This paper aims to describe the performance of the pretemporal craniotomy performed didactically from 2002 to 2012 in eighty patients. It is therefore a fundamentally descriptive text, organized in the sequence of the main stages in which such a craniotomy is performed, and describing in detail the technique with which this group of evolutionarily authors came to accomplish the task.

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Objective: To study the ideal patient's head positioning for the anterior circulation aneurysms microsurgery. Method: We divided the study in two parts. Firstly, 10 fresh cadaveric heads were positioned and dissected in order to ideally expose the anterior circulation aneurysm sites. Afterwards, 110 patients were submitted to anterior circulation aneurysms microsurgery. During the surgery, the patient's head was positioned accordingly to the aneurysm location and the results from the cadaveric study. The effectiveness of the position was noted. Results: We could determine mainly two patterns for head positioning for the anterior circulation aneurysms. Conclusion: The best surgical exposure is related to specific head positions. The proper angle of microscopic view may minimize neurovascular injury and brain retraction.Keywords: cerebral aneurysm, head positioning, anatomical landmarks, anterior circulation arteries, microsurgery. RESUMOObjetivo: Estudar o posicionamento da cabeça para a cirurgia de aneurismas cerebrais da circulação anterior. Método: Dividimos o estudo em duas partes. Inicialmente, dez cabeças de cadáveres frescos foram posicionadas e dissecadas de modo a expor, de maneira ideal, os principais sítios de aneurismas na circulação anterior do cérebro. Posteriormente, 110 pacientes foram submetidos a microcirurgia para clipagem de aneurismas cerebrais da circulação anterior. Durante as cirurgias, as cabeças foram posicionadas de acordo com a localização específica de cada aneurisma e o resultado obtido no estudo dos cadáveres. Cada paciente teve sua posição avaliada quanto a sua eficácia. Resultados: Obtivemos basicamente dois padrões de posicionamento da cabeça para cirurgias de aneurismas cerebrais da circulação anterior. Conclusão: A melhor exposição cirúrgica está relacionada à posição específica da cabeça para cada localização aneurismática. O ângulo de visão microscópica adequado minimiza lesões neurovasculares e a excessiva retração cerebral.Palavras-chave: aneurisma cerebral, posicionamento da cabeça, reparos anatômicos, artérias da circulação anterior, microcirurgia.

The cerebellum is an exquisite anatomic structure within the human brain, which needs to be considered from the surgical standpoint because of its functional importance and common pathologies that affect this area 1 . It is possible to reach the cerebellum avoiding damaging neural structures by approaches which target tentorial, petrosal, or suboccipital surfaces. Each has its microsurgical particularities in order to reach the desired region and preserve neural structures 2 . In this article, we have presented the microsurgical anatomy of the suboccipital and supracerebellar approaches to the cerebellar surfaces using comprehensives anatomic and functional relations with the final objective of performing better operations with less damage to the cerebellar nucli and important deep pathways. MetHODSThe dentate nucleus, cerebellar peduncles and their relationship with others cerebellar structures were studied in 20 adult cerebellar hemispheres, 12 male and 8 female corpses, obtained from São Paulo death verification service using X3 to X40 magnifications. AbStrActObjective: To define the anatomy of dentate nucleus and cerebellar peduncles, demonstrating the surgical application of anatomic landmarks in cerebellar resections. Methods: Twenty cerebellar hemispheres were studied. Results: The majority of dentate nucleus and cerebellar peduncles had demonstrated constant relationship to other cerebellar structures, which provided landmarks for surgical approaching. The lateral border is separated from the midline by 19.5 mm in both hemispheres. The posterior border of the cortex is separated 23.3 mm from the posterior segment of the dentate nucleus; the lateral one is separated 26 mm from the lateral border of the nucleus; and the posterior segment of the dentate nucleus is separated 25.4 mm from the posterolateral angle formed by the junction of lateral and posterior borders of cerebellar hemisphere. Conclusions: Microsurgical anatomy has provided important landmarks that could be applied to cerebellar surgical resections.Key words: cerebellum, anatomy, neurosurgery.reSuMO Objetivo: Definir a anatomia do núcleo denteado e dos pedúnculos cerebelares, demonstrando a aplicação dos marcos anatômicos em cirurgias cerebelares. Métodos: Foram estudados 20 hemisférios cerebelares. Resultados: A maioria dos núcleos denteados e pedúnculos cerebelares demonstraram relação anatômica constante com outras estruturas cerebelares, fato que proporcionou o estabelecimento de marcos anatômi-cos específicos a serem utilizados em acessos cirúrgicos. O bordo lateral do núcleo denteado é separado da linha média em 19,5 mm em ambos os hemisférios cerebelares. O bordo posterior do córtex é separado do segmento posterior do núcleo denteado por 23,3 mm. O bordo lateral do córtex é separado do bordo lateral do núcleo por 26 mm e o segmento posterior do núcleo denteado é separado por 25,4 mm do ângulo posterolateral, que é formado pela junção dos bordos lateral e posterior do hemisfério cerebelar. Conclusões: O estudo da anatomia microcirúrgic...

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