====== 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.