Fig. 6

Different reasons lead to dural stripping. There are two distinct methods of separating the dura from the inner table of the skull. The relative displacement between the inner skull plate (red dot a) and the dura (red dot b) may result in dural detachment, which can cause extradural vessel hemorrhage. The vertical and parallel direction relative displacement is caused by forces in different directions (A). The use of a milling cutter can cause dural stripping (B). Downward pressure is produced by the lever principle when using the Penfield dissector to remove the bone flap (C). When exposing a giant meningioma, due to the large bone window and intracranial hypertension, intracranial content bulges through the opening, leading to the displacement of the dura and bone window margin in a parallel direction (D). Falling intracranial pressure causes the cortex to collapse and result in dural detachment (E)