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Schneck E, Leicht D, Bender M, Stein M, Uhl E, Sander M, Koch C. Management of Cardiopulmonary Resuscitation in Patients Undergoing Intracranial Surgery Using Pin-type Head Clamps: A 12-years Retrospective Study. J Neurosurg Anesthesiol 2024; 36:172-173. [PMID: 36706359 DOI: 10.1097/ana.0000000000000898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/27/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Emmanuel Schneck
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen and Marburg, Giessen
| | - Dominik Leicht
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen and Marburg, Giessen
| | - Michael Bender
- Department of Neurosurgery, Justus Liebig University of Giessen, Germany
| | - Marco Stein
- Department of Neurosurgery, Justus Liebig University of Giessen, Germany
| | - Eberhard Uhl
- Department of Neurosurgery, Justus Liebig University of Giessen, Germany
| | - Michael Sander
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen and Marburg, Giessen
| | - Christian Koch
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen and Marburg, Giessen
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Kurt E, Kollenburg L, van Dongen R, Volkers R, Mulleners W, Vinke S. The Untold Story of Occipital Nerve Stimulation in Patients With Cluster Headache: Surgical Technique in Relation to Clinical Efficacy. Neuromodulation 2024; 27:22-35. [PMID: 38032594 DOI: 10.1016/j.neurom.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/24/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES Approximately one in every 1000 adults experiences cluster headache (CH). Although occipital nerve stimulation (ONS) appears encouraging in treatment for most patients with refractory CH, some patients do not reach adequate pain relief with ONS. A reason for failure of ONS might be anatomical variations and different surgical approaches. Therefore, an extensive literature analysis was performed, and cadaveric experimentation was combined with our clinical experience to provide a standardized proposal for ONS and obtain optimal management of patients with refractory CH. MATERIALS AND METHODS Data from 36 articles published between 1998 and 2023 were analyzed to retrieve information on the anatomical landmarks and surgical technique of ONS. For the cadaveric experimentation (N = 1), two electrodes were inserted from the region over the foramen magnum and projected toward the lower third of the mastoid process. RESULTS The existence of multiple approaches of ONS has been confirmed by the present analysis. Discrepancies have been found in the anatomical locations and corresponding landmarks of the greater and lesser occipital nerve. The surgical approaches differed in patient positioning, electrode placement, and imaging techniques, with an overall efficacy range of 35.7% to 90%. CONCLUSIONS Reports on the surgical approach of ONS remain contradictory, hence emphasizing the need for standardization. Only if all implanting physicians perform the ONS surgery using a standardized protocol, can future data be combined and outcomes compared and analyzed.
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Affiliation(s)
- Erkan Kurt
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Linda Kollenburg
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Robert van Dongen
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ruben Volkers
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wim Mulleners
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Saman Vinke
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Shah HA, Mehta NH, Mehta SH, Ward M, McBriar JD, D'Amico RS. Characterizing complications associated with skull clamps: A review of the manufacturer and user facility device experience database. Clin Neurol Neurosurg 2023; 235:108043. [PMID: 37944306 DOI: 10.1016/j.clineuro.2023.108043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Head immobilization with skull clamps is a prerequisite of many neurosurgical procedures. Adverse events relating to the use of skull clamps have been reported, however, given the paucity of published reports, we sought to conduct a more comprehensive analysis using the Manufacturer and User Facility Device Experience (MAUDE) database. METHODS The MAUDE database was queried for neurosurgical skull clamp events over a 10-year period between January 2013 and December 2022. Reports were qualitatively analyzed and categorically assigned by the study authors as 'mechanical failure,' 'slippage,' 'contamination,' 'insufficient information,' and 'other.' Patient injury reports were also classified as 'abrasion,' 'laceration,' 'hematoma,' 'fracture,' 'intracranial hemorrhage (ICH),' 'other,' 'insufficient information,' and 'death.' RESULTS Of 3672 reports retrieved, 2689 (73.2%) were device malfunctions, with mechanical failure (50.7%) and slippage (47.7%) being the most common causes. There were 983 reports (26.8%) involving patient injury which included lacerations (n = 776, 78.9%), fractures (n = 24, 2.4%), abrasions (n = 23, 2.3%), hematomas (n = 7, 0.71%), ICH (n = 3, 0.31%), and other causes (n = 6, 0.61%). Five (0.1%) deaths due to skull clamp related complications were also reported. CONCLUSIONS This study provides a more comprehensive picture of adverse events in neurosurgical procedures relating to the use of skull clamps. Mechanical failures of device parts were the most common device-related complication, and lacerations the most common adverse patient-related event. While more severe patient-related events were reported, they are relatively rare. The MAUDE database is useful for characterizing underreported device-related and patient-related adverse events.
