Surgical Case Study: Cranioplasty

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    E. Enp|d`vcpedn

    K sv|hf|u es dnf dg pof adsp sp|fssgvm z|dcf`v|fs k zkpefnp cdvm` vn`f|hd. Pof|f

    k|f nvaf|dvs puzfs dg sv|hf|efs- fkco dnf pkemd|f` pd gep k cf|pken zv|zdsf- aku ep lf pd

    `fmewf| k coem` / e.f. cfsk|fkn sfcpedn%- |fadwf k zk|p / e.f. c|knefcpdau%- pd wesvkmerf kn`

    hken kccfss pd k sp|vcpv|f xepoen / e.f. c|knedpdau% d| pd |fzke| k `fgfcp / e.f. c|knedzmkspu%.

    Poes es k cksf dg Akspf| Mkl|k`d|- \kmzo- ;< ufk|s dm`- xod xks k`aeppf` mksp

    Aku

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    Poes cksf spv`u xks codsfn lfckvsf dg pof cokmmfnhf pokp ep zdsf`! ep enwdmwfs pof

    ofk` kn` sivmm xoeco cdnpkens pof cfnp|km z|dcfssenh vnep dg pof ld`u- k senhmf aespkif

    cdvm` lf gkpkm kn` cdvm` pv|n k megf vzse`f `dxn eg ndp fn` ep.

    Kp pof fn` dg poes cksf spv`u- pof spv`fnp nv|sf fzfcps pd fzkn` of| indxmf`hf

    |fhk|`enh pof sv|heckm z|dcf`v|f indxn ks c|knedzmkspu- kn` |fgenf of| siemms en ck|enh gd|

    k zkpefnp xod oks vn`f|hdnf pof ske` sv|heckm z|dcf`v|f.

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    EE. Dlbfcpewfs

    Hfnf|km Dlbfcpewfs2

    Kgpf| 3 `kus dg spv`fnp nv|sf!zkpefnp enpf|kcpedn- pof spv`fnp nv|sf xemm lf klmf pd

    mfk|n ad|f kldvp c|knedzmkspu- fggfcpewfmu z|dwe`f odmespec ck|enh ck|f kn` encvmckpf

    zdsepewf kppepv`f xoemf ck|enh gd| k zkpefnp xod oks vn`f|hdnf pof ske` z|dcf`v|f.

    Kgpf| 3 `kus dg spv`fnp nv|sf!zkpefnp enpf|kcpedn- pof zkpefnp xemm lf klmf pd mfk|n

    ad|f kn` cdzf xepo pof sv|heckm dzf|kpedn c|knedzmkspu- kwde` cdazmeckpedns pokp aku

    k|esf zdsp!dzf|kpewfmu kn` encd|zd|kpf megfspumf ad egeckpedns vnpem of |fpv|ns pd oes

    dzpeava mfwfm dg gvncpednenh.

    Szfcegec dlbfcpewfs2

    Kgpf| 3 `kus dg z|dwe`enh odmespec ck|enh ck|f kn` gkcemepkpenh spv`fnp nv|sf!zkpefnp

    enpf|kcpedn- pof spv`fnp nv|sf xemm lf klmf pd2

    ;. zf|gd|a k pod|dvho kssfssafnp dg k scoddm!khf coem en oes z|fsfnp cdn`epedn- kn`

    `escvss pof zouseckm- sdcekm kn` cdhnepewf cok|kcpf|especs dg k scoddm!khf coem`

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    EEE. Nv|senh Kssfssafnp

    ;. Zf|sdnkm Oespd|u

    ;.; Zkpefnps z|dgemf

    Nkaf2 \kmzo `f mds \fufs Mkl|k`d|

    Khf2 ;< ufk|s dm`

    Sf2 Akmf

    Cewem Spkpvs2 Senhmf

    \fmehedn2 \dakn Ckpodmec

    @kpf dg k`aessedn2 Aku

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    ouzf|pfnsedn dn pof akpf|nkm kn` zkpf|nkm se`fs kn` l|dncoekm kspoak dn pof

    zkpf|nkm se`f.

    Of oks nd gdd` kn` `|vh kmmf|hefs. Of es kspoakpec. Mksp kspoak kppkci xks

    pxd ufk|s khd kn` xks aknkhf` xepo wfnpdmen su|vz.

    ;.3 Mfwfm dg H|dxpo kn` @fwfmdzafnp

    ;.3.; Nd|akm @fwfmdzafnp

    Zouseckm Coknhfs

    Zousedmdheckmmu- pof scoddm!khf ufk|s d| ae``mf ufk|s lfhen xepo pof

    sof``enh dg pof ge|sp `fce`vdvs pddpo kn` fn` kp zvlf|pu xepo pof kc{vesepedn dg pof

    genkm- zf|aknfnp pffpo / xepo pof fcfzpedn dg xes`da pffpo%. Pof zf|ed` dg ae``mf

    coem`odd` es k peaf dg h|k`vkm h|dxpo kn` `fwfmdzafnp xepo ad|f fwfn z|dh|fss

    en ldpo zouseckm kn` fadpednkm kszfcps.

    Scoddm!khf coem`|fns knnvkm kwf|khf xfehop hken es kzz|deakpfmu 3!6 ml.

    /;.3!

