Small Incisions For Traditional Procedures

In the late 1990s, some microneurosurgeons made a strong case for small openings to manage traditional neurosurgical procedures such as aneurysm clipping. This was equated with silver dollar openings in such procedures as vascular repositioning and anterior circulation aneurysm surgery. Often these claims were associated with claims of virtuoso capability in neurosurgery, and it became difficult to separate the advantages of minimal invasive management from self-promotion. However, it is clear that microsurgical approaches lessened morbidity enough at sites such as the cerebellar pontine angle or the circle of Willis for us neurosurgeons to think of more parsimonious openings and approaches. This in turn led to the general concept of small, discrete operative approaches rather than the more traditional exploratory flap.

The influence of this on neurosurgical practice is very important. With small openings, healing is quicker, incisions are more attractive, and, in general, the impact on the body is sufficiently less that such incisions dramatically change a patient's response to the surgery. This is particularly true in the posterior fossa.

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