The following is a photo progression of craniotomy for a dominant (left) frontal lobe AA in Broca’s area in a 6-year-old boy with seizures.
![](https://ispnguidetest.wpenginepowered.com/wp-content/uploads/2017/05/Positioning-for-resection-left-sided-AA.jpg)
Positioning for resection of left-sided AA: The boy is in a supine position, roll under his left shoulder, head turned to the right, scalp prepared and marked for incision.
![](https://ispnguidetest.wpenginepowered.com/wp-content/uploads/2017/05/Scalp-and-temporalis-muscle-turned-as-single-flap.jpg)
Scalp and temporalis muscle turned as single flap: A left fronto-temporal myocutaneous flap has been turned anteriorly.
![](https://ispnguidetest.wpenginepowered.com/wp-content/uploads/2017/05/Frontotemporal-Craniotomy.jpg)
Frontotemporal craniotomy: A frontotemporal bone flap has been removed and the dura tacked to bone.
![](https://ispnguidetest.wpenginepowered.com/wp-content/uploads/2017/05/Exposed-cortex.jpg)
Exposed cortex: Opening of the dura exposes the brain. Swollen gyrus marks location of tumor.
![](https://ispnguidetest.wpenginepowered.com/wp-content/uploads/2017/05/Exposed-left-frontal-lobe.jpg)
Exposed left frontal lobe:
![](https://ispnguidetest.wpenginepowered.com/wp-content/uploads/2017/05/Placement-of-20-contact-electrode-grid.-.jpg)
Placement of 20 contact electrode grid: Intraoperative electrocorticography is done to evaluate for epileptogenic foci and to identify motor cortex using stimulation through grid and/or by phase reversal of sensory evoked potentials (cortical mapping).
![](https://ispnguidetest.wpenginepowered.com/wp-content/uploads/2017/05/Monitoring-personel.-.jpg)
Monitoring personnel: Neurologist evaluating intraoperative electrocorticography (ECoG).
![](https://ispnguidetest.wpenginepowered.com/wp-content/uploads/2017/05/Cortical-incision.jpg)
Cortical incision: Shown is a dissector being used to perform a cortical opening to expose the tumor.
![](https://ispnguidetest.wpenginepowered.com/wp-content/uploads/2017/05/Resecting-the-tumor.jpg)
Resecting the tumor: Sharp dissection in addition to ultrasonic aspiration, blunt dissection with micro-dissectors, and suction/bipolar cautery are used to accomplish the tumor’s removal.
![](https://ispnguidetest.wpenginepowered.com/wp-content/uploads/2017/05/The-resection-cavity.jpg)
Resection cavity: After the tumor’s removal the swollen appearance resolves, with the gyral patterns and vascularity assuming a more normal appearance.
![](https://ispnguidetest.wpenginepowered.com/wp-content/uploads/2017/05/Higher-magnification-of-the-tumor-cavity.jpg)
Higher magnification of the tumor cavity: Under microscopic magnification the walls of the resection cavity begin to appear as normal white and gray matter at the margins of the tumor.
![](https://ispnguidetest.wpenginepowered.com/wp-content/uploads/2017/05/Dural-closure.jpg)
Dural closure: The dura is closed to avoid CSF leakage and adherence of the cortical surface to any material in the epidural space.
![](https://ispnguidetest.wpenginepowered.com/wp-content/uploads/2017/05/Bone-flap-reattached.jpg)
Bone flap reattached: The bone flap is fixed into position so that it can revascularize and undergo the normal reossification process.
![](https://ispnguidetest.wpenginepowered.com/wp-content/uploads/2017/05/Scalp-incision-closed.jpg)
Scalp incision closed: The scalp is closed in such a manner that removal of any suture material will be as easy as possible for the young child.
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