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    khfs 7 pd ;

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    dzf|kpedns- xofn coem`|fn k|f klmf pd vsf podvhop z|dcfssfs pd fzf|efncf fwfnps

    kn` kcpedns. Pof |ehe`- fhdcfnp|ec wefx dg pof z|fscoddm ufk|s es |fzmkcf` lu

    afnpkm z|dcfssfs pokp kmmdx coem`|fn pd sff poenhs g|da kndpof|s zdenp dg wefx.

    @v|enh poes spkhf- coem`|fn `fwfmdz kn vn`f|spkn`enh dg |fmkpednsoezs

    lfpxffn poenhs kn` e`fks. Pofu z|dh|fss g|da akienh bv`hafnps lksf` dn xokp

    pofu sff pd akienh bv`hafnps lksf` dn xokp pofu |fksdn. Pofu akspf| pof

    cdncfzp dg cdnwf|skpedn- `fwfmdz cmkssegeckpedn siemms kn` pofe| klemepu pd |fk`

    lfcdafs pof adsp sehnegecknp kn` wkmvklmf pddm gd| en`fzfn`fnp en{ve|u.

    Sfvkmepu

    Z|fk`dmfscfncf es pof zf|ed` dg kzz|deakpfmu < ufk|s pokp lfhens kp pof

    fn` dg ae``mf coem`odd` kn` fn`s xepo pof poe|pffnpo le|po`ku. Lfckvsf zvlf|pu

    sehnkms pof lfhennenh dg pof `fwfmdzafnp dg sfcdn`k|u sf cok|kcpf|especs-

    z|fzvlfscfncf puzeckmmu dccv|s `v|enh z|fk`dmfscfncf.

    Pof|fs nd vnewf|skm khf kp xoeco coem`|fn kssvaf pof cok|kcpf|especs dg

    z|fzvlfscfncf. Pof ge|sp zousedmdhec sehns kzzfk| kp kldvp 5 ufk|s dg khf kn` k|f

    vsvkmmu cmfk|mu fwe`fnp en ;;!;< ufk|s dm` coem`|fn.

    Ldus fzf|efncf meppmf weselmf sfvkm akpv|kpedn `v|enh z|fk`dmfscfncf.

    Zvlec oke| z|fsfnp kc|dss zvles- zfnes mfnhpofns- l|fksp fnmk|hfafnp dccv|s kn`

    pof|fs `|kakpec menfk| h|dxpo szv|p.

    ;.3.< Pof Emm Scoddm!Khf Coem

    Dnf dg pof lehhfsp z|dlmfas gkcenh k scoddm!khf coem` xepo kn emmnfss d|

    zouseckm cokmmfnhf es peaf mdsp g|da scoddm. Poes po|fkpfns ndp dnmu kck`faec

    kcoefwfafnp lvp kmsd pof coem`s |fmkpednsoezs xepo oes d| of| zff|s. Ep aku akif

    oea d| of| pof d`` zf|sdn dvp xepo |fszfcp pd akienh g|efn`s d| bdenenh hknhs.

    Xofpof| coem`|fn k|f cdngenf` pd odaf d| odszepkmerf`- ofmzenh pofa iffz en

    cdnpkcp xepo g|efn`s ckn ofmz gdspf| sdcekmerkpedn pokp es eazd|pknp gd| cdnpenvf`

    `fwfmdzafnp.

    ?

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    En ck|enh gd| k scoddm!khf coem` xod es emm- coddsf sod|p pf|a kcpewepefs pokp

    ckn lf cdazmfpf` en`fzfn`fnpmu. Lf ck|fgvm ndp pd ensvmp k coem` xepo pksis pokp k|f

    dlwedvsmu ndp khf!kzz|dz|ekpf.

    Akspf| Mkl|k`d|- \kmzo xks k`aeppf` mksp Aku

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    Nfvp|dzoem 06 &

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    3.< Nvp|epednkm! Afpkldmec Zkppf|n

    Zkpefnp fkps po|ff gvmm afkms dg |ecf- geso kn` sdafpeafs coecifn kn` |f` afkp. Of fkps

    pofsf `v|enh l|fkigksp- mvnco kn` `ennf|. Of vsvkmmu fkps bvnigdd` kn` `|enis ecf bvecf d|

    ecf ckn`u `v|enh snkci peaf. Of `|enis vz pd ;.6 mepf|s dg xkpf| k `ku kn` |k|fmu pkifs en

    g|vep bvecfs- aemi d| cdggff. Of `dfs ndp pkif knu wepkaens d| gdd` svzzmfafnps. Vzdn

    k`aessedn- oes xfehop xks

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    Z|ed| pd odszepkmerkpedn- pof zkpefnp smffzs kp k|dvn` ?za kn` xkifs vz kp 8 ka pof nfp

    `ku. Of oks nd `eggecvmpu gkmmenh kn` spkuenh ksmffz. Vzdn odszepkmerkpedn- zkpefnp es klmf

    pd smffz kp 5!523: za- kn` sdafpeafs ;: za `vf pd wepkm sehns pkienh kn` dpof| |dvpenf

    z|dcf`v|fs. Oes adpof| spkpf` pokp pof zkpefnp es vnvsvkmmu |fspmfss `v|enh pof nehop kn` es

    z|dlklmu knedvs kldvp pof vzcdaenh z|dcf`v|f.Of vsvkmmu pkifs sod|p nkz kp odaf-

    vsvkmmu kgpf| k||ewenh g|da scoddm.

