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Muh CR, Dorilio JR, Beaudreault CP, McGoldrick PE, Pisapia JM, Wolf SM. Feasibility and safety of stereoelectroencephalography in young children. Childs Nerv Syst 2024; 40:1331-1337. [PMID: 38451299 DOI: 10.1007/s00381-024-06335-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/23/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE Stereoelectroencephalography (SEEG) is a diagnostic surgery that implants electrodes to identify areas of epileptic onset in patients with drug-resistant epilepsy (DRE). SEEG is effective in identifying the epileptic zone; however, placement of electrodes in very young children has been considered contraindicated due to skull thinness. The goal of this study was to evaluate if SEEG is safe and accurate in young children with thin skulls. METHODS Four children under the age of two years old with DRE underwent SEEG to locate the region of seizure onset. Presurgical planning and placement of electrodes were performed using ROSA One Brain. Preoperative electrode plans were merged with postoperative CT scans to determine accuracy. Euclidean distance between the planned and actual trajectories was calculated using a 3D coordinate system at both the entry and target points for each electrode. RESULTS Sixty-three electrodes were placed among four patients. Mean skull thickness at electrode entry sites was 2.34 mm. The mean difference between the planned and actual entry points was 1.12 mm, and the mean difference between the planned and actual target points was 1.73 mm. No significant correlation was observed between planned and actual target points and skull thickness (Pearson R = - 0.170). No perioperative or postoperative complications were observed. CONCLUSIONS This study demonstrates that SEEG can be safe and accurate in children under two years of age despite thin skulls. SEEG should be considered for young children with DRE, and age and skull thickness are not definite contraindications to the surgery.
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Affiliation(s)
- Carrie R Muh
- Department of Neurosurgery and Department of Pediatrics, Westchester Medical Center, 100 Woods Road, Taylor Pavilion E135, Valhalla, NY, 10595, USA.
- Department of Neurosurgery, New York Medical College, Valhalla, NY, 10595, USA.
| | | | | | - Patricia E McGoldrick
- Department of Pediatric Neurology, Boston Children's Health Physicians, Hawthorne, NY, USA
| | - Jared M Pisapia
- Department of Neurosurgery and Department of Pediatrics, Westchester Medical Center, 100 Woods Road, Taylor Pavilion E135, Valhalla, NY, 10595, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, 10595, USA
| | - Steven M Wolf
- Department of Pediatric Neurology, Boston Children's Health Physicians, Hawthorne, NY, USA
- Department of Neurology, New York Medical College, Valhalla, NY, USA
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Perez Zabala J, Basilotta Marquez Y, Argañaraz R, Mantese B. Safe First-Time use of Stereotactic Headband Fixation in a 5-Month-Old Child: An Economical and Easily Accessible Method. World Neurosurg 2024; 181:60-63. [PMID: 37844845 DOI: 10.1016/j.wneu.2023.10.050] [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: 06/03/2023] [Revised: 10/08/2023] [Accepted: 10/08/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE We present a low-cost and easily accessible adaptation system to perform stereotactic procedures in infants. METHODS We used an adaptive device consisting of a headband with a plaster bandage, cotton bandage roll, and gauze bandages. Prior to its clinical application, the device was tested in our neuroscience laboratory using a simulation model of a size similar to that of a 5-month-old infant, during which no complications arose. The headband cast technique was subsequently reproduced in a 5-month-old patient, serving as a fixation point for the placement of a Micromar frame for biopsy of a thalamic lesion. RESULTS A stereotactic biopsy was successfully performed in a 5-month-old patient using a headband cast to secure the stereotactic frame. This method enabled precise targeting of the selected site, resulting in a histopathological diagnosis without any associated complications. CONCLUSIONS The adaptive device is safe, easily accessible, and reproducible, facilitating the performance of stereotactic diagnostic procedures in infants, accurately reaching the planned objective without causing injuries or additional complications.
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Affiliation(s)
- Joaquin Perez Zabala
- Neurosurgery Department Buenos Aires, Juan P. Garrahan Hospital, Buenos Aires, Argentina.
| | | | - Romina Argañaraz
- Neurosurgery Department Buenos Aires, Juan P. Garrahan Hospital, Buenos Aires, Argentina
| | - Beatriz Mantese
- Neurosurgery Department Buenos Aires, Juan P. Garrahan Hospital, Buenos Aires, Argentina
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3
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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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A novel technique for frame-based MR-guided laser ablation in an infant. Childs Nerv Syst 2023; 39:497-503. [PMID: 35925382 DOI: 10.1007/s00381-022-05616-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/23/2022] [Indexed: 11/03/2022]
Abstract
Hypothalamic hamartomata (HH) not only are usually associated with drug-resistant epilepsy but can also cause precocious puberty and developmental delay. Gelastic seizures are the most common type of seizures. Magnetic resonance image (MRI)-guided laser interstitial thermal therapy (LiTT) is a technique whereby a laser fibre is stereotactically implanted into a target lesion and heat is used to ablate whilst tissue temperature is monitored using MRI thermography. MRI-guided LiTT has proven to be an effective and safe method to treat HH. To use the LiTT system, highly accurate stereotactic fibre implantation is required. This can be achieved by the use of frame-based or frameless neuronavigation techniques. However, these techniques generally involve rigid head immobilisation using cranial pin fixation. Patients need sufficient skull thickness to safely secure the pins and sufficient skull rigidity to prevent deformation. Hence, most of the clinical reports on the use of LiTT for children describe patients aged 2 years or older. We report a novel and practical technique of using a paste cast helmet to securely place a stereotactic frame in a 5-month-old infant with HH and drug-resistant epilepsy that allowed the successful application of MRI-guided LiTT.
