Mastering Neurosurgery Operative Skills

 The neurosurgery operative skill can be mastered by learning 2 basic steps

1. Starts with making Burr hole & craniotomy, corticectomy 

2. Suboccipital craniectomy

2. Laminectomy

4. Laminectomy, durotomy , myelotomy

For operating all supratentorial lesions, craniotomy is done. 

For operating midline posterior fossa or infra tentorial lesions, sub occipital craniotomy is performed.

For operating spinal lesions, laminectomy is very commonly performed. This is basic neurosurgical skill.

The surface marking and understanding of the applied neuroanatomy is important. Once you reach the brain surface after craniotomy and opening of the dura, all he cortical surface looks similar, i.e., clci, gyri, CSF in subarachnoid space, and cortical vessels. So, there is only one way of identifying intracranial cerebral structures, like frontal lobe, parietal lobe , temporal lobe or occipital lobe is by surface marking of the skull, before start of the surgery. Similar principle is applied for identifying motor strip, speech area, hearing area, visual area or any other eloquent area of cerebral cortex, is by surface marking. So, before draping of the surgical area, a marking is made over the scalp.

Majority of the neurosurgical procedures are done through non eloquent area of the brain, especially, right middle frontal gyrus or right superior parietal lobule.