called epidural haematoma and would cause serious damage to the brain. 

Find out more

This is a summary of our live-tweet operation, which took place on Nov 16th 2012. Click below to learn about the next stage of the operation and to find the answers to some common questions about the procedure or let us know what you think on Twitter @premium_medical
Visit Website - See the previous stage

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