by Michael Ghali (Author), George Ghali (Author)
Microsurgical operations in the vicinity of the bulb or its intraaxial contents is frequently fraught with operator angst and catastrophic neurologic deficits. Accordingly, the most rudimentary of Nature’s beautiful creations also happens to be among its most complex and delicate. The brainstem houses the core circuitry generating sympathetic tone and a breathing rhythm which maintain Life. The reticular activating propriobulbar circuitry diffusely projects and activates cerebral cortex directly and through thalamic relay nuclei to maintain Vigilance. Cranial nerve motor nuclei control the movements of the head and neck and cranial sensory nuclei represent the initial relays transmitting somatosensory information of the face and cephaloviscera to the ventral posterior medial thalamic nuclei. These nuclei are complexly, though discretely and wisely organized within its interior and multimodally modulated by suprabulbar and peripheral influences. Haphazard microsurgical maneuvers or the slightest transgression upon one of its critical structures may hasten and expedite a patient’s rapid demise. Fortuitously, innovation in microsurgical techniques by the works of Emeritus Professor Dr. Robert F. Spetzler and Emeritus Professor Dr. Albert I. Rhoton has provided us with an elegant set of operative steps to achieve the safe and effective removal of pathology sans deficit, rendering the safe removal of previously inoperable neoplastic and vascular lesions commonplace and facile. Familiarity, versatility, and comfort with the faithful performance of these techniques augment the neurosurgeon’s armamentarium and confidence to intervene upon brainstem proximate and intraaxial pathology.