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104 Section II: Intracranial Procedures

small periosteal elevator is inserted into the bone incision. Care is for closure. This type of approach allows replacement of the bone
taken to check for residual bone connections that can make detach­ flap at the end of the surgery.
ment of the bone flap difficult and increase the possibility of frac­ The sinuses can be irrigated with povidone‐iodine solution prior
turing or damaging the flap (Figure 10.11). Prior to detachment of to accessing the brain. However, there is no general consensus on
the flap it is advisable to predrill the holes (Figure 10.13) for the
sutures or wire fixation of the flap at the end of the surgery. The flap
is elevated dorsally and detached from the septum of the frontal
sinus. The bone is wrapped in moistened gauze sponges and saved

Figure 10.12 Mesocephalic cranium. 1, Junction of nasal bones; 2, zygo­
matic process of the orbit; 3, frontal–parietal sutures. Figure 10.14 Brachycephalic cranium. 1, Junction of nasal bones; 2, zygo­
matic process of the orbit; 3, frontal–parietal sutures; 4, internal table of
frontal bone; 5, cribriform plate.

Figure 10.13 Dolichocephalic cranium. The osteotomy is completed. Before
elevating the bone flap, holes for placing the suture at the end of the surgery Figure 10.15 Mesocephalic cranium. 1, Junction of nasal bones; 2, zygo­
are predrilled. 1, Junction of nasal bones; 2, zygomatic process of the orbit; matic process of the orbit; 3, frontal–parietal sutures; 4, internal table of
3, frontal–parietal sutures. frontal bone; 5, cribriform plate.