title: Some collected principles of microneurosurgery: simple and fast, while preserving normal anatomy: a review.
abstract: Microneurosurgical techniques introduced by Prof Yasargil in the 1960s have increased the neurosurgeon's ability to operate in small and often very narrow and deep gaps. Microneurosurgical techniques-ensuring an almost bloodless field and mostly obviating need for transfusion-should be atraumatic and noninvasive to the already lesioned central nervous system tissues and structures. Instruments in microneurosurgery range from very short to very long and from sturdy to delicate, depending on the working depth, characteristics of tissues, and the microneurosurgical anatomy. However, to keep it simple and fast, and to appreciate normal anatomy, it is preferable to use only a limited array of instruments. Besides the use of instruments and the operating microscope, everything else in the neurosurgical arena should be optimized and professional, such as the positioning of the patient and the conduct of neuroanesthesia. This review of the very basics is distilled from the Helsinki and Kuopio neurosurgery practices in Finland and from the senior author's (JH) experience of close to 10,000 operations, and this is to encourage young neurosurgeons of the world-most of them working with limited resources-to continue to improve their microneurosurgical skills to serve their patients best.
authors.affiliation: Department of Neurosurgery, Helsinki University Hospital, 00260 Helsinki, Finland. juha.hernesniemi@hus.fi
authors.forename: Juha
authors.initials: J
authors.lastname: Hernesniemi
authors.forename: Mika
authors.initials: M
authors.lastname: Niemelä
authors.forename: Ayse
authors.initials: A
authors.lastname: Karatas
authors.forename: Leena
authors.initials: L
authors.lastname: Kivipelto
authors.forename: Keisuke
authors.initials: K
authors.lastname: Ishii
authors.forename: Jaakko
authors.initials: J
authors.lastname: Rinne
authors.forename: Antti
authors.initials: A
authors.lastname: Ronkainen
authors.forename: Timo
authors.initials: T
authors.lastname: Koivisto
authors.forename: Riku
authors.initials: R
authors.lastname: Kivisaari
authors.forename: Hu
authors.initials: H
authors.lastname: Shen
authors.forename: Martin
authors.initials: M
authors.lastname: Lehecka
authors.forename: Juhana
authors.initials: J
authors.lastname: Frösen
authors.forename: Anna
authors.initials: A
authors.lastname: Piippo
authors.forename: Juha E
authors.initials: JE
authors.lastname: Jääskeläinen
mesh_terms: D001927:Brain Diseases / Q000601:surgery; D002983:Clinical Competence; D006801:Humans; D008866:Microsurgery / Q000193:education / Q000295:instrumentation / Q000379:methods*; D019635:Neurosurgical Procedures / Q000193:education / Q000295:instrumentation / Q000379:methods*