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5
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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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Yue JK, Chang D, Caton MT, Haddad AF, Dalle Ore CL, Wozny TA, Oh T, Wang AS, Tonetti DA, Auguste KI, Sun PP, Cooke DL, Hetts SW, Abla AA, Gupta N, Roland JL. The Hybrid Operative Suite with Intraoperative Biplane Rotational Angiography in Pediatric Cerebrovascular Neurosurgery: Utility and Lessons Learned. Pediatr Neurosurg 2022; 57:245-259. [PMID: 35508115 DOI: 10.1159/000524875] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/26/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The benefits of performing open and endovascular procedures in a hybrid neuroangiography surgical suite include confirmation of treatment results and reduction in number of procedures, leading to improved efficiency of care. Combined procedural suites are infrequently used in pediatric facilities due to technical and logistical limitations. We report the safety, utility, and lessons learned from a single-institution experience using a hybrid suite equipped with biplane rotational digital subtraction angiography and pan-surgical capabilities. METHODS We conducted a retrospective review of consecutive cases performed at our institution that utilized the hybrid neuroangiography surgical suite from February 2020 to August 2021. Demographics, surgical metrics, and imaging results were collected from the electronic medical record. Outcomes, interventions, and nuances for optimizing preoperative/intraoperative setup and postoperative care were presented. RESULTS Eighteen procedures were performed in 17 patients (mean age 13.4 years, range 6-19). Cases included 14 arteriovenous malformations (AVM; 85.7% ruptured), one dural arteriovenous fistula, one mycotic aneurysm, and one hemangioblastoma. The average operative time was 416 min (range 321-745). There were no intraoperative or postoperative complications. All patients were alive at follow-up (range 0.1-14.7 months). Five patients had anticipated postoperative deficits arising from their hemorrhage, and 12 returned to baseline neurological status. Four illustrative cases demonstrating specific, unique applications of the hybrid angiography suite are presented. CONCLUSION The hybrid neuroangiography surgical suite is a safe option for pediatric cerebrovascular pathologies requiring combined surgical and endovascular intervention. Hybrid cases can be completed within the same anesthesia session and reduce the need for return to the operating room for resection or surveillance angiography. High-quality intraoperative angiography enables diagnostic confirmation under a single procedure, mitigating risk of morbidity and accelerating recovery. Effective multidisciplinary planning enables preoperative angiograms to be completed to inform the operative plan immediately prior to definitive resection.
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Affiliation(s)
- John K Yue
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Diana Chang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Michael Travis Caton
- Department of Neurointerventional Radiology, University of California, San Francisco, San Francisco, California, USA
| | - Alexander F Haddad
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Cecilia L Dalle Ore
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Thomas A Wozny
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Taemin Oh
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Albert S Wang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Daniel A Tonetti
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Kurtis I Auguste
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.,Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Peter P Sun
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.,Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Daniel L Cooke
- Department of Neurointerventional Radiology, University of California, San Francisco, San Francisco, California, USA
| | - Steven W Hetts
- Department of Neurointerventional Radiology, University of California, San Francisco, San Francisco, California, USA
| | - Adib A Abla
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Nalin Gupta
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.,Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Jarod L Roland
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
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Smith AD, Teague AJ, Naik A, Janbahan M, Smith EJ, Krist DT, Parupalli S, Teal K, Hassaneen W. Robotic external ventricular drain placement for acute neurosurgical care in low-resource settings: feasibility considerations and a prototype design. Neurosurg Focus 2022; 52:E14. [PMID: 34973667 DOI: 10.3171/2021.10.focus21544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/18/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Emergency neurosurgical care in lower-middle-income countries faces pronounced shortages in neurosurgical personnel and infrastructure. In instances of traumatic brain injury (TBI), hydrocephalus, and subarachnoid hemorrhage, the timely placement of external ventricular drains (EVDs) strongly dictates prognosis and can provide necessary stabilization before transfer to a higher-level center of care that has access to neurosurgery. Accordingly, the authors have developed an inexpensive and portable robotic navigation tool to allow surgeons who do not have explicit neurosurgical training to place EVDs. In this article, the authors aimed to highlight income disparities in neurosurgical care, evaluate access to CT imaging around the world, and introduce a novel, inexpensive robotic navigation tool for EVD placement. METHODS By combining the worldwide distribution of neurosurgeons, CT scanners, and gross domestic product with the incidence of TBI, meningitis, and hydrocephalus, the authors identified regions and countries where development of an inexpensive, passive robotic navigation system would be most beneficial and feasible. A prototype of the robotic navigation system was constructed using encoders, 3D-printed components, machined parts, and a printed circuit board. RESULTS Global analysis showed Montenegro, Antigua and Barbuda, and Seychelles to be primary candidates for implementation and feasibility testing of the novel robotic navigation system. To validate the feasibility of the system for further development, its performance was analyzed through an accuracy study resulting in accuracy and repeatability within 1.53 ± 2.50 mm (mean ± 2 × SD, 95% CI). CONCLUSIONS By considering regions of the world that have a shortage of neurosurgeons and a high incidence of EVD placement, the authors were able to provide an analysis of where to prioritize the development of a robotic navigation system. Subsequently, a proof-of-principle prototype has been provided, with sufficient accuracy to target the ventricles for EVD placement.
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Affiliation(s)
- Alexander D Smith
- 1Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana; and
| | - Alexander J Teague
- 1Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana; and
| | - Anant Naik
- 1Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana; and
| | - Mika Janbahan
- 1Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana; and
| | - Emily J Smith
- 1Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana; and
| | - David T Krist
- 1Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana; and
| | - Sindhu Parupalli
- 1Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana; and
| | - Kevin Teal
- 1Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana; and.,2Department of Neurological Surgery, Neuroscience Institute, Carle Foundation Hospital, Urbana, Illinois
| | - Wael Hassaneen
- 1Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana; and.,2Department of Neurological Surgery, Neuroscience Institute, Carle Foundation Hospital, Urbana, Illinois
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Hiwatari T, Yamahata H, Yonenaga M, Fujio S, Higa N, Hanaya R, Arita K, Yoshimoto K. The Incidence of Depressed Skull Fractures Due to the Use of Pin-Type Head Frame Systems in the Adult Population: 10-year Experience of a Single Neurosurgical Center. World Neurosurg 2021; 155:e395-e401. [PMID: 34425293 DOI: 10.1016/j.wneu.2021.08.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Pin-type head frame systems have become a worldwide standard procedure, but they can cause some complications on rare occasions. This study aimed to examine the incidence and associated risk factors of depressed skull fracture and related intracranial hematoma (DSFH) due to the use of head frames in our institute over the past 10 years. METHODS This study included 1749 patients who underwent neurosurgical surgeries using pin-type head frames, including the Mayfield (Integra NeuroSciences, Plainsboro, NJ) skull clamp (721 cases) and the Sugita (Mizuho Ikakogyo Co., Ltd., Tokyo, Japan) head frame (1028 cases). We retrospectively reviewed hospital records of our institute to identify cases of DSFH, and documented the type of head frame used, as well as patient characteristics. RESULTS The incidence of DSFH was 0.29% (5 of 1749 cases). All 5 cases had an associated epidural hematoma, with a single case having an additional dural laceration (without subdural damage). All perforation sites, located at the parietal bone near the pterion, occurred by the unilateral horizontal screw of the Sugita head frame. None of the patients experienced postoperative neurological decline. CONCLUSIONS Even in the adult population, the DSFH by the pin-type head frame can occur infrequently. Based on our results, we recommend that the following factors should be considered when the pin-type head frame is used for neurosurgical procedures: location of pin application, thickness and fragility of the skull, and adequate control of compressive forces exerted by the head frame.