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Affiliation(s)
- Harshal A Shah
- Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.
| | | | - Shyle H Mehta
- Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Max Ward
- Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Joshua D McBriar
- Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Randy S D'Amico
- Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
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Plevko M, Vybíhal V, Sova M, Fadrus P, Smrčka M. Epidural Hematoma, a Rare Complication After the Use of Mayfield Clamp: A Case Report and Review of the Literature. Korean J Neurotrauma 2023; 19:471-479. [PMID: 38222839 PMCID: PMC10782104 DOI: 10.13004/kjnt.2023.19.e39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/23/2023] [Accepted: 08/29/2023] [Indexed: 01/16/2024] Open
Abstract
Herein, we describe a case of epidural hematoma associated with the use of a Mayfield head clamp. An 18-year old patient with an upper brainstem tumour causing obstructive hydrocephalus underwent a routine third ventriculostomy, which unexpectedly revealed an intracranial hemorrhage. We outline potential risk factors, propose an algorithm for preventing complications associated with the use of pin-type fixation, and conducted a structured review of the literature to identify similar clinical scenarios.
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Affiliation(s)
- Martin Plevko
- Department of Neurosurgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Neurosurgery, University Hospital Brno, Brno, Czech Republic
| | - Václav Vybíhal
- Department of Neurosurgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Neurosurgery, University Hospital Brno, Brno, Czech Republic
| | - Marek Sova
- Department of Neurosurgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Neurosurgery, University Hospital Brno, Brno, Czech Republic
| | - Pavel Fadrus
- Department of Neurosurgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Neurosurgery, University Hospital Brno, Brno, Czech Republic
| | - Martin Smrčka
- Department of Neurosurgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Neurosurgery, University Hospital Brno, Brno, Czech Republic
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Lohss M, Ho J, Naylor N, Cashman S, Fu R, Tonya Stefko S, Byrne LC. Adaptable three-pin skull clamp for large animal research. HARDWAREX 2023; 15:e00472. [PMID: 37680492 PMCID: PMC10480779 DOI: 10.1016/j.ohx.2023.e00472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/10/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023]
Abstract
Traditionally, surgical head immobilization for neurobiological research with large animals is achieved using stereotaxic frames. Despite their widespread use, these frames are bulky, expensive, and inflexible, ultimately limiting surgical access and preventing research groups from practicing surgical approaches used to treat humans. Here, we designed a mobile, low-cost, three-pin skull clamp for performing a variety of neurosurgical procedures on non-human primates. Modeled after skull clamps used to operate on humans, our system was designed with added adjustability to secure heads with small or irregular geometries for innovative surgical approaches. The system has six degrees of freedom with skull pins attached to setscrews for independent, fine-tuned depth adjustment. Unlike other conventional skull clamps which require additional mounting fixtures, our system has an integrated tray with mounting bracket for easy use on most operating room tables. Our system has successfully secured primate heads in the supine and lateral position, allowing surgeons to match surgical approaches currently practiced when operating on humans. The system also expands the opportunity for researchers to utilize imaged-guided robotic surgery techniques. Overall, we hope that our system can serve as an adaptable, affordable, and robust surgery platform for any laboratory performing neurobiological research with large animal models.