    3.8 Sfmg!Zf|cfzpedn Zkppf|n

    \kmzo es xfmm!k`bvspf`. Of spkpf` pokp of es sdafxokp knedvs gd| pdad||dxs sv|hf|u lvp

    oes adpof| oks ofmzf` ckma oea `dxn. Of fz|fssf` oes `fse|f pd hd odaf kn` zmku xepo

    oes selmenhs

    3.? \dmf!\fmkpednsoez Zkppf|n

    \kmzo szfkis xfmm- xepo cdof|fnp podvhops- kn` gkcekm fz|fssedns xepo hfspv|fs pokp k|f

    kzz|dz|ekpf. Of mewfs xepo poes adpof| en K|hkd kn` oks pxd selmenhs- kmm ldus kn` kmm

    udvnhf| pokn oea- Oes zk|fnps k|f sfzk|kpf`. Oes adpof| spkpf` pokp \kmzo es ok|`!ofk`f`

    kn` dgpfn- xknps pd hd oes dxn xku.

    3.5 Sfvkmepu kn` \fz|d`vcpewf Zkppf|n

    \kmzo es en pof z|fzvlfscfncf zf|ed`. Of k`aeps pd okwenh ndpecf` h|dxpo dg oke|

    vn`f| pof kemmk kn` zvlec oke| kc|dss pof zvles lvp dpof| pokn pokp of |fgvsfs pd

    `ewvmhf `fpkems.

    3.;:Cdzenh!Sp|fss Pdmf|kncf Zkppf|n

    \kmzo zmkus lksifplkmm kgpf| scoddm. Xofnfwf| of gffms `dxn- of xkpcofs pfmfwesedn

    d| zmku xepo oes l|dpof|s kp odaf.

    3.;;Wkmvf!Lfmefg Suspfa

    \kmzo es k \dakn Ckpodmec kn` es pkvhop lu oes adpof| pd z|ku kn` kppfn` akss fwf|u

    Svn`ku. Of spkpf` pokp of es poknigvm pd Hd` gd| ndp pkienh oea pxd ufk|s khd. Of

    bdienhmu ske` pokp pof kcce`fnp aku lf k xkif!vz ckmm gd| oea pd spdz lfenh ok|`!

    ofk`f` kn` k lv|`fn pd oes adpof|.

    ;3

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    0. Z|fsfnp Z|dgemf dg Gvncpednkm Ofkmpo Zkppf|n /Zdsp!dzf|kpewf%

    0.; Ofkmpo Zf|cfzpedn

    \kmzo cdnse`f|s oes z|fsfnp spkpf dg ofkmpo ks xfmm lvp |fcvzf|kpenh. Of

    kn` oes adpof| ldpo indx pokp ks mdnh ks of pkifs ck|f dg oeasfmg kn` gdmmdx pof `dcpd|s

    d|`f|s of xemm ofkm en peaf kn` z|fwfnp cdazmeckpedns dg pof sv|hf|u.

    0.< Nvp|epednkm!Afpkldmec Zkppf|n

    Pof zkpefnp xks pd okwf `efp ks pdmf|kpf` vzdn gvmm kxkifnenh ks d|`f|f`

    lu oes `dcpd|. Of spemm fkps pof skaf afkm kp l|fkigksp- mvnco kn` `ennf|. Of fkps l|fk`

    kn` c|kcif|s gd| snkcis. Of `|enis ;

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    0.8 Sfmg!zf|cfzpedn Zkppf|n

    \kmzo es |fmefwf` ndx pokp pof dzf|kpedn es dwf|. Of indxs pokp eg of

    gdmmdxs oes af`eckpedn |fheafn kn` spkus en pof odszepkm gd| k gfx `kus pd |fcvzf|{kpf- of

    xemm fwfnpvkmmu ofkm kn` |fpv|n pd oes vsvkm mfwfm dg gvncpednenh.

    0.? \dmf!|fmkpednsoez Zkppf|n

    Zkpefnp fz|fssf` oes mdnhenh pd lf odaf kn` zmku xepo oes l|dpof|s. Oes

    odszepkm spku oks spk|pf` pd ld|f oea km|fk`u.

    0.5 Cdzenh!sp|fss pdmf|kncf Zkppf|n

    Pof zkpefnp oks nd dpof| dzpedn mfgp ndx pd cdzf xepo sp|fss fcfzp pkmienh

    xepo oes adpof| kn` kvnps kn` xkpcoenh pfmfwesedn.

    0.;: Wkmvf!Lfmefg suspfa

    \kmzo z|kus gf|wfnpmu gd| ofkmenh. Of fz|fssf` oes h|kpepv`f pd pof Md|`

    gd| iffzenh oea skgf `v|enh kn` kgpf| sv|hf|u.

    6. Zkpodzousedmdhu kn` \kpednkmf

    6.; Nd|akm Knkpdau kn` Zousedmdhu

    Sp|vcpv|f Z|dpfcpenh pof L|ken

    Pof l|ken es cdnpkenf` en pof |ehe` sivmm- xoeco z|dpfcps ep g|da enbv|u. Pof

    akbd| ldnfs dg pof sivmm k|f pof g|dnpkm- pfazd|km- zk|efpkm kn` dccezepkm ldnfs. Pofsf

    ldnfs bden kp pof svpv|f menfs.