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Affiliation(s)
- Takaaki Hiwatari
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Hitoshi Yamahata
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
| | - Masanori Yonenaga
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Shingo Fujio
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Nayuta Higa
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Ryosuke Hanaya
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kazunori Arita
- Department of Neurosurgery, Izumi Regional Hospital, Kagoshima, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Thijs D, Menovsky T. The Mayfield Skull Clamp: A Literature Review of Its Complications and Technical Nuances for Application. World Neurosurg 2021; 151:102-109. [PMID: 33940273 DOI: 10.1016/j.wneu.2021.04.081] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Mayfield skull clamp is the most commonly used 3-pin head immobilization device. It is routinely used in cranial neurosurgical procedures and selected cervical procedures. Despite its role in some serious complications, guidelines and nuances on the correct application of the Mayfield clamp are lacking. The goal of this article was to present an overview of the complications associated with the Mayfield skull clamp. We also present a conceptual framework of the correct use-in our opinion-of the Mayfield clamp in several standard approaches to avoid the most common complications. METHODS PubMed was searched for original articles published between 1980 and 2020 with the search terms "Mayfield skull clamp" and "Mayfield head clamp." Eligibility criteria were availability of English abstract and complications clearly attributed to the Mayfield skull clamp. Both authors assessed all search results for eligibility. Additional articles were found with cross-references. RESULTS The most common complications associated with Mayfield clamp application were due to vascular injury inflicted by the pins or skull fractures. Complications related to use of the Mayfield clamp were rare but often serious and avoidable. A conceptual framework was presented on how to avoid these complications. CONCLUSIONS Attention to detail, anatomy, and the primum non nocere principle are imperative in every step of the neurosurgical pathway, including placement of the Mayfield skull clamp. Thoughtful application, taking into consideration several nuances, is recommended to avoid inadvertent patient harm.
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Affiliation(s)
- Dieter Thijs
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium.
| | - Tomas Menovsky
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium
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10
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Cheng G, Hao S, Ye Z, Wang B, Huangpu B, Zhang P, Wang H, Hao Q. Potential risk analysis and experience summarization of unstable factors of cranial fixation devices in neurosurgical operations: three-case reports and systematic review. Chin Neurosurg J 2021; 7:25. [PMID: 33910652 PMCID: PMC8080414 DOI: 10.1186/s41016-021-00244-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 04/13/2021] [Indexed: 11/28/2022] Open
Abstract
Background The use of cranial fixation devices in neurosurgery is very common, which is considered to be an important auxiliary method for many craniotomies. However, previous studies have reported complications of using cranial fixation devices, including brain tissue, nerve and blood vessel damage, scalp laceration, subcutaneous hematoma, etc. Some of the complications are serious and even potentially fatal, and the causes of which may be related to the incorrect use of cranial fixation devices. Although there are no serious complications in our review, the cause of that needs to be further summarized and analyzed, as so to minimize the serious consequences caused by the cranial fixation device slippage and ensure the safety of the patients’ surgical procedure. Case presentation In our recent work, we have continuously found three cases of unstable cranial fixation devices, which make us to analyze the possible factors and summarize experience combined with the review of other senior neurosurgeons (more than 3 years of working experience) from different departments of neurosurgery. Conclusions Based on our recent incidents of unstable cranial fixation and the experience of investigating and analyzing senior doctors from different neurosurgery centers, we summarized experience to minimize the risk of unstable cranial fixation. We tried a variety of options, including a safe anatomical location for cranial fixation, teamwork, and communication with anesthesiologists and itinerant nurses, to ensure the stability of the patient’s cranial fixation devices. The data obtained in this survey has great limitations, including the doctor’s personal prejudice and dependence on anecdotal memories. Therefore, the data should be interpreted with caution. However, there are still some modes that can help to better understand the use of safe cranial fixation. Based on the above research and analysis, we have made recommendations that may help neurosurgeons to avoid preventable complications
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Affiliation(s)
- Gaopeng Cheng
- Department of Neurosurgery, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi Province, China
| | - Shuyu Hao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhifen Ye
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bao Wang
- Department of Neurosurgery, Jinzhong First People's Hospital, Jinzhong, Shanxi Province, China
| | - Bin Huangpu
- Department of Neurosurgery, Linfen People's Hospital, Linfen, Shanxi Province, China
| | - Pengfei Zhang
- Department of Neurosurgery, The Seventh Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hao Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qiang Hao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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11
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Furuya T, Yamazaki M, Nemoto T, Okawa A, Ohtori S. Skull fracture and epidural hematoma caused by use of a Mayfield skull clamp in an adult patient with chronic hemodialysis: a case report. J Med Case Rep 2021; 15:154. [PMID: 33832515 PMCID: PMC8033709 DOI: 10.1186/s13256-021-02776-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mayfield skull clamps are widely used and indispensable in current neurosurgery. Complications such as skull fractures or intracranial hematoma from using a Mayfield skull clamp have largely been reported in the pediatric population, are likely related to the relative thinness of the skull, such as in patients with hydrocephalus, and are extremely rare in adults. Here, we report a case of skull fracture and epidural hematoma caused by a Mayfield skull clamp used for posterior decompression surgery in an adult patient with chronic hemodialysis. CASE PRESENTATION A 67-year-old Asian male patient with a history of dialysis-dependent chronic renal failure over 36 years suffered from severe cervical myelopathy. Neurological examination and radiographic images revealed cervical spondylotic myelopathy due to dialysis-related spondyloarthropathy. Laminoplasty was planned on patient consent. A Mayfield skull clamp was applied with the patient supine. Torque was applied to the screws with gentle care, but there was no resistance and it was not easy to reach the standard 60 lb (267 N) to 80 lb (356 N). Because a skull fracture was suspected, we canceled the surgery. Emergency head computed tomography showed depressed skull fractures underlying the single-pin sites with an associated epidural hematoma. The fractures and epidural hematoma were treated conservatively, and spontaneous resolution of the hematoma was confirmed. Cervical laminoplasty was performed successfully using a mask-type head holder on the subsequent day. CONCLUSIONS As a precaution for fractures and epidural hematoma in neurosurgical patients with bone fragility or a thin skull, use of a mask-type fixing device or halo ring is recommended.
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Affiliation(s)
- Takeo Furuya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba-shi, Chiba, 260-8677, Japan.
