Table Of ContentSCHMIDEK & SWEET
Operative Neurosurgical
Techniques
Seventh Edition
Indications, Methods, and Results
ALFREDO QUIÑONES- HINOJOSA, MD
WILLIAM J. AND CHARLES H. MAYO PROFESSOR
CHAIR, NEUROLOGIC SURGERY
DEPARTMENT OF NEUROSURGERY
MAYO CLINIC
JACKSONVILLE, FLORIDA
Elsevier
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103- 2899
SCHMIDEK & SWEET OPERATIVE NEUROSURGICAL TECHNIQUES: ISBN: 978- 0- 323- 41479- 1
INDICATIONS, METHODS, AND RESULTS, Volume 1: 978-0-323-84721-6
SEVENTH EDITION Volume 2: 978-0-323-84722-3
Copyright © 2022, 2012, 2006, 2000, 1995, 1988, 1982 by Saunders, an imprint of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any
means, electronic or mechanical, including photocopying, recording, or any information storage and
retrieval system, without permission in writing from the publisher. Details on how to seek permission,
further information about the Publisher’s permissions policies and our arrangements with organizations
such as the Copyright Clearance Center and the Copyright Licensing Agency can be found at our website:
www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical treatment
may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds, or experiments described herein. In using such
information or methods they should be mindful of their own safety and the safety of others, including
parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most
current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended dose or formula, the method and duration of administration, and
contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of
their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient,
and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume
any liability for any injury and/or damage to persons or property as a matter of products liability,
negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas
contained in the material herein.
Library of Congress Control Number: 2021930850
Content Strategist: Belinda Kuhn
Director, Content Development: Laurie K. Gower
Senior Content Development Manager: Laura Schmidt
Content Development Specialist: Denise Roslonski
Publishing Services Manager: Julie Eddy
Senior Project Manager: Cindy Thoms
Book Designer: Brian Salisbury
Printed in Canada
Last digit is the print number: 9 8 7 6 5 4 3 2 1
DEDICATION
I dedicated the 6th edition (the first edition where I served and humble by asking me questions to which I do not have
as Chief Editor) to Dr. Henry Schmidek, who was undoubt- answers.
edly an extraordinary and visionary man. Dr. Schmidek was Thanks to all my mentors thorough the decades since
intellectually gifted with a voracious curiosity and never- I came to the United States and special gratitude to our
ending gusto for knowledge and life. His immense love of extraordinary team of nurses, administrators, anesthesiolo-
his family was apparent to everyone who had the pleasure gists, neurologists, neurosurgeons, otolaryngologists, radi-
of his company. Dr. Schmidek died in the fall of 2008, but ologists, endocrinologists, residents, fellows, and medical
his legacy has continued through the 6th and now the 7th students who have dedicated their lives to the pursuit of per-
editions of this book. This book continues to be the most fection and patient care and who are an integral part of these
universal text in neurosurgery. advances in surgery—they all have helped me become a bet-
This new 7th edition of Schmidek & Sweet Operative Neu- ter surgeon and a compassionate physician. I have been given
rosurgical Techniques is part of a legacy of academic excel- guidance and light during moments when the room was dark
lence. I tried to keep the same spirit that characterized the and the visibility was dimmed by moments of doubt and fear.
prior editions of this book and made it a favorite among A million thanks to my amazing patients and their fami-
students, residents, health care providers, and faculty alike lies—they are the true unsung heroes who day after day stay
since its first printing. As I edited this text with the help positive and filled with hope despite their health struggles
of a superb team of section editors and contributors in the and often put their lives in our hands, ask questions, and
middle of the most extraordinary life- altering COVID- 19 constantly push us to be better physicians, surgeons, and
pandemic, I reflected on the many lives we have lost in the human beings.
