Exposure of intraparenchymal or intraventricular tumors necessitates opening the cerebrum (cerebrotomy). Classically, there are two techniques for performing cerebrotomy: (1) going through a gyrus; (2) going through a sulcus. Proponents of each sustain that their particular procedure of choice affords easier access to the cerebral substance or ventricle, and causes less damage. This, indeed, is a moot point, since cortical tissue at the gyral and sulcal levels: is equally damaged when cut. Retraction of a cortical cerebrotomy may result in extension of the opening and, consequently, increase the risk of damage, just as retraction of a sulcal cerebrotomy may cause tearing of sulcal vessels and also increase the risk of cerebral damage. For matters purely of habit, the author prefers the sulcal cerebrotomy, but herein describes both. Also, the use of laser to incise cerebral substance is described, as is the technique for surface thermocoagulation and parenchymal spreading.
KeywordsWhite Matter Cortical Surface Cerebral Damage Moot Point Bipolar Forceps
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