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tenodai, Tsukuba-shi, Ibaraki, 305-8575, Japan
| | - Tetsuharu Nemoto
- Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2 Ebaradai, Sakura-shi, Chiba, 285-8765, Japan
| | - Akihiko Okawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba-shi, Chiba, 260-8677, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba-shi, Chiba, 260-8677, Japan
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12
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Visentin A, van Dooren K, Mertens J, Brina O, Schaller K. Respond of the different human cranial bones to pin-type head fixation device. Acta Neurochir (Wien) 2021; 163:885-893. [PMID: 33515124 PMCID: PMC7966194 DOI: 10.1007/s00701-021-04728-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/18/2021] [Indexed: 11/24/2022]
Abstract
Background At this juncture, there is no consensus in the literature for the use and the safety of pin-type head holders in cranial procedures. Methods The present analysis of the bone response to the fixation of the instrument provides data to understand its impact on the entire skull as well as associated complications. An experimental study was conducted on fresh-frozen human specimens to analyze the puncture hole due to the fixation of each single pin of the pin-type head holder. Cone-beam CT images were acquired to measure the diameter of the puncture hole caused by the instrument according to several parameters: the pin angle, the clamping force, and different neurosurgical approaches most clinically used. Results The deepest hole, 2.67 ± 0.27 mm, was recorded for a 35° angle and a clamping force of 270 N at the middle fossa approach. The shallowest hole was 0.62 ± 0.22 mm for the 43° angle with a pinning force of 180 N in the pterional approach. The pterional approach had a significantly different effect on the depth of the puncture hole compared with the middle fossa craniotomy for 270 N pinning at 35° angle. The puncture hole measured with the 43° angle and 180 N force in prone position is significantly different from the other approaches with the same force. Conclusions These results could lead to recommendations about the use of the head holder depending on the patient’s history and cranial thickness to reduce complications associated with the pin-type head holder during clinical applications.
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Affiliation(s)
- Alissa Visentin
- Department of Neurosurgery, University of Geneva Medical Center & Faculty of Medicine, University of Geneva, Swiss Foundation for Innovation & Training in Surgery (SFITS), Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland.
| | - Kristina van Dooren
- Department of Neurosurgery, University of Geneva Medical Center & Faculty of Medicine, University of Geneva, Swiss Foundation for Innovation & Training in Surgery (SFITS), Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland
| | - Jan Mertens
- Black Forest Medical Group, Freiburg, Germany
| | - Olivier Brina
- Division of Neuroradiology, University of Geneva Medical Center & Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Karl Schaller
- Department of Neurosurgery, University of Geneva Medical Center & Faculty of Medicine, University of Geneva, Swiss Foundation for Innovation & Training in Surgery (SFITS), Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland
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13
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Setiawan CT, Landrigan-Ossar M. Pediatric Anesthesia Outside the Operating Room: Case Management. Anesthesiol Clin 2020; 38:587-604. [PMID: 32792186 DOI: 10.1016/j.anclin.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anesthesiology teams care for children in diverse locations, including diagnostic and interventional radiology, gastroenterology and pulmonary endoscopy suites, radiation oncology units, and cardiac catheterization laboratories. To provide safe, high-quality care, anesthesiologists working in these environments must understand the unique environmental and perioperative considerations and risks involved with each remote location and patient population. Once these variables are addressed, anesthesia and procedural teams can coordinate to ensure that patients and families receive the same high-quality care that they have come to expect in the operating room. This article also describes some of the considerations for anesthetic care in outfield locations.
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Affiliation(s)
- Christopher Tan Setiawan
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Anesthesiology, Children's Medical Center, 1935 Medical District Drive, Dallas, TX 75235, USA
| | - Mary Landrigan-Ossar
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA.
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14
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LoPresti MA, Nguyen J, Lam SK. Pinning in pediatric neurosurgery: the modified rubber stopper technique. J Neurosurg Pediatr 2020; 26:98-103. [PMID: 32276245 DOI: 10.3171/2020.1.peds19541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/31/2020] [Indexed: 11/06/2022]
Abstract
Head immobilization devices with skull pins are commonly used by neurosurgeons to stabilize the head for microsurgical techniques and to maintain accurate intraoperative neuronavigation. Pediatric patients, who may have open fontanelles, unfused sutures, and thin skulls, are vulnerable to complications during placement in pins. We review the various methods of pinning in pediatric neurosurgery and revisit the modified rubber stopper technique using a commonly available rubber stopper from a medication bottle over a standard adult pin of a Mayfield head clamp to prevent the pins from plunging through the thin pediatric skull.
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Affiliation(s)
- Melissa A LoPresti
- 1Department of Neurosurgery, Baylor College of Medicine, Houston
- 2Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, Texas
| | - Joshua Nguyen
- 3Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago; and
- 4Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Sandi K Lam
- 3Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago; and
- 4Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
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15
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Pindrik J, Hoang N, Smith L, Halverson M, Wojnaroski M, McNally K, Gedela S, Ostendorf AP. Preoperative evaluation and surgical management of infants and toddlers with drug-resistant epilepsy. Neurosurg Focus 2019; 45:E3. [PMID: 30173613 DOI: 10.3171/2018.7.focus18220] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Despite perioperative risks, epilepsy surgery represents a legitimate curative or palliative treatment approach for children with drug-resistant epilepsy (DRE). Several factors characterizing infants and toddlers with DRE create unique challenges regarding optimal evaluation and management. Epilepsy surgery within children < 3 years of age has received moderate attention in the literature, including mainly case series and retrospective studies. This article presents a systematic literature review and explores multidisciplinary considerations for the preoperative evaluation and surgical management of infants and toddlers with DRE. METHODS The study team conducted a systematic literature review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, targeting studies that investigated children < 3 years of age undergoing surgical treatment of DRE. Using the PubMed database, investigators selected peer-reviewed articles that reported seizure outcomes with or without developmental outcomes and/or perioperative complications. Studies were eliminated based on the following exclusion criteria: sample size < 5 patients; and inclusion of patients > 3 years of age, when demographic and outcomes data could not be separated from the cohort of patients < 3 years of age. RESULTS The study team identified 20 studies published between January 1990 and May 2017 that satisfied eligibility criteria. All selected studies represented retrospective reviews, observational studies, and uncontrolled case series. The compiled group of studies incorporated 465 patients who underwent resective or disconnective surgery (18 studies, 444 patients) or vagus nerve stimulator insertion (2 studies, 21 patients). Patient age at surgery ranged between 28 days and 36 months, with a mean of 16.8 months (1.4 years). DISCUSSION The study team provided a detailed summary of the literature review, focusing on the etiologies, preoperative evaluation, surgical treatments, seizure and developmental outcomes, and potential for functional recovery of infants and toddlers with DRE. Additionally, the authors discussed special considerations in this vulnerable age group from the perspective of multiple disciplines. CONCLUSIONS While presenting notable challenges, pediatric epilepsy surgery within infants and toddlers (children < 3 years of age) offers significant opportunities for improved seizure frequency, neuro-cognitive development, and quality of life. Successful evaluation and treatment of young children with DRE requires special consideration of multiple aspects related to neurological and physiological immaturity and surgical morbidity.