world and came to realize that it is not about how long we Much gratitude and thanks also to Elsevier, Karim
live but the contributions we make to this world, the people ReFaey, Laurie Gower, Denise Roslonski, Laura Schmidt,
we touch, and the legacy we leave behind. Belinda Kuhn, Cindy Thoms, and the extraordinary team
I would like to thank my wife, Anna, and our chil- who made this book possible. It has taken many years of
dren, Gabriella, David, and Olivia, for their extraordinary work, many years’ experience and knowledge to produce
patience, love, and dedication to my career and life and, this book. It would not have been possible without all of you.
ultimately, their commitment to our patients, who are also
part of our family. Our children keep me young, grounded, Alfredo Quiñones- Hinojosa
iii
SECTION EDITORS
Section One Section Four
Surgical Management of Brain Abnormalities of Cerebrospinal Fluid Dynamics
and Skull Base Tumors
Daniele Rigamonti, MD
Alfredo Quiñones- Hinojosa, MD Professor, Neurosurgery
William J. and Charles H. Mayo Professor Johns Hopkins School of Medicine
Chair, Neurologic Surgery Baltimore, Maryland
Department of Neurosurgery CEO
Mayo Clinic Johns Hopkins Aramco Healthcare
Jacksonville, Florida Dhahran, Eastern Province, Saudi Arabia
Maryam Rahman, MD, MS Section Five
Assistant Professor Stereotactic Radiosurgery
Neurosurgery
University of Florida Cesare Giorgi, MD
Gainesville, Florida Consultant Neurosurgeon
Gamma Knife Unit
Section Two Fondazione Poliambulanza
Vascular Diseases Brescis, Italy
Michael T. Lawton, MD Daniel M. Trifiletti, MD
Professor and Chair, Department of Neurosurgery Associate Professor
Barrow Neurological Institute Radiation Oncology
St. Joseph’s Hospital and Medical Center Mayo Clinic
Phoenix, Arizona Jacksonville, Florida
Rabih G. Tawk, MD Section Six
Associate Professor Functional Neurosurgery
Department of Neurosurgery
Mayo Clinic Emad N. Eskandar, MD
Jacksonville, Florida Associate Professor, Neurosurgery
Massachusetts General Hospital and Harvard Medical School
Brian L. Hoh, MD Director, Stereotactic and Functional Neurosurgery
James & Brigitte Marino Family Professor and Chair Director, Neurosurgery Residency Program
Neurosurgery Massachusetts General Hospital
University of Florida Boston, Massachusetts
Gainesville, Florida
Edward F. Chang, MD
Section Three Associate Professor, Neurological Surgery
Operative Techniques in Pediatric Neurosurgery School of Medicine
University of California
George I. Jallo, MD San Francisco, California
Professor, Neurosurgery, Pediatrics, and Oncology
Division of Pediatric Neurosurgery
Director, Institute for Brain Protection Sciences
Johns Hopkins All Children’s Hospital
St Petersburg, Florida
ix
x SECTION EDITORS
Section Seven Section Nine
Trauma Neurosurgical Management of Spinal Disorders
J. Marc Simard, MD, PhD Ziya L. Gokaslan, MD, FAANS, FACS
Professor Julius Stoll, MD Professor and Chair, Department of
Neurosurgery, Pathology, and Physiology Neurosurgery
School of Medicine The Warren Alpert Medical School of Brown University
University of Maryland Neurosurgeon- in- Chief, Rhode Island Hospital and The
Baltimore, Maryland Miriam Hospital
Clinical Director, Norman Prince Neurosciences Institute
Section Eight President, Brown Neurosurgery Foundation
Surgical Management of Nervous Providence, Rhode Island
System Infections
Mohamad Bydon, MD
Rodrigo Ramos- Zuniga Sr., MD, PhD Associate Professor
Professor of Neurosciences Department of Neurologic Surgery
Institute of Translational Neurosciences. Mayo Clinic
Department of Neurosciences Rochester, Minnesota
University of Guadalajara
Guadalajara, Jalisco, Mexico Section Ten
Surgical Management of the Peripheral
Mohamed E. El- Fiki, MBBCh, MS, MD, DNCh Nervous System
Professor, Neurosurgery
University of Alexandria Robert J. Spinner, MD
Alexandria, Egypt Chair, Department of Neurologic Surgery
Neurosurgery
Professor
Departments of Anatomy, Neurologic Surgery, and
Orthopedic Surgery
Mayo Clinic
Rochester, Minnesota
IN MEMORIAM
Frank Lugo Acosta Jr., MD Edward H. Oldfield, MD
1975-2020 1947-2017
Edward H. Oldfield, MD, passed away on September 1,
2017. His death was a significant loss to everyone who
knew him, including the over 100 trainees he mentored
worldwide. While neurosurgery has lost a giant, Ed’s life
left an indelible mark through scientific discovery and
Dr. Frank Lugo Acosta Jr., MD, age 45, passed away on surgical innovation, as well as generations of trainees and
November 21, 2020. Frank grew up in East Los Angeles/ colleagues.