    ;6

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    Gehv|f ;. Pof Ovakn Sivmm

    Pof afnenhfs- pof gel|dvs cdnnfcpewf pessvfs pokp cdwf| pof l|ken kn` szenkm cd|`-

    z|dwe`f z|dpfcpedn- svzzd|p kn` ndv|esoafnp pd pof l|ken kn` szenkm cd|`. Pof mkuf|s dg

    pof afnenhfs k|f pof `v|k- k|kconde` kn` zek akpf|.

    @v|k akpf|! pof dvpf|adsp mkuf|9 cdwf|s pof l|ken kn` pof szenkm cd|`. Ep es pdvho-

    poeci- enfmkspec- gel|dvs- kn` h|ku. Pof|f k|f gdv| fpfnsedns dg pof `v|k2 pof gkm cf|fl|e-

    xoeco sfzk|kpfs pof pxd ofaeszof|fs en k mdnhepv`enkm zmknf9 pof pfnpd|eva- xoeco es kn

    vngdm`enh dg pof `v|k pokp gd|as k pdvho- afal|kndvs sofmg9 pof gkm cf|flfmme- xoeco es

    lfpxffn pof pxd mkpf|km mdlfs dg pof cf|flfmmva9 kn` pof `ekzo|kha sfmmkf- xoeco

    z|dwe`fs k |ddg gd| pof sfmmk pv|ceck. Pof pfnpd|eva svzzd|ps pof ofaeszof|fs kn`

    sfzk|kpfs pofa g|da pof mdxf| zk|p dg pof l|ken. Xofn fcfss z|fssv|f dccv|s en pof

    c|knekm ckwepu- l|ken pessvf aku lf cdaz|fssf` khkensp pof pfnpd|eva d| `eszmkcf`

    `dxnxk|`- k z|dcfss ckmmf` of|nekpedn. Lfpxffn pof `v|k akpf| kn` pof sivmm en pof

    c|kneva- kn` lfpxffn pof zf|edspfva kn` `v|k en pof wf|pfl|km cdmvan- es pof fze`v|km

    szkcf- k zdpfnpekm szkcf.

    K|kconde`! pof ae``mf afal|knf9 kn fp|fafmu poen- `fmeckpf afal|knf pokp

    cmdsfmu |fsfalmfs k sze`f| xfl. Ep kzzfk|s xoepf lfckvsf pof|f es nd lmdd` svzzmu. Ep

    cdnpkens pof cod|de`s zmfvs xoeco es |fszdnselmf gd| pof cfl|dszenkm gmve` z|d`vcpedn.

    Svl`v|km szkcf es lfpxffn pof `v|k kn` k|kconde` mkuf| kn` svlk|kconde` szkcf es

    lfpxffn pof k|kconde` kn` zek mkuf|s kn` cdnpkens pof cf|fl|dszenkm gmve`.

    Zek akpf|! pof ennf|adsp afal|knf9 k poen- p|knszk|fnp mkuf| pokp ovhs pof l|ken

    cmdsfmu kn` fpfn`s enpd fwf|u gdm` dg pof l|kens sv|gkcf.

    Gehv|f

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    6.< Scofakpec @ekh|ka

    ;8

    Z|f`eszdsenh Gkcpd|

    Cdnhfnepkm kndakmefs

    Ldnf engfcpedn

    Pvad| en pof ofk`

    Gkaemu oespd|u dg l|ken ckncf|sp|dif

    Z|fcezepkpenh Gkcpd|

    Adpd|!wfoecvmk| kcce`fnps

    C|knedpdau

    C|knefcpdau

    C|knekm ldnf ledzsuSehns kn` Suazpdas

    @fgfcp en pof c|knekm ldnf ks

    sodxn en pof CP sckn9 en pof

    zkpefnps cksf `fgfcp xks dn pof

    |ehop zk|efnpkm ldnf

    Sdgpnfss dg pof k|fk dg `fgfcp

    vzdn zkmzkpedn

    Sck| dn pof k|fk dg z|fwedvs

    sv|hf|u 9 en pof zkpefnps cksf-

    sck| dn pof |ehop zk|efpkm k|fk dgpof sckmz

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    6.3 C|knedzmkspu sfcdn`k|u pd k C|knedpdau pd Fwkcvkpf kn Fze`v|km Ofakpdak

    K c|knedzmkspu- ks afnpednf` fk|mef|- es k sv|heckm |fzke| dg k `fgfcp dg pof c|kneva.

    C|knekm `fgfcps |fsvmp g|da g|kcpv|fs- engfcpedns- sv|heckm z|dcf`v|fs d| k cdnhfnepkm

    `fgd|aepu.

    \kmzo Mkl|k`d| es k ;< ufk| dm` coem` xod ok` vn`f|hdnf c|knedpdau pxd ufk|s

    khd pd fwkcvkpf kn fze`v|km ofakpdak. Of xks svzzdsf` pd cdaf lkci 7 adnpos kgpf|

    k cdazmfpf |fcdwf|u g|da pof z|fwedvs sv|heckm z|dcf`v|f lvp xks ndp klmf pd `vf pdz

    genkncekm cdnsp|kenps.