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Affiliation(s)
- Jonathan Pindrik
- 1Division of Pediatric Neurosurgery, Department of Neurosurgery.,2Department of Neurological Surgery, The Ohio State University College of Medicine; and
| | - Nguyen Hoang
- 2Department of Neurological Surgery, The Ohio State University College of Medicine; and
| | - Luke Smith
- 2Department of Neurological Surgery, The Ohio State University College of Medicine; and
| | - Mark Halverson
- 3Division of Pediatric Neuroradiology, Department of Radiology, and
| | - Mary Wojnaroski
- 4Section of Pediatric Psychology and Neuropsychology, Department of Pediatrics, Nationwide Children's Hospital
| | - Kelly McNally
- 4Section of Pediatric Psychology and Neuropsychology, Department of Pediatrics, Nationwide Children's Hospital
| | - Satyanarayana Gedela
- 5Division of Child Neurology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Adam P Ostendorf
- 5Division of Child Neurology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
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16
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Atteya MME, Raslan S, Elkallaf M. Letter: Complications of Head Immobilization Devices in Children: Contact Mechanics, and Analysis of a Single Institutional Experience. Neurosurgery 2019; 84:E95. [PMID: 30295865 DOI: 10.1093/neuros/nyy462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mostafa M E Atteya
- Department of Neurosurgery Faculty of Medicine Helwan University Cairo, Egypt
| | - Sherif Raslan
- Department of Neurosurgery Faculty of Medicine Helwan University Cairo, Egypt
| | - Mohamed Elkallaf
- Department of Critical Care and Anesthesiology Kasr Al Ainy School of Medicine Cairo University Cairo, Egypt
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17
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Atteya MME, Raslan S, Elkallaf M, Soliman MS, AlQalla MA. A novel method for safe and accurate placement of the rocker pins of head immobilization devices utilizing a digital caliber phantom: technical note. Childs Nerv Syst 2019; 35:1599-1602. [PMID: 31187236 DOI: 10.1007/s00381-019-04216-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/21/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Immobilization of the head and skull by head immobilization devices (HIDs) is a common practice in neurosurgery. A variety of complications and morbidities are associated with pinning the skull during application of HIDs. OBJECTIVE Our aim is to describe a new technique that avoids repeated puncturing of the head and skull during application of HIDs and hence avoiding the potential complications resulting from multiple re-adjustments. METHODS We used a pre-adjusted digital millimetric caliber (DMC) as a phantom for the two rocker pins of the HID to mimic and simulate the process of skull pinning. Localization and preparation of the accurate skull pinning sites are safely guided by the pinning phantom. RESULTS The technique was applied in different neurosurgical approaches. The pinning phantom was utilized to accurately locate the suitable pinning sites. Contrary to the common practice, there was no need for repeated head and skull puncturing. Minimal manipulations of the head and neck are exerted in this approach as compared with the usual techniques. The head of the patient is allowed to be kept safe on the operating table until the final one-time confident skull pinning by the sterilized skull clamp pins. CONCLUSION The process of scalp and skull pinning of HIDs is technically demanding. The DMC utilized as a pinning phantom is a useful technique which provides safe and confident application of the skull rocker pins of HIDs allowing the neurosurgeon to avoid multiple puncturing of scalp and skull and minimizing manipulations of the head and cervical spine.
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Affiliation(s)
- Mostafa M E Atteya
- Department of Neurosurgery, Faculty of Medicine, Helwan University, Helwan, Egypt. .,Department of Neurosurgery, Faculty of Medicine, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt.
| | - Sherif Raslan
- Department of Neurosurgery, Faculty of Medicine, Helwan University, Helwan, Egypt
| | - Mohamed Elkallaf
- Department of Neurosurgery, Faculty of Medicine, Helwan University, Helwan, Egypt
| | - Mahmoud Salem Soliman
- Department of Critical Care and Anesthesiology, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
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18
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Alexander H, Fayed I, Oluigbo CO. Rigid Cranial Fixation for Robot-Assisted Stereoelectroencephalography in Toddlers: Technical Considerations. Oper Neurosurg (Hagerstown) 2019; 18:614-620. [DOI: 10.1093/ons/opz247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/31/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Stereoelectroencephalography (sEEG) using depth electrodes has become a mainstay of pediatric epilepsy surgery. This technique relies on rigid cranial fixation using skull pins, which forms the basis for accurate stereotactic navigation. The use of cranial fixation pins poses the threat of traumatic skull injuries in young children because of inadequate cranial bone thickness.
OBJECTIVE
To describe a rigid cranial fixation technique involving the integrated Gel Head Ring from the DORO QR3 multipurpose skull clamp set (Pro Med Instruments) with superimposed pin fixation in children below the age of 36 mo undergoing sEEG.
METHODS
Patients were placed in the supine position and the head was fixed using a DORO skull clamp with 3 pediatric cranial pins. The head was supported on the integrated Gel Head Ring, and a pin pressure of 20 pounds was applied. The DORO skull clamp set was then attached to the ROSA neurosurgical robot support telescopic arm for stereotactic navigation.
RESULTS
We present an illustrative series of 2 patients below the age of 3 yr with medically refractory epilepsy who underwent sEEG using our modified cranial fixation technique. Head position and reference registration were stable throughout the surgeries. Postoperative volumetric computed tomography scans of the head showed accurate placement of sEEG depth electrodes and did not reveal any fractures or epidural hematoma. No other complications related to cranial fixation were noted.
CONCLUSION
Concurrent use of rigid and nonrigid cranial fixation using the DORO skull clamp set provides safe and effective cranial fixation in infants and toddlers undergoing sEEG.
