Surgical Neuroanatomy of the Frontal Region Applied to Decompressive Craniectomy
The study of Neuroanatomy had a spectacular advance with the advent of Neurosurgical techniques and approaches and Microsurgery. One of the great references of Surgical Neuroanatomy is Dr. Albert Rhoton who stood out for his work in cadaveric dissections, later published in his books on “Cranial Anatomy and Surgical Approcahes”. For the neurosurgeon in training, it is very important to know in detail the topography of the skull regions for a correct surgical performance. The objective of this work is to describe the cranio-cerebral topographic anatomy of the frontal region through cadaveric dissection and apply it to neurosurgery through Bifrontotemporal Decompressive Craniectomy. A frontal region dissection was performed through a bicoronal incision exposing the skull by reclining the frontal myocutaneous flap. After craniectomy, the frontal dura and the relief of the superior longitudinal sinus can be seen. When reclining the dura, the brain tissue with its frontal drainage veins appears. To perform the bifrontotemporal decompressive craniectomy, the frontal flap is reclined first and then the craniectomy is performed with a bone bridge over the midline to protect the venous sinus. The dural opening in a “U”-shape with medial base allows good decompression of the cranial content and preserves the integrity of venous vessels by respecting the midline. Dural reconstruction is a late step that, depending on each case, may or may not be performed. The acquisition of practical skills through cadaveric dissection is a very important tool for the neurosurgeon and allows the assimilation of key neuroanatomical knowledge to carry out good surgical practice.
Keywords: Surgical neuroanatomy, frontal lobe, bifrontotemporal decompressive craniectomy, cadaveric dissection.
Citation: Fabia n E. Dodaro. “Surgical Neuroanatomy of the Frontal Region Applied to Decompressive Craniectomy”. SVOA Neurology 2:5 (2021) Pages 164-169.
