The Neurosurgical Atlas

The full exposure for a posterior petrosal approach is shown in the image above. When opening the dura, before transecting the medial edge of the tentorium, what cranial nerve must be identified and protected?

In this operative video, Dr. Cohen details the clip occlusion of a PICA aneurysm and the management of a massive intraoperative rupture. The patient, a 42-year-old female, presented with an acute spontaneous intraventricular hemorrhage. To watch the full video and gain insights into this complex case, sign in with your Neurosurgical Atlas subscription—or sign up for a free 30-day trial if you’re not yet subscribed | https://zurl.co/a1CL.

In this operative video, Dr. Cohen demonstrates final removal of a fourth ventricular dermoid cyst using a midline suboccipital craniotomy and the telovelar approach. During the surgery, the dura was opened, and the arachnoid bands were incised, revealing the tumor protruding through the foramen of Magendie. Retractors mobilized the tonsils, and evidence of fat and hair was found within the tumor. The tumor was debulked, and the capsule adhered to the fourth ventricle floor which was left intact. Additional tumor was removed near the aqueduct and from the surgeon's blind spots. The final view showed the aqueduct and the residual tumor capsule. Learn more here | https://zurl.co/f1D3.

During dural opening for a posterior petrosal approach, the superior petrosal sinus must be isolated, coagulated, or ligated, then divided at a point anterior to the insertion point of the temporal lobe’s draining veins. Learn more here | https://zurl.co/DZ3d.

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When opening dura for a posterior petrosal approach, the incision runs anterior and parallel to the sigmoid sinus, then turns to follow the floor of the temporal fossa. What venous structure is encountered and must be isolated, coagulated, or ligated?

As a neurosurgeon, three key factors are critical to skill development: • Objective self-reflection and learning from all experiences. • Confidence to tackle complex cases and prioritize patient welfare. • Visionary innovation, always questioning old methods and adopting new techniques. Want to learn more about what it takes to be a neurosurgeon? Log in to Neurosurgical Atlas to learn more about these principles and explore essential resources | https://zurl.co/HKgL.

In this operative video, Dr. Cohen reviews how to place the external ventricular drain, one of the most basic and principle procedures in neurological surgery. To watch the full video and access free educational resources, visit the Neurosurgical Atlas website today | https://zurl.co/ZVtD.

During the posterior petrosal approach, bone resection should stop when cortical bone over the posterior semicircular canals is encountered. Aggressive drilling can lead to injury of the jugular bulb or facial nerve. Learn more here | https://zurl.co/i5bi.

A posterior petrosal approach involves removal of bone over Trautmann’s triangle (dashed line). What is the stopping point for the bone resection anteriorly? What structures can be injured if the bone is drilled too aggressively?