====== Microsurgical Technique ====== ===== 🔍 Definition ===== **Microsurgical technique** refers to [[surgical procedure]]s performed under high magnification using an operating microscope and specialized fine instruments. It enables precise manipulation of delicate neurovascular and parenchymal structures, essential in neurosurgery, otology, ophthalmology, and reconstructive surgery. ===== 🧰 Core Elements ===== * **Operating microscope**: High-resolution, variable magnification with coaxial illumination. * **Microsurgical instruments**: Fine-tipped dissectors, microforceps, scissors, bipolar forceps. * **Microsutures** and microvascular clamps in vascular procedures. * Use of **neuronavigation**, **neurophysiological monitoring**, and **high-speed drills** when indicated. ===== 🧠 Principles in Neurosurgery ===== * **Atraumatic dissection** and preservation of normal neurovascular structures. * Maintenance of **clear surgical planes**, often subarachnoid or subpial. * Precise **hemostasis** using bipolar coagulation. * Use of **CSF drainage** and **brain relaxation techniques** to avoid retraction injury. * **Dynamic retraction** with suction or handheld instruments rather than fixed blades. ===== ⚙️ Applications ===== * [[tumor_resection|Tumor resection]]: gliomas, meningiomas, schwannomas. * [[vascular_surgery|Vascular surgery]]: aneurysms, AVMs, bypasses. * [[cranial_base|Skull base surgery]]: anterior, middle, posterior fossa. * [[epilepsy_surgery|Epilepsy surgery]]: temporal lobectomy, selective amygdalohippocampectomy. * [[spine_microsurgery|Spine microsurgery]]: herniated discs, intradural tumors. ===== 🛡️ Advantages ===== * Enhanced **visualization and precision** * Minimizes **neural trauma** * Enables **complex resections or reconstructions** with low morbidity * Facilitates **neurovascular preservation** ===== ⚠️ Limitations and Challenges ===== * Requires extensive **training and dexterity** * Prolonged operating times in certain cases * High initial investment in **equipment and infrastructure** ===== 📚 References ===== * Yasargil MG. ''Microneurosurgery''. Thieme. * Spetzler RF, Kalani MYS. ''The Techniques of Microsurgery in Neurosurgery''. Thieme. * Rhoton AL. ''Cranial Anatomy and Surgical Approaches''. Neurosurgery, Supplement 1, 2003.