    Kn fze`v|km ofakpdak |fsvmps g|da k|pf|ekm lmff`enh enpd pof szkcf lfpxffn pof

    `v|k kn` pof ennf| pklmf dg pof sivmm. Ep es dgpfn ckvsf` lu k g|kcpv|f d gpof pfazd|km

    ;?

    Sv|heckm

    Aknkhfafnp

    C|knedzmkspu pd |fzke|

    pof c|knekm ldnf `fgfcp

    Af`eckm Aknkhfafnp

    Knpeledpec pof|kzu pd

    z|fwfnp engfcpedn

    Knkmhfsek gd| zken

    aknkhfafnp

    Nv|senh Aknkhfafnp

    Fmfwkpf ofk` dg lf` 3: `fh|ffs

    Fncdv|khf ffz l|fkpoenh

    ff|cesfs

    Z|dadpf cmfknmenfss kn`

    z|dzf| okn`xksoenh

    Fncdv|khf enc|fksf` gmve`

    enpkif

    Pfkco `ewf|pednkm kcpewepefs pdofmz aknkhf zken

    Dzpeava Mfwfm dg Gvncpednenh

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    ldnf- xoeco odvsfs pof afnenhfkm k|pf|u. Fze`v|km ofakpdaks aku lf cok|kcpf|erf`

    lu pof z|fsfncf dg k mvce` enpf|wkm pokp mksps gd| aenvpfs `v|enh xoeco pof cmefnp es

    pkmienh kn` xkmienh. Poes gdmmdxs k adafnpk|u vncdnscedvsnfss pokp dccv||f` xepoen

    aenvpfs dg enbv|u. Gdmmdxenh pof mvce` enpf|wkm- pof suazpdas z|dh|fss |kze`mu xepo

    zdpfnpekm ckpksp|dzoec enp|kc|knekm z|fssv|f fmfwkpedn kn` sp|vcpv|km coknhfs. Kn

    fze`v|km ofakpdak es k nfv|dsv|heckm faf|hfncu.

    \kmzo Mkl|k`d| dlpkenf` pof fze`v|km ofakpdak g|da k adpd|!wfoecvmk| kcce`fnp

    pxd ufk|s khd kn` of vn`f|xfnp c|knedpdau pd fwkcvkpf pof fze`v|km ofakpdak kn`

    skwf oes megf. Zdsp sv|hf|u of xks en cdak gd| 0 `kus. Of xdif vz pof nfp `ku

    cdngvsf` . Pxd ufk|s zdsp!sv|hf|u- of kn` oes adpof| ndpecf` k coknhf en oes

    kck`faec zf|gd|akncf mfwfm kn` sod|p!pf|a afad|u mkzsfs. Of kmsd oks `eggecvmpu

    ofk|enh xepo oes |ehop fk| kn` cdazmkens dg okwenh `eggecvmpu svaadnenh pof |ehop

    xd|` gd| k cf|pken fwfnp d| dlbfcp.

    Kgpf| k sfwf|f p|kvakpec l|ken enbv|u- pof zkpefnp es kmxkus fzfcpf` pd foelep

    klnd|akmepefs sfcdn`k|u pd pof enbv|u dlpkenf`. Pof z|fwedvsmu afnpednf` `fgeceps

    foelepf` lu \kmzo Mkl|k`d| kmm lfmdnh pd pof pfazd|km mdlfs gvncpedn. Pof pfazd|km

    mdlf es |fszdnselmf gd| pof cdazmeckpf` afad|u zkppf|ns kn` es pof kv`epd|u cfnpf| gd|

    sdvn` enpf|z|fpkpedn. Ep es kmsd en poes mdlf pokp pof Xf|necifs k|fk gd| szffco es

    gdvn`. Poes kssdcekpedn k|fk zmkus k sehnegecknp |dmf en oehof|!mfwfm l|ken gvncpedn. Ep

    fnklmfs z|dcfssenh dg xd|`s enpd cdof|fnp podvhop kn` |fcdhnepedn dg pof e`fk lfoen`

    x|eppfn d| z|enpf` mknhvkhfs.

    ;5

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    C|knedzmkspu xks zf|gd|af` pd |fzke| pof c|knekm `fgfcp dn \kmzos |ehop zk|efpkm

    ldnf- k `fgfcp dlpkenf` g|da pof faf|hfncu sv|heckm z|dcf`v|f zf|gd|af` dn oea pxd

    ufk|s khd. Poes c|knedzmkspu xemm ofmz z|dpfcp oes l|ken g|da pof p|kvakpec enbv|efs en

    pof gvpv|f kn` |fengd|cf pof gvncpedn dg oes sivmm.

    Gehv|f 3. Ofakpdak

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    6.0 Sehns kn` Suazpdas

    Cmksseckm Sehns Cmeneckm Sehns \kpednkmf

    @fgfcp en pof c|knekm

    ldnf ks sodxn en

    pof CP sckn

    Sck| dn pof k|fk dg

    z|fwedvs sv|hf|u

    Z|f!dzf|kpewf

    Aknegfspf`9 `fgfcp

    dn |ehop zk|efpkm

    ldnf

    Aknegfspf`9 dn |ehop

    zk|efpkm k|fk dg sckmz

    Zdsp!dzf|kpewf

    Ndp aknegfspf`

    Aknegfspf`

    Pof `fgfcp sodxn dn

    pof CP sckn xks k

    |fanknp dg pof

    z|fwedvs sv|hf|u pof

    zkpefnp aku okwf

    vn`f|hdnf.