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Affiliation(s)
- Hepzibha Alexander
- Children's National Medical Center, Department of Neurosurgery, School of Medicine, Georgetown University, Washington, District of Columbia
| | - Islam Fayed
- Children's National Medical Center, Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Chima O Oluigbo
- Children's National Medical Center, Department of Neurosurgery, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
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19
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Parenrengi MA, Adhiatmadja F, Arifianto MR, Apriawan T, Fauzi AA, Servadei F. Bilateral skull fracture with massive epidural hematoma secondary to pin-type head fixation in a pediatric patient: Case report and review of the literature. Int J Surg Case Rep 2019; 62:43-49. [PMID: 31445499 PMCID: PMC6717090 DOI: 10.1016/j.ijscr.2019.07.079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/04/2019] [Accepted: 07/28/2019] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION A head fixation device containing pins is common equipment used in neurosurgical procedures. Previous reports analysed some of the complications associated with the application of this device for adults and children, even the indications for the use in pediatric are not well defined. CASE PRESENTATION An 11-year-old girl diagnosed with non-communicating hydrocephalus, caused by posterior fossa tumor. During the surgery, complications were found in the form of acute epidural hematoma due to head fixation pins. So, the operation was stopped. Emergent CT scan was carried out and showed a bilateral skull fracture and a massive right-sided epidural hematoma. An emergency craniotomy for clot removal was performed and five days later, a second surgery was carried out uneventfully for the residual tumor. The patient fully recovered after the second surgery. DISCUSSION Complications due to the use of a pin head fixation are easier to occur in pediatric patients, because the bones are thinner and need more carefull strategy when pinning. With promp identification of any complications and earlier treatment, the good outcome will be achieved. We compared our case report with published literature in order to suggest the way to prevent this complication. CONCLUSION Skull fractures and associated epidural hematomas in pediatric patients need to be considered as possible complications of the pin-type head fixation application. The head fixation devices in pediatric need to be used with great caution and knowing the risk factors, safe technique for application and management of complications will prevent worse outcome.
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Affiliation(s)
- M Arifin Parenrengi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic Medical Center Hospital, Surabaya, Indonesia.
| | - Fatkhul Adhiatmadja
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic Medical Center Hospital, Surabaya, Indonesia.
| | - Muhammad Reza Arifianto
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic Medical Center Hospital, Surabaya, Indonesia.
| | - Tedy Apriawan
- Department of Neurosurgery, Universitas Airlangga Teaching Hospital, Surabaya, Indonesia.
| | - Asra Al Fauzi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic Medical Center Hospital, Surabaya, Indonesia.
| | - Franco Servadei
- Department of Neurosurgery, Humanitas University-Research Institute, Milan, Italy.
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20
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Tejada S, Avula S, Pettorini B, Henningan D, Abernethy L, Mallucci C. The impact of intraoperative magnetic resonance in routine pediatric neurosurgical practice-a 6-year appraisal. Childs Nerv Syst 2018; 34:617-626. [PMID: 29460065 DOI: 10.1007/s00381-018-3751-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 02/04/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND The intraoperative magnetic resonance scanner (ioMR) was introduced in our unit in 2009, and has been used routinely since then. OBJECTIVE This study aims to describe indications, radiological features, and clinical outcomes of the patients operated on with ioMRI and analyze our experience. METHODS A retrospective analysis of a prospective surgical database has been performed, including surgical procedure, intent, radiological reports, need for second-look surgery, and complications, supplemented by further review of the clinical notes and the scans. RESULTS From 2009 to 2015, 255 surgical procedures with ioMR were performed: 175 were craniotomies for tumor excision, 65 were epilepsy related, and 15 were biopsies or cyst drainages. The mean age was 9.4 years. One ioMR was performed in 79.5% patients; the mean duration of the MR was 41 min. In 172 cases (67.4%), no actions followed the ioMR. When the aim of the surgery was debulking of the tumor, the percentage of patients in which the ioMR was followed by resection was higher than when complete resection was the aim (56 vs 27.5%). The complication rate was not increased when compared with our previous results (infection 1%, neurological deficits 12%). CONCLUSION This is the largest published series of ioMRI-aided pediatric neurosurgery to date. We have demonstrated that it can be used safely and routinely in pediatric neurosurgical procedures at any age, assisting the surgeon in achieving the best extent of resection and aiding in intra-operative decision-making for tumor- and non-tumor-related intracranial pathology.
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Affiliation(s)
- Sonia Tejada
- Department of Neurosurgery, Clínica Universidad de Navarra, Calle Pio XII, 36, 31008, Pamplona, Spain.
| | - Shivaram Avula
- Department of Radiology, Alder Hey Children's NHS Foundation, Liverpool, UK
| | - Benedetta Pettorini
- Department of Neurosurgery, Alder Hey Children's NHS Foundation, Liverpool, UK
| | - Dawn Henningan
- Department of Neurosurgery, Alder Hey Children's NHS Foundation, Liverpool, UK
| | - Laurence Abernethy
- Department of Radiology, Alder Hey Children's NHS Foundation, Liverpool, UK
| | - Conor Mallucci
- Department of Neurosurgery, Alder Hey Children's NHS Foundation, Liverpool, UK
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21
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Del Rio RJ, Gonzalez RO, Jaimovich R. Method to perform safety stereotactic procedures in children under 2 years of age. Childs Nerv Syst 2018; 34:555-558. [PMID: 29063265 DOI: 10.1007/s00381-017-3624-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 10/13/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Stereotactic procedures have been used in neurosurgery for many years. In children especially, care should be considered to avoid complication caused by fixation of the frame in a not fully developed skull bone. We present our method to adapt the frame in children under 2 years of age. METHODS Twelve procedures in patients under 24 months were performed between 2003 and 2015. Micromar frame was used. It was adapted with a small pillow made of gauss attached to the posterior part to hold the head, then four pins were fixed without adjustment. We analyze for each patient age, indication, histopathology, and complications. RESULTS Eleven patients with a mean age of 13.5 months (range 9 to 22 months) underwent 12 stereotactic procedures. In all cases, biopsy samples were obtained, histopathology was positive in 11/12 cases. No complications occurred. CONCLUSION Stereotactic frame procedures need special attention in small children where the skull bones are not fully developed. We present a simple method to perform this surgery in patients under 2 years of age.
