Anatomical Base of Surgery

Muscles, nerves, and vessels of the neck must be dissected carefully to avoid problems in wound healing. Therefore, the anatomy of these extracranial structures is illustrated in detail. To avoid dural bleeding and air embolism, a detailed illustration of variants of the sinuses and adjacent veins is presented. In particular, possible bleeding from the cerebellar falx is appreciated. The cisterns, the forth ventricle, vessels, and cranial nerves are illustrated in detail. The thorough knowledge of these structures is a prerequisite for planning surgical approaches to the fourth ventricle and the basal cisterns. In contrast to the phylogenetically young cerebellar and neocortical structures, the brain stem as well as the basal ganglia and allocortex contain anatomically constant structures of high vulnerability. To enable microsurgery and endoscopic surgery around these areas, a detailed illustration of the microanatomy is given. Here, a modified selection of remarkable anatomic publications (e.g., of Nieuwenhuys et al.) is presented for use in neurosurgery and other neuro-disciplines. Landmarks at the surface of the brain stem recognizable during surgery are given for microsurgery and endoscopy. Typical ramifications of perforating arteries and their topographical relationships to important nuclei and fiber systems of the brain stem are shown.