Microsurgical techniques offer to surgeons a great improvement in working conditions to achieve the effective surgery of intracranial aneurysms and other small lesions, and an improved outcome for patients.

Microsurgery, however, requires a clear definition: it is not just the sole use of a microscope during a conventional neurosurgical exploration. It is an entirely new surgical discipline and concept requiring the use of a mobile counter-balanced operating microscope, and necessitating mastery of indirect eye-hand interaction which can only be acquired in a specially equipped laboratory.

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Microneurosurgery constitutes two main components:

1. Special equipment:

• Counter-balanced mobile operating microscope equipped with T.V. camera and monitors to enhance and promote team work in the operating room between surgeon, neuroanesthesiologist, nurses, and technicians.
• Bipolar coagulators and bipolar forceps of different lengths and tip size. Also “Isocool” (J&J product) bipolar tips that need minimal cleaning due to patented internal thermodynamic countercurrent cooling mechanism.
• Pressure regulated suction apparatus and suction tubes in different lengths and diameters.
• Bayonet-shaped surgical instruments in different lengths and tip sizes and malleable microinstruments.
• Microsutures and special needle holders.
• Self-retaining "protective" brain retractors.
• Hydraulic chair and adjustable arm rest for the surgeon.
• Magnified Loupes (glasses for general Neurosurgery, peripheral nerve surgery and spinal surgery outside the dura (spinal cord and root covering). Also used with a headlight for optimal lighting.

2. Special surgical techniques requiring laboratory training:

• Enhanced eye-hand interaction working under conditions of indirect vision with the operating microscope.
• Delicate manipulation with microinstruments during dissection, clipping, coagulating, neurovascular repair, and grafting.
• Tactics to operating within a key-hole approach performing the procedures as mentioned above; but, under more difficult conditions, for example plastic boxes of different heights (5-12 cm) and with narrow openings cm diameter) simulate deep narrow approaches within and around the brain. RACS workshops and accredited Microneurosurgical courses. Also Da Vinci robotic surgical techniques used in Urology.
• Delicate and controlled manipulations within the confines of a small gap and using a self-retaining protective brain retractor.
• Training the use and applications of the bipolar coagulator and microsuction equipment.
• Training to develop expertise and comfort using high-speed surgical drills. i.e. Midas Rex (Medtronic) drill workshops accredited world-wide.
  

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