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General Principles

Figure 1: Harvery Cushing demonstrates creation of a trephine craniotomy at the upper edge of frontal bone work.  Note the use of tourniquet to control scalp bleeding.  This Cranial Approaches volume provides a road map regarding the indications, rationale, and technical nuances for execution of common supratentorial and infratentorial operative corridors. Although the skull base osteotomies will be discussed in the Skull Base Surgery volume within the Skull Base Exposures section, these osteotomies are also included in this volume. My personal philosophy for reaching appropriate exposure is based on the following principles: The ideal approach protects normal cerebrovascular structures and allows efficient and thorough handling of the lesion. The technical complexity of the approach is secondary in importance. The operator should avoid a routine and overzealous use of a limited number of approaches. Instead, one should tailor the approach to the underlying target. The most im...

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