الفهرس 
NERVE SUPPLY AND ARTERIAL SUPPLY OF SCALPOnly 14 pages are availabe for public view
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Abstract
Nerve supply of the scalp comes from the fifth cranial nerve
(trigeminal), as well as the cervical plexus. The forehead is
innervated by branches of the V1 division, specifically the
supraorbital and supratrochlear nerves. The vertex and lateral
region of the scalp receives its nerve supply from the V2 and V3
divisions (zygomaticotemporal, and temporomandibular and
auriculotemporal nerves, respectively). The posterior scalp
sensation is supplied by the greater auricular and occipital
nerves. All of these nerves become superficial (and accessible to
anesthetic access) above an imaginary line drawn from the
occipital protuberance to the eyebrows, passing along the upper
border of the ear. In the scalp, the nerves travel between the
connective tissue and aponeurosis.
The classic scalp infiltration techniques introduced a
century ago has evolved into a modern precise scalp nerve
blockade. The “scalp block”technique is safe and reproducibly
successful in maintaining hemodynamic stability. Its use is
being extended to children and appears to be of great use in
postoperative pain management.
The technique has a steep learning curve and its practice
will undoubtedly help the anesthesiologist in the perioperative
management of patients undergoing craniotomy. Further
improvements and applications of “scalp blocks”are growing areas of research, and the next decade will likely see a wider
use of this technique.
Indications can be anatomical, physiological or
pharmacological. In addition, awake techniques are widely used
for stereotactic brain biopsy in many parts of the world.
Confusion and communication difficulties (e.g. severe
dysphasia) are absolute contraindications and extreme anxiety or
an exaggerated response to pain are relative contraindications.
The application of awake craniotomy has been
continually evolving. The success of each different anesthetic
technique depends on proper preoperative preparation, proper
anesthetic technique, proper choice of anesthetic agents and
immediate management of complications. Modern anesthetic
approaches may be divided as follows: Monitored anesthesia
care (MAC) and asleep- awake -asleep (AAA) and recently a
new approach of awake-awake-awake technique.
Many case reports for AC were published around the
world. Clinical studies in specific groups such as children and
pregnant women were done. Many retrospective studies are still
needed for better assessment for AC.