Although small meningiomas may be removed "en bloc", internal decompression is a key initial step in actual tumor removal for most meningiomas following adequate exposure and initial devascularization. Internal debulking is carried out until a thin rim of exposed portion of the tumor is remaining. This internal debulk-ing minimizes brain retraction and facilitates extracapsular dissection. Following initial internal decompression, extracapsular dissection is initiated by identifying a layer of arachnoid (maintained in most meningiomas) at the brain-tumor interface. As surgery progresses, rather than increasing brain retraction to expose more of the tumor hidden under the brain, the thinned capsule is pulled towards the center of decompression. Cottonoid patties are placed in the brain-tumor interface as the capsule is being pulled away from the brain,
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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.