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Affiliation(s)
- Ramiro J Del Rio
- National Hospital of Pediatrics "Prof. Dr. Juan P. Garrahan", Combate de los Pozos 1881, C1245AAM, Buenos Aires, Argentina.
| | - Roberto O Gonzalez
- National Hospital of Pediatrics "Prof. Dr. Juan P. Garrahan", Combate de los Pozos 1881, C1245AAM, Buenos Aires, Argentina
| | - R Jaimovich
- National Hospital of Pediatrics "Prof. Dr. Juan P. Garrahan", Combate de los Pozos 1881, C1245AAM, Buenos Aires, Argentina
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22
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LoPresti MA, Sellin JN, DeMonte F. Developmental Considerations in Pediatric Skull Base Surgery. J Neurol Surg B Skull Base 2018; 79:3-12. [PMID: 29404235 DOI: 10.1055/s-0037-1617449] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Objectives To review developmental surgical anatomy and technical nuances related to pediatric skull base surgery. Design Retrospective, single-center case series with literature review. Setting MD Anderson Cancer Center. Participants Patients undergoing pediatric skull base surgery. Main Outcome Measures Review developmental anatomy of the pediatric skull base as it relates to technical nuance of various surgical approaches and insight gained from a 25-year institutional experience with this unique patient population. Results Thirty-nine patients meeting these criteria were identified over a 13-year period from 2003 to 2016 and compared to a previously reported earlier cohort from 1992 to 2002. The most common benign pathologies included nerve sheath tumors (11%), juvenile nasopharyngeal angiofibromas (9.5%), and craniopharyngiomas (4.8%). The most common malignancies were chondrosarcoma (11%), chordoma (11%), and rabdomyosarcoma (11%). Varied surgical approaches were utilized and were similar between the two cohorts save for the increased use of endoscopic surgical techniques in the most recent cohort. The most common sites of tumor origin were the infratemporal fossa, sinonasal cavities, clivus, temporal bone, and parasellar region. Gross total resection and postoperative complication rates were similar between the two patient cohorts. Conclusions Pediatric skull base tumors, while rare, often are treated surgically, necessitating an in depth understanding of the anatomy of the developing skull base.
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Affiliation(s)
- Melissa A LoPresti
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - Jonathan N Sellin
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - Franco DeMonte
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
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23
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Demartini Z, Gatto LAM, da Rocha TC, Maeda AK, Valerio A, Koppe GL, Francisco AN. Is the Mayfield Head Holder Obligatory for Intracranial Aneurysm Clipping? Pediatr Neurosurg 2018; 53:360-363. [PMID: 30145594 DOI: 10.1159/000491825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 07/04/2018] [Indexed: 11/19/2022]
Abstract
Intracranial aneurysm surgery is commonly performed using pinned head holders, which pose a higher risk for the pediatric population. Several authors recommend avoiding the use of this device when it is not strictly necessary, and this is currently possible considering advances in anesthesiology and monitoring. As the literature on microsurgery without skull clamp use is scant, we report the case of a 15-year-old boy presenting with a subarachnoid hemorrhage after rupture of a middle cerebral artery aneurysm. Surgical treatment was performed with the head resting on a gel cushion horseshoe; aneurysm clipping was achieved without wakefulness or awareness and the patient had a good recovery.
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Affiliation(s)
- Zeferino Demartini
- Department of Neurosurgery, Cajuru University Hospital, Pontifical Catholic University of Parana, Curitiba, Brazil.,Department of Neurosurgery, Hospital Pequeno Principe, Curitiba, Brazil
| | - Luana Antunes Maranha Gatto
- Department of Neurosurgery, Cajuru University Hospital, Pontifical Catholic University of Parana, Curitiba, Brazil
| | | | | | - Adriana Valerio
- Department of Anesthesiology, Hospital Pequeno Principe, Curitiba, Brazil
| | - Gelson Luis Koppe
- Department of Neurosurgery, Hospital Pequeno Principe and Hospital Vita Curitiba, Curitiba, Brazil
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24
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Zaazoue MA, Bedewy M, Goumnerova LC. Complications of Head Immobilization Devices in Children: Contact Mechanics, and Analysis of a Single Institutional Experience. Neurosurgery 2017; 82:678-685. [DOI: 10.1093/neuros/nyx315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 05/30/2017] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Head immobilization devices (HIDs) are a staple of neurosurgical procedures, including in the intraoperative magnetic resonance imaging (iMRI) operating rooms (ORs) where material modifications were necessary for compatibility with the magnets utilized.
OBJECTIVE
To present the experience in this OR environment and discuss the multifactorial nature of the observed adverse events.
METHODS
A retrospective chart review was performed, utilizing the Department of Neurosurgery and iMRI OR databases to identify patients who suffered complications related to HIDs between November 2007 and March 2016. A literature review was also done to identify the magnitude of the problem and the availability of safety guidelines.
RESULTS
Nine hundred and forty patients underwent surgery in the iMRI OR requiring head immobilization. Seven (0.7%) suffered complications related to the HID—depressed skull fractures (n = 7) and epidural hematomas (n = 6). Age at surgery ranged from 1.6 to 10.3 yr. All patients had posterior fossa neoplasms and associated obstructive hydrocephalus. Four patients (57%) suffered permanent neurological deficits. Six patients (86%) underwent a surgical procedure to evacuate the epidural hematomas and repair the depressed skull fracture. In contrast, 1 out of 445 patient (0.2%) suffered HID-related adverse events in the conventional ORs, aged 10.2 yr.
CONCLUSION
HIDs are important to provide stability and support during neurosurgical procedures. Modifications in the material or the shape of the pins can significantly change the pressure exerted. Most of these complications are preventable if certain precautionary measures are taken especially in certain high-risk patients, and the overall benefits of HIDs continue to outweigh the risks. There is a need for consensus on guidelines for the safe use of these devices.
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Affiliation(s)
- Mohamed A Zaazoue
- Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts
| | - Mostafa Bedewy
- Department of Industrial Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
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25
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Beuriat PA, Jacquesson T, Jouanneau E, Berhouma M. Headholders' - complications in neurosurgery: A review of the literature and recommendations for its use. Neurochirurgie 2016; 62:289-294. [PMID: 27865516 DOI: 10.1016/j.neuchi.2016.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 09/04/2016] [Accepted: 09/08/2016] [Indexed: 11/30/2022]
Abstract
Several types of headholders are routinely used in neurosurgical practice to secure the head in a precise position, providing better security during surgical dissection as well as an absence of eye compression during prone positions. Nevertheless, potentially lethal complications might occur. We performed a review of the literature via PubMed and Google Scholar using the terms "Mayfield skull clamp", "Sugita headholders", "headholder complications" and "skull clamp complications". Twenty-six complications directly related to the use of headholders were identified through 19 papers published from 1981 to 2014: mainly skull fractures with or without a dural laceration (50%), epidural hematomas (23.8%), skull fractures with or without a dural laceration (50%), and air embolism (9.5%). The authors propose recommendations for the safe use of headholders.