    !zh. ;:6:9 Af`eckm!

    Sv|heckm Nv|senh lu

    Ehnkpkwecevs

    Pof `fgfcp sodxn dn

    pof CP sckn xks k

    |fanknp dg pof

    z|fwedvs sv|hf|u pof

    zkpefnp aku okwf

    vn`f|hdnf.

    !zh. ;:6:9 Af`eckm!

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    Sdgpnfss dg pof k|fk

    dg `fgfcp vzdn

    zkmzkpedn

    Aknegfspf`9 dn |ehop

    zk|efpkm k|fk dg sckmz

    Ndp dlsf|wklmf

    Sv|heckm Nv|senh lu

    Ehnkpkwecevs

    En c|knedpdau- k

    lv|| odmf es ak`f pd

    sf|wf ks kn dzfnenh

    po|dvho xoeco lmdd`

    d| gmve` aku lf

    fwkcvkpf`.

    C|knedzmkspu es dgpfn

    `dnf kgpf|.

    !zh. 378 Zdcifp

    Hve`f pd pof

    Dzf|kpenh \dda lu

    Hdm`akn

    EW. Nv|senh Enpf|wfnpedns

    ;. Ck|f Hve`f gd| Zkpefnps xod okwf vn`f|hdnf c|knedzmkspu

    Nvp|epedn kn` Gmve`s

    Cmefnps sodvm` lf kssespf` pd pkif en kp mfksp

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    Pof|f k|f pxd aken kszfcps dg cdnp|dmmenh xdvn` engfcpedn2 z|fwfnpenh

    aec|dd|hknesas g|da fnpf|enh pof xdvn` kn` z|fwfnpenh p|knsaessedn dg lmdd` ld|nf

    zkpodhfns pd d| g|da pof cmefnp pd dpof|s. Spkn`k|` z|fckvpedns encmv`f xfk|enh dg hmdwfs

    xofn pdvcoenh lmdd` kn` ld`u gmve`s kn` xofn okn`menh epfas sdemf` xepo lmdd` d| ld`u

    gmve`s9 kn` xksoenh pod|dvhomu dg okn`s kgpf| |fadwenh hmdwfs.

    Ofk` `|fssenh sodvm` lf enszfcpf` fkco `ku zdsp!dzf|kpewfmu vnpem ep es |fadwf` dn

    pof poe|` zdsp!dzf|kpewf `ku. Ofk` `|fssenhs sodvm` ndp lf `espv|lf` gd| pof ge|sp

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    Sffn zkpefnp -

    Aksp. \kmzo

    Mkl|k`d|-seppen

    h dn lf`xkpcoenh

    pfmfwesedn xepodvp

    EW. Of es ;< ufk|s

    dm` kn` es gd|

    c|knedzmkspu.

    5? &

    |fsdmv

    !pedn

    DgZsucodmdhe

    c

    kn`zousedmdhec

    z|dlmfas

    fzf|efncf` lu

    pof zkpefnp

    E.Knefpu2|fspmfssnfss |fmkpf` pd gfk| dg

    vnindxn dvpcdafs dg sv|hf|u

    EE.@espv|lf` smffz zkppf|n2 smffzenh mkpf|

    pokn oes lf`peaf |fmkpf` pd gfk| dg

    vnindxn dvpcdaf dg sv|hf|u

    EEE. Indxmf`hf `fgecep 2 g|f{vfnp ksienh dg

    {vfspedns |fhk|`enh pof sv|heckm z|dcf`v|f

    c|knedzmkspu |fmkpf` pd mkci dg

    fzmknkpedn g|da sehnegecknp dpof|s

    L|vnsxeci Mfns Ad`fm

    /Z|f!dzf|kpewf%

    Kcpvkm spkpf

    Dg zkpefnps

    cdn`epedn

    cvfs Nv|senh @ekhndsfs Nv|senh Kcpedns @fse|f` Dvpcdaf

    Dlbfcpewfs Hdkm

    K. Zsucodmdhec `fgecep2

    Knefpu

    !|fspmfssnfss

    !cmefnp |fzd|pf` enc|fksf` gffmenh

    dg pfnsedn d| ks adpof| spkpf`2

    dwf|fcepfafnp

    !cmefnp dfs gddp sovggmenh

    !ivmlkkn hkaku ks wf|lkmerf`

    lu pof zkpefnp

    L. Zousedmdhec fgecep2 espv|lf`

    smffz zkppf|n

    ! cmefnp ndx smffzs mkpf pokn oes

    vsvkm lf` peaf

    !adpof| spkpf` pkp cmefnp es

    vnvsvkmmu |fspmfss v|enh pof

    nehop z|dlklmu vf pd knefpu

    !cmefnp |fzd|pf` enc|fksf` gffmenh

    dg pfnsedn d| ks adpof| spkpf`2

    dwf|fcepfafnp

    C. Indxmf`hf `fgecep

    !zkpefnp g|f{vfnpmu ksis {vfspedns

    |fhk|`enh pof z|dcf`v|f

    !zkpefnp es dnmu ;< ufk|s dm`

    !ndnf dg pof gkaemu afalf|s esen pof af`eckm gefm` kn` ndnf

    cdvm` hewf k seazmf fzmknkpedn

    dg xokp of es kldvp pd hd po|dvho

    Afksv|fs pd2

    K. |f`vcf Knefpu

    !kcindxmf`hf` gfk|

    !fncdv|khf` zkpefnp pd wf|lkmerf

    gffmenhs

    !szfnp sdaf peaf xepo pof zkpefnp

    !fncdv|khf` hve`f` eakhf|u

    !z|dwe`f` pdvco- aksskhf

    L eaz|dwf Smffz Zkppf|n

    ! cmvspf|f` nv|senh kcpewepefs

    ! aeneaerf` gmve` enpkif `v|enh

    nehop peaf

    !|fsp|ecpf` enpkif dg ckggfenf!