Montebello. As a kid, Frank was smart, loved science, and Ed was born in the small town of Mount Sterling, Ken-
enjoyed soccer. He went to Don Bosco Tech for high school tucky, on November 22, 1947, to Ellis and Amanda (née
and excelled in science, counting units, and chess. He got Miller) Oldfield. He was the second of five children, with
accepted to every Ivy League school in the country, choos- one older sister, two younger brothers, and one younger
ing Harvard University to pursue his passion in chemistry, sister. Ed’s father was a decorated World War II veteran,
math, and physics. Frank matriculated at Harvard Medical having been awarded two Bronze Stars and a Purple Heart.
School where he completed an HHMI Research fellowship. Ed continued to study physics at the University of Ken-
Frank went to the University of California at San Francisco tucky, during which he met Susan, the love of his life and
for his neurosurgical training. Frank specialized in complex future wife. Upon completing three years of college, Ed
spine surgeries, and he was known around the world for his joined the University of Kentucky College of Medicine.
clinical and scientific contributions to deformity and com- Afterward, he joined Vanderbilt University Medical Center
plex spine neurosurgery. He was a top spine neurosurgeon for his neurosurgical training. Dr. Oldfield made significant
in the county, an amazingly gifted, talented, and a very edu- clinical and scientific contributions to neurosurgery. He
cated young man. excelled in spinal vascular malformations, Chiari I mal-
Frank was a beloved son, brother, husband, father, col- formation and syringomyelia, pituitary adenomas, drug
league, and friend who loved to make others laugh. He will delivery, nervous system neoplasia, gene therapy, and vaso-
be deeply missed by his family, daughter, friends, colleagues, spasm, which led to over 500 peer-r eviewed publications, an
and all who knew him. H- index over 100, and over 43,000 citations.
v
vi IN MEMORIAM
Evandro de Oliveira, MD, PhD Rhoton, Jr. and M. Gazi Yasargil, which led to a lifelong
friendship and collaborations. Evandro led a philosophy
1944-2021
based on the mastery of anatomy and microneurosurgery,
where the anatomy learned in the lab must be applied in the
operative room, in a clean, beautiful, and effective manner.
Evandro was a uniquely dedicated surgeon-a rtist in chase of
perfection. Nothing but the best was acceptable. He took
Brazilian neurosurgery to the next level and inspired genera-
tions. Through his multiple positions, including Director of
Institute of Neurological Sciences, Sao Paulo, he mentored
92 clinical fellows, over 600 visiting fellows, and additional
7000 surgeons, who attended one or more of the 350 courses
held in his lab in Sao Paulo.
Evandro was passionate about his family, his friends, and
about neurosurgery. He always cared for his personal and
“surgical” families, including during his battle against ALS.
He remains alive through his wife, daughters, and grand-
daughter and through his disciples. Undoubtedly, Evandro
was “The Unbelievable” surgeon, mentor, and master and will
be forever missed.