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Affiliation(s)
- Maxwell Lohss
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, United States
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, United States
| | - Jonathan Ho
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, United States
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, United States
| | - Nathan Naylor
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, United States
| | - Stacy Cashman
- Division of Laboratory Animal Resources, University of Pittsburgh, Pittsburgh, United States
| | - Roxana Fu
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, United States
| | - S. Tonya Stefko
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, United States
| | - Leah C. Byrne
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, United States
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, United States
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, United States
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Harwick E, Singhal I, Conway B, Mueller W, Treffy R, Krucoff MO. Pinless Electromagnetic Neuronavigation During Awake Craniotomies: Technical Pearls, Pitfalls, and Nuances. World Neurosurg 2023; 175:e159-e166. [PMID: 36924891 DOI: 10.1016/j.wneu.2023.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/11/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Awake craniotomies are often performed with rigid pin fixation to support optical neuronavigation. Newer electromagnetic (EM) neuronavigation technology now enables unpinned cranial neurosurgery while maintaining robust intraoperative image guidance. Here, we share technical nuances, operative pearls, and lessons learned from our institutional experience using Curve EM neuronavigation during awake, unpinned craniotomies. METHODS We describe our process for patient positioning, instrumentation setup, system registration, intraoperative navigation, and surgical adjunct use (e.g., intraoperative neuromonitoring and intraoperative magnetic resonance imaging) in detail. At each step, we provide pearls for success and tips for pitfall avoidance based on our experience. RESULTS Ten patients underwent awake pinless intra-axial tumor resection using Curve EM neuronavigation from May 2021 to August 2022 with a single surgeon. Postoperative transient neurological deficits were seen in 8 of 10 cases (80.0%), as all resections were taken to functional margins. Of the 9 patients with a 3-month follow-up visit at the time of publication, all 9 (100%) had improved or stable preoperative symptoms. No surgical complications, clinically appreciable inaccuracies, intraoperative losses of registration, unexpected postoperative magnetic resonance imaging findings, or errors related to the use of EM neuronavigation occurred. CONCLUSIONS The technical pearls outlined here will help interested neurosurgeons integrate EM neuronavigation into awake craniotomies. In our experience, using unpinned neuronavigation during awake cases provides many advantages to the patient, surgeon, and entire operative team. It has thus become the standard practice at our institution.
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Affiliation(s)
- Edward Harwick
- Medical College of Wisconsin, School of Medicine, Milwaukee, Wisconsin, USA
| | - Ishan Singhal
- Medical College of Wisconsin, School of Medicine, Milwaukee, Wisconsin, USA
| | - Brian Conway
- Medical College of Wisconsin, School of Medicine, Milwaukee, Wisconsin, USA
| | - Wade Mueller
- Department of Neurosurgery, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin, USA
| | - Randall Treffy
- Department of Neurosurgery, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin, USA
| | - Max O Krucoff
- Department of Neurosurgery, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin, USA; Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin Graduate School, Milwaukee, Wisconsin, USA.
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Pediatric neuroanesthesia experiences: A single center retrospective cohort study. JOURNAL OF SURGERY AND MEDICINE 2023. [DOI: 10.28982/josam.7731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Background/Aim: Pediatric neuroanesthesia is a special field that requires significant experience and infrastructure because of anatomical, neurological, and pharmacological differences in the pediatric patient population. Although technological improvements provide more effective and safer neuroanesthesiological management, the principles of neuroanesthesia, neurocognitive development, and the effects of anesthetic agents on central nervous system development are well-known. The majority of pediatric neuroanesthesia articles in the literature are reviews; however, retrospective/prospective case series and controlled research are limited. In this retrospective cohort study, we aimed to contribute to the existing literature by reviewing and analyzing our single-center 10-year experiences and results addressing pediatric neuroanesthesia management.
Methods: After ethical committee approval, anesthetic and surgical reports from 1165 pediatric neurosurgical cases over ten years were collected. Demographic data, intra-operative vascular management, anesthesia techniques, airway management, patient positions, analgesia methods, and complications were evaluated in this retrospective cohort study. The available surgical intervention, patient positions, intra-operative neuromonitorization (IONM), and intra-operative magnetic resonance imaging (IOMR) records were also analyzed.