    cdnpkenenh gdd`s kn` gmve`s

    !svzzd|pf` cdnpenvkpedn dg

    zkpefnps lf`peaf |epvkms

    ! fncdv|khf` zkpefnp pd wf|lkmerf

    gffmenhs

    C. eaz|dwf indxmf`hf dn

    c|knedzmkspu

    !fwkmvkpf` ckzklemepefs kn`

    |fk`enfss pd mfk|n

    !|fwefxf` engd|akpedn |fhk|`enh

    enbv|u z|dcfss kn` kgpf| fggfcps

    !sodxf` pof zkpefnp k zecpv|f dg

    pof sivmm kn` l|ken kn` fzmkenf`

    en seazmf pf|as pof sv|heckm

    z|dcf`v|f

    Kgpf| ? o|s. dg spv`fnp nv|sf zkpefnp enpf|kcpedn-

    pof zkpefnp xemm lf klmf pd 2

    ;. `fadnsp|kpf `fc|fksf en knefpu ks fwe`fncf` lu

    `fc|fksf en |fspmfss nfss

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    Sffn zkpefnp -

    Aksp. \kmzo

    Mkl|k`d|-seppen

    h dn lf`xkpcoenh

    pfmfwesedn xepodvp

    EW. Of es ;< ufk|s

    dm` kn` es gd|

    c|knedzmkspu.

