Читать книгу Neurosurgery Outlines - Paul E. Kaloostian - Страница 46

1. Follow AVM laminoplasty procedure above until initial hemostasis is completed and self-retaining retractors are placed, keeping the musculature set aside

2. Use Leksell rongeurs and high-speed burr drill to remove the posterior spinous processes and bilateral lamina

3. Remove the free ligamentum flavum using Kerrison rongeurs to decompress the nerve roots

4. Open the lamina via “green-stick” fracture technique

5. Utilizing Adson Periosteal Elevator, elevate lamina from the side (do not slide underneath it)

6. Fasten plates and screws at the lateral borders of each lamina and the facet joint, decompressing the spinal cord (if needed, often fusion is not necessary)

7. Wash out the wound with antibiotic saline solution and reachieve hemostasis via Bovie electrocautery and bipolar, applying local anesthetic to the wound to reduce bleeding

8. Place a postoperative drain (can be removed after 2–3 days)

9. Close the fascia and subcutaneous tissue with Vicryl

10. Close the skin with suture, skin-glue, steri-strips, or surgical staples