Results: Six-hundred forty-six (55.4%) girls and 519 (44.5%) boys were included in the study. The median age was 60 (0–216) months. Cranial interventions were performed in 842 (72.3%) patients, and spinal interventions were performed in 323 (27.7%) patients. Patients’ American Society of Anesthesiologists (ASA) physical scales grouped as I, II, III, and IV were 718 (61.6%), 360 (30.9%), 82 (7%), and 5 (0.4%), respectively. Sevoflurane (40.3%), propofol (37.2%), and sodium thiopental (2.5%) were used for anesthetic induction. Neuromuscular block was performed with rocuronium (56.7%) and atracurium (14.4%). Neuromuscular blocking agents were not used in 337 patients (28.9%). A blood transfusion was required in 120 patients (10.3%), and 40% of these patients underwent surgery for craniosynostosis. Two-hundred twenty-two (19.1%) were monitored with IONM, and IOMR was carried out in 124 (10.6%) of the cases. The anesthesia-related complication rate was 5.15% (60 patients).
Conclusion: Although pediatric neurosurgical interventions involve high risks, they are becoming increasingly common in our daily practice. Neuroanesthesiologists should know the procedures, techniques, and advances for safe and effective management of pediatric neurosurgical cases. We think that these data may be helpful as a guide for the anesthetic management of pediatric neurosurgical cases.
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Endoscopic microvascular decompression without the use of rigid head fixation. J Clin Neurosci 2022; 106:213-216. [DOI: 10.1016/j.jocn.2022.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/05/2022] [Accepted: 10/28/2022] [Indexed: 11/11/2022]
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Nie JZ, Weber MW, Revelt NJ, Nordmann NJ, Watson VL, Nie JW, Menezes SA, Delfino K, Cozzens JW, Espinosa JA, Amin D, Acakpo-Satchivi L. Comparison of Using Intraoperative Computed Tomography-Based 3-Dimensional Navigation and Fluoroscopy in Anterior Cervical Diskectomy and Fusion for Cervical Spondylosis. World Neurosurg 2022; 161:e740-e747. [PMID: 35231621 DOI: 10.1016/j.wneu.2022.02.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Anterior cervical diskectomy and fusion (ACDF) is a highly successful procedure to treat spinal cord or nerve root compression; however, complications can still occur. With advancements in imaging, 3-dimensional (3D) reconstruction allows real-time instrument tracking in a surgical field relative to the patient's anatomy. Here, we compare plate positioning and short-term outcomes when using 3D navigation to fluoroscopy in ACDF for degenerative spine disease. METHODS All ACDFs for cervical spondylosis performed by 6 surgeons at a single center between 2010 and 2018 were included. ACDFs were divided into those performed using 3D navigation or fluoroscopy. Records were assessed for patient demographics, American Society of Anesthesiology score, number of operated interspaces, operative time, length of stay, perioperative complications, and 90-day readmissions. Postoperative images were reviewed for lateral and angular plate deviations. RESULTS A total of 193 ACDFs performed with 3D navigation and 728 performed with fluoroscopy were included. After controlling for demographics and surgical characteristics, using 3D navigation was associated with less lateral plate deviation (P = 0.048) and longer operative times per interspace (P < 0.001) but was not associated with angular plate deviation (P = 0.724), length of stay (P = 0.393), perioperative complications (P = 0.844), and 90-day readmissions (P = 0.539). CONCLUSIONS Using 3D navigation in ACDF for degenerative disease is associated with slightly more midline plate positioning and comparable short-term outcomes as using fluoroscopy and can be a suitable alternative. Advantages of using this technology, such as improved visualization of anatomy, should be weighed against disadvantages, such as increased operative time, on a per-patient basis.
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Affiliation(s)
- Jeffrey Z Nie
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA.
| | - Matthew W Weber
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Nicolas J Revelt
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Nathan J Nordmann
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Victoria L Watson
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - James W Nie
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA; University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Stephanie A Menezes
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Kristin Delfino
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Jeffrey W Cozzens
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Jose A Espinosa
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Devin Amin
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Leslie Acakpo-Satchivi
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA; Neurological Surgery, Springfield Clinic, Springfield, Illinois, USA
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