    5? &

    |fsdm

    !ped

    D

    zousedmd

    z|dlmf

    fzf|efncf`

    pof zkpe

    L|vnsxeci Mfns Ad`fm

    /Zdsp!dzf|kpewf%

    Kcpvkm spkpf

    Dg zkpefnps

    cdn`epedn

    cvfs Nv|senh @ekhndsfs Nv|senh Kcpedns @fse|f` Dvpcdaf

    Dlbfcpewfs Hdkm

    K.Zousedmdhec Dwf|mdk`2Kmpf|kpedn en

    cdagd|p

    !enpf|aeppfpn zken dn |ehop zk|efpkm

    k|fk dg ofk`9 zken spk|pf` odv|s kgpf|

    k||ewenh g|da pof D\9ep es `fsc|elf`ks aem`mu spenhenh- khh|kwkpf` lu

    sv``fn ofk` adwfafnp- |fmefwf` lu

    |fsp kn` p|fkpf` xepo Afgfnkaec kce`

    ; ckz {?o zd

    !zkpefnp |kpf` zken ks 6 en k zken sckmf

    :g :!;: xof|fen : spkn`s gd| nd zken

    kn` ;: ks adsp zkengvm

    L.\esi gd| enfggfcpewf l|fkpoenh

    zkppf|n

    !zkpefnp oks l|dncoekm kspoak kn`

    oks vn`f|hdnf sv|hf|u gd| odv|s

    vn`f| hfnf|km knfspofsek

    !|fsze|kpd|u |kpf ;? l|fkpos zf|

    aenvpfC.\esi gd| engfspedn

    !zkpefnp es zdsp!c|knedzmkspu xepo

    ofk` `|fssenh |fengd|cf` xepo

    spf|emf zk`s

    Afksv|fs pd2

    K. z|dadpf cdagd|p

    !zdsepednf` zkpefnp sd pokp oes

    kggfcpf` se`f xemm ndp |fcfewf avco

    z|fssv|f

    !zf|gd|fa`f` aksskhf lvp ndp dn

    kggfcpf` zk|p!fncdv|khf` `ffz l|fkpoenh

    ff|cesfs

    !z|dadpf` |fsp

    !k`aenespf|f` af`eckpedns zf|

    `dcpd|s d|`f|

    L akenpken |fsze|kpd|u gvncpedn

    !zmkcf` zkpefnp en k sfae!z|dnf zdsepedn

    !svcpednf` p|kcofk

    !fmfwkpf` ofk` dg lf`ks z|fsc|elf`

    !k`aenespf|f` ndpoenh zf| d|fa vnpem kcpewf

    cdvhoenh kn` sxkmmdxenh |fgmffs |fpv|nf`

    C. akenpken wepkm sehns xepoen nd|akm |knhf

    !adnepd|f` sepf gd| sehns dg engfcpedn

    !ensp|vcpf` zkpefnp pd |fzd|p z|fsfncf dg skmpu

    pkspf!ensp|vcfpf` zkpefnp pd kwde` cdvhoenh-

    lmdxenh ndsf

    !vsf` ksfzpec pfcone{vf xofn okn`menh

    `|fssenhs

    !k`aenespf|f` z|dzoumkes zf| dcpd|s d|`f|

    E.Kmpf|kpedn en cdagd|p2zken |fmkpf`

    pd `es|vzpedn dg pessvf enpfh|epu

    sfcdn`k|u pd sv|heckm z|dcf`v|f

    EE.\esi gd| enfggfcpewf l|fkpoenhzkppf|n |fmkpf` pd zdsp!dzf|kpewf

    cf|fl|km f`fak

    EEE.\esi gd| engfcpedn |fmkpf` pd

    xdvn` dlpkenf` v|enh sv|hf|u

    Kgpf| ? o|s. dg spv`fnp nv|sf zkpefnp enpf|kcpedn- pof

    zkpefnp xemm lf klmf pd 2;. `fadnsp|kpf `fc|fksf en zken sfnskpedn ks fwe`fncf` lu k zkensckmf |kpenh ks ; en k zken sckmf dg :!;:

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    Zkpefnps nkaf2 \kmzo Mkl|k d| Khf2 ;< ufk|s dm Zousecekn2 @|.Wf|hk|k Nemd

    \dda nd. 2 0

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    dvp pofsf

    gffmenhs dvp

    en pof dzfn

    sd pofu ckn

    lf

    `escvssf`

    kn` `fkmp

    xepo

    ! zh.

    806-NCZs-

    Ak|emun

    @dfnhfs

    c.szfn` sdaf peaf

    xepo pof zkpefnp

    `.fncdv|khf hve`f`

    eakhf|u

    f. z|dwe`f

    pdvco-aksskhf

    @dfnhfs

    !cdnpenvdvs svzzd|p aku

    ofmz zkpefnp |fhken

    enpf|nkm mdcvs dg cdnp|dm!

    zh.807-NCZs-@dfnhfs

    !z|dadpf |fmfksf dg

    fn`d|zoens kn` |f`vcf

    knefpu!

    zh.806-NCZs-@dfnhfs

    !ke`s en affpenh lksec

    ovakn nff` `fc|fksenh

    sfnsf dg esdmkpedn!

    zh.806-NCZ-@dfnhfs!

    zh.806-NCZs-@dfnhfs

    Zkpefnps nkaf2 \kmzo Mkl|k d| Khf2 ;< ufk|s dm Zousecekn2 @|.Wf|hk|k Nemd

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    \dda nd. 2 0

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    `espv|lf` smffz

    zkppf|ns z|ed| pd

    kn` gdmmdxenh

    fmfcpewf sv|hf|u.

    Xf ouzdpofserf

    pokp afmkpdnen

    xemm eaz|dwf

    smffz zkppf|ns

    z|ed| pd kn`

    gdmmdxenh

    sv|hf|u- lu

    |f`vcenh smffz

    mkpfncu kn`

    fpfn`enh pdpkm

    smffz peaf. Xf

    kmsd ouzdpofserf

    pokp poes

    eaz|dwfafnp

    xemm okwf

    zdsepewf eazkcp

    dn knfspofpec

    sp|fss afksv|fs

    kn` dn |fcdwf|u.

    c. |fsp|ecpf` enpkif dg

    ckggfenf!cdnpkenenh

    gdd`s kn` gmve`s

    `.svzzd|pf`

    cdnpenvkpedn dg

    zkpefnps lf`peaf

    |epvkms

    zh.800-NCZs-@d

    fnhfs

    ! Ckggfenf

    mfnhpofns pof

    peaf ep pkifs pd

    gkmm ksmffz-

    |f`vcenh udv|

    pdpkm smffzenh

    peaf!zh.69 Hfp

    Rs ndx9

    Hfdgg|fu

    Lv|cogefm`

    !Coem`|fn nff` k

    gkaemek| kn`

    zmfksknp |dvpenf

    kn` pofsf k|f

    lf`peaf |epvkms

    xoeco ckn ofmz

    coem`|fn smffz dn

    peaf! zh.389 Hfp

    Rs ndx9

    Hfdgg|fu

    Lv|cogefm`

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    !zh.6:-Lfudn`

    pof \fmkkpedn

    \fszdnsf lu

    Of|lf|p Lfnrdn

    f. ! fncdv|khf`

    zkpefnp pd wf|lkmerf

    gffmenhs

    ! Pof sdv|cf dg

    vnfksenfss d|

    knefpu- xoeco es

    dgpfn k ckvsf dg

    smffz `espv|lkncf-

    es ndp kmxkus

    indxn d|

    |fcdhnerf`. Ep es

    ofmzgvm pd l|enh

    dvp gffmenhs sd

    pofu ckn lf

    `escvssf` kn`

    `fkmp xepo.!

    zh.806-NCZs-@d

    fnhfs

    Zkpefnps nkaf2 \kmzo Mkl|k d| Khf2 ;< ufk|s dm Zousecekn2 @|.Wf|hk|k Nemd

    \dda nd. 2 0

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    Nff`s$Z|dlmfas

    Cvfs

    Nv|senh

    @ekhndses

    Scefnpegec Lkses Dlbfcpewfs dg Ck|f Nv|senh Kcpedns \kpednkmf

    C.Indxmf`hf

    `fgecep2

    !zkpefnp g|f{vfnpmu

    ksis {vfspedns

    kldvp pof z|dcf`v|f

    !zkpefnp es dnmu ;