Microsurgery uses the operating room microscope or high-powered loupe magnification to aid in the techniques of microvascular surgery to anastomose small vessels and nerves.
History of the procedure
The field of microsurgery began with the introduction of the operating microscope when Jacobson and Suarez described the anastomosis of blood vessels. In the 1960s, as microsurgical techniques were perfected, increasing success was seen with digital artery repairs and finger replantation. This laid the foundation for microsurgical composite tissue transfer, which became popular in the 1970s. In the 1980s, an emphasis was placed on improved function with autologous tissue transplantation, which is exemplified in mandibular reconstructions for cancer. Composite grafts consisting of soft tissue and bone aided in stabilizing the mandible, assisted with mastication, and allowed for reliable coverage during the postoperative period, when radiation usually was required. Today, microsurgical techniques have become an integral part of the armamentarium for plastic surgeons, allowing for soft tissue coverage and function after trauma or oncologic resections.
The earliest use of micro-operative techniques in neurosurgery occurred near the time that I was completing residency training in 1965.
The goal of that research project was to trace the pain-bearing afferents of the cranial nerves. The operating microscope was used for the surgery in small animals and, during this period, it was realized that the surgical microscope was capable of revealing previously unreported details of neuroanatomy, the knowledge of which could improve the outcome in operations for tumors and aneurysms.
Soon after embracing microsurgery as an essential component of our neurosurgical practice, it became obvious that there were several generations of surgeons who needed training in these techniques.
Main divisions of neurosurgery
General neurosurgery involves most neurosurgical conditions including neuro-trauma and other neuro-emergencies such as intracranial hemorrhage. Most level 1 hospitals have this kind of practice.
Specialized branches have developed to cater to special and difficult conditions. These specialized branches co-exist with general neurosurgery in more sophisticated hospitals. To practice advanced specialization within neurosurgery, additional higher fellowship training of one to two years is expected from the neurosurgeon.
Some of these divisions of neurosurgery are:
MICROSURGERY APPLIED TO NEUROSRGERY By M. G. Yasargil. (Pp. xvi + 230; illustrated; £6-30.) Thieme: Stuttgart. 1970. Microsurgical techniques in neurosurgery have been advocated for several years now and recently dealt with in some detail by Professor Krayenbuhl in his Hugh Cairns Memorial Lecture. I would think that most neurosurgeons in this country still believe that this is just a rather elaborate method of magnification and that if your eyes are good or you buy a pair of magnifying spectacles this is all you need. This was probably my view until I read this book and came to realize that microsurgery is a totally different technique applied to neurosurgical problems. The book is a compendium of all that the neurosurgeon using these techniques needs to know. The microscopes and instruments and their use are described in detail. Techniques of suturing small vessels are excellently described and a planned programme of training on small animals is provided. The anatomy and physiology of the cerebral vasculature is described in detail and almost every conceivable operation to which this technique could be applied is described and lavishly illustrated from case material. The standard of printing and illustration are such as we have come to expect from this publishing house and could not be bettered. I consider myself reasonably unimpressionable but this book has completely convinced me of the value, indeed the absolute necessity, of adopting these techniques in the future. It may be unlikely that the older neurosurgeons will wish to undergo the rigorous training and continuing experience that are necessary to master this type of surgery and to keep in training, but they should insist their juniors do so. Every neurosurgeon must read this book, it will open for them a window on a new world in operative neurosurgery and show them prospects of treatment, particularly in vascular disorders, hitherto considered impossible.