Dr. Evandro De Oliveira passed away on February 11, 2021.
Evandro was from Santa Catarina, Brazil, and completed
medical school at the Federal University of Santa Catarina
and then Neurosurgery Residency at the Universidad del
Republica, in Montevideo, Uruguay. He spent time with Al
ABOUT THE AUTHOR/EDITOR
Dr. Q is an internationally renowned neurosurgeon
and neuroscientist who leads NIH- funded research to
cure brain cancer. He is the principal investigator at the
Brain Tumors Stem Cell Laboratory at the Mayo Clinic.
He has published more than 450 peer-r eviewed papers
and 100 book chapters, edited 14 high- impact neurosur-
gical textbooks, and published his memoir, Becoming Dr.
Q, in both English and Spanish. Dr. Q is the founder and
president of the nonprofit organization Mission:BRAIN,
providing patients in need access to advanced neurosurgi-
cal procedures around the world. For all his work, Dr. Q
has also been recognized with several prestigious awards,
including being named as one of the 100 most influential
Hispanics in the U.S. by Hispanic Business Journal; as 2014
Neurosurgeon of the Year by Voices Against Brain Can-
cer, where he was also recognized with the Gary Lich-
tenstein Humanitarian Award; and by the 2015 Forbes
magazine as one of Mexico’s most brilliant minds in the
world; he was also selected by Popular Science magazine
as one of their 6th Annual Brilliant Ten in their search
Dr. Alfredo Quiñones- Hinojosa, commonly known as Dr. Q, for young genius influencing the course of science. He
received his medical degree from Harvard University where has received honorary degrees from Southern Vermont
he graduated cum laude. He completed his residency in neuro- College, Lackawanna College, Dominican University,
surgery at the University of California, San Francisco, where University of Notre Dame, Loyola University, and Uni-
he also completed a postdoctoral fellowship in developmental versidad Anahuac Mexico. He was awarded the Cortes de
and stem cell biology. His career began at the Johns Hopkins Cadiz Prize in the category of surgery by the city council
University School of Medicine, where he became Professor of Cadiz, Spain, and was also named by Forbes as one of the
of Neurosurgery and Oncology, Neurology, and Cellular and most creative Mexicans. Dr. Q’s story was featured on the
Molecular Medicine and Director of the Brain Tumor Stem BBC and Netflix show “The Surgeon’s Cut” in December
Cell Laboratory. Nowadays, he is the “William J. and Charles 2020, and more recently Annapurna Pictures and Plan B
H. Mayo Professor” and Chair of Neurologic Surgery at the Entertainment productions announced that his inspira-
Mayo Clinic in Jacksonville, Florida. tional life story is going to be featured in a movie.
vii
VIDEO AND CONTENT ASSOCIATE EDITOR
Qatari Royal Family and most recently by grants from the
National Institutes of Health. Dr. ReFaey’s research focuses
on gliomas and awake brain mapping to preserve speech
and motor functions and preserve the crucial areas of the
brain. Dr. ReFaey has published in clinical and translational
research, producing close to 40 peer- reviewed publications
and more than 30 book chapters. His work involving the
design and utilization of high-d ensity electrocorticography
(HD-ECoG) in intraoperative monitoring during awake
craniotomies and its effect on the patient’s outcome led
to national invited presentations, high-tier clinical pub-
lications, as well as five US patents complementing this
technology (one issued, PCT/US2018/039956; two pend-
ing, # 2019-388; # 2017-113; and two in submission). He
has been recognized by the American Epilepsy Society for
the impact of his work and was awarded the Young Inves-
tigator Award of the Year in 2017. Dr. ReFaey is apply-
ing for neurosurgery residency to pursue his career as a
neurosurgeon- scientist.
Dr. Karim ReFaey earned his medical degree from Ain
Shams University in Cairo, Egypt. He conducts cutting-
edge research in neurosurgery, neuro- oncology, and onco-
epilepsy, sponsored originally by a generous grant from the
viii