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Affiliation(s)
- P-A Beuriat
- Skull base surgery unit, department of neurosurgery B, Pierre-Wertheimer neurological and neurosurgical hospital, hospices civils de Lyon, 59, boulevard Pinel, 69394 Lyon cedex 03, France
| | - T Jacquesson
- Skull base surgery unit, department of neurosurgery B, Pierre-Wertheimer neurological and neurosurgical hospital, hospices civils de Lyon, 59, boulevard Pinel, 69394 Lyon cedex 03, France
| | - E Jouanneau
- Skull base surgery unit, department of neurosurgery B, Pierre-Wertheimer neurological and neurosurgical hospital, hospices civils de Lyon, 59, boulevard Pinel, 69394 Lyon cedex 03, France
| | - M Berhouma
- Skull base surgery unit, department of neurosurgery B, Pierre-Wertheimer neurological and neurosurgical hospital, hospices civils de Lyon, 59, boulevard Pinel, 69394 Lyon cedex 03, France.
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Moutaoukil M, Bensghir M, Eddik S, Jaafari A, Ahtil R, Meziane M, Haimeur C. [Depressed skull fracture following the use of Mayfield headrest in adult patients: about a case and review of the literature]. Pan Afr Med J 2016; 24:129. [PMID: 27642467 PMCID: PMC5012808 DOI: 10.11604/pamj.2016.24.129.8367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 12/01/2015] [Indexed: 11/11/2022] Open
Abstract
Un grand nombre d'interventions neurochirurgicales nécessitent l'utilisation d'une têtière à broches pour immobiliser la tête du patient. Nous rapportons le cas d'une embarrure chez un adulte secondaire à l'utilisation de la têtière de Mayfeild. Le diagnostic a été posé en postopératoire d'une résection chirurgicale d'un médulloblastome par une tomodensitométrie cérébrale. Plusieurs facteurs semblent contribuer à augmenter le risque de complications dues à l'utilisation de la têtière de Mayfield. Les mesures de prévention sont discutées à travers une revue de littérature.
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Affiliation(s)
- Mohamed Moutaoukil
- Service d'Anesthésiologie, Hôpital Militaire Med V, Université Souissi Med V, Rabat, Maroc
| | - Mustapha Bensghir
- Service d'Anesthésiologie, Hôpital Militaire Med V, Université Souissi Med V, Rabat, Maroc
| | - Soukaina Eddik
- Service d'Anesthésiologie, Hôpital Militaire Med V, Université Souissi Med V, Rabat, Maroc
| | - Abdelhamid Jaafari
- Service d'Anesthésiologie, Hôpital Militaire Med V, Université Souissi Med V, Rabat, Maroc
| | - Redouane Ahtil
- Service d'Anesthésiologie, Hôpital Militaire Med V, Université Souissi Med V, Rabat, Maroc
| | - Mohammed Meziane
- Service d'Anesthésiologie, Hôpital Militaire Med V, Université Souissi Med V, Rabat, Maroc
| | - Charki Haimeur
- Service d'Anesthésiologie, Hôpital Militaire Med V, Université Souissi Med V, Rabat, Maroc
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van Lindert EJ, Arts S, Blok LM, Hendriks MP, Tielens L, van Bilsen M, Delye H. Intraoperative complications in pediatric neurosurgery: review of 1807 cases. J Neurosurg Pediatr 2016; 18:363-71. [PMID: 27231823 DOI: 10.3171/2016.3.peds15679] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Minimal literature exists on the intraoperative complication rate of pediatric neurosurgical procedures with respect to both surgical and anesthesiological complications. The aim of this study, therefore, was to establish intraoperative complication rates to provide patients and parents with information on which to base their informed consent and to establish a baseline for further targeted improvement of pediatric neurosurgical care. METHODS A clinical complication registration database comprising a consecutive cohort of all pediatric neurosurgical procedures carried out in a general neurosurgical department from January 1, 2004, until July 1, 2012, was analyzed. During the study period, 1807 procedures were performed on patients below the age of 17 years. RESULTS Sixty-four intraoperative complications occurred in 62 patients (3.5% of procedures). Intraoperative mortality was 0.17% (n = 3). Seventy-eight percent of the complications (n = 50) were related to the neurosurgical procedures, whereas 22% (n = 14) were due to anesthesiology. The highest intraoperative complication rates were for cerebrovascular surgery (7.7%) and tumor surgery (7.4%). The most frequently occurring complications were cerebrovascular complications (33%). CONCLUSIONS Intraoperative complications are not exceptional during pediatric neurosurgical procedures. Awareness of these complications is the first step in preventing them.
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Affiliation(s)
| | - Sebastian Arts
- Anesthesiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Laura M Blok
- Anesthesiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mark P Hendriks
- Anesthesiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Luc Tielens
- Anesthesiology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Krishnan P, Kumar SK, Kartikueyan R, Patel SM. Pin-site epidural hematoma: A catastrophic complication of cranial fixation in a child. J Neurosci Rural Pract 2016; 7:286-9. [PMID: 27114664 PMCID: PMC4821941 DOI: 10.4103/0976-3147.178661] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Cranial fixation with pins is a routine adjunct in neurosurgery and is usually considered safe. A rarely reported complication is skull fracture at the pin site and consequent epidural hematoma. Usually, these are picked up only postoperatively and rarely, intraoperatively if there is unexplained "brain bulge" in which case the operation should be terminated and urgent imaging has to be done. We describe such a complication that occurred while operating on a 12-year-old child with a posterior fossa tumor and review the available literature dealing with such events.
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Affiliation(s)
- Prasad Krishnan
- Department of Neurosurgery, National Neurosciences Centre, Kolkata, West Bengal, India
| | - Soumen Kanti Kumar
- Department of Neurosurgery, National Neurosciences Centre, Kolkata, West Bengal, India
| | - Rajaraman Kartikueyan
- Department of Neurosurgery, National Neurosciences Centre, Kolkata, West Bengal, India
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Valencia Calderón C, Castro Cevallos A, Calderón Valdiviezo A, Escobar Dávila R, Parra Rosales F, Quispe Alcocer J, Vásquez Hahn C. [Neuronavigation in the surgical planning of callosotomy]. Neurocirugia (Astur) 2015; 27:186-93. [PMID: 26260206 DOI: 10.1016/j.neucir.2015.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/30/2015] [Accepted: 06/08/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the usefulness of 3D computer-assisted preoperative neuronavigation for stereoscopic location of the venous sinuses, arterial branches, and corpus callosum, to extrapolate anatomical landmarks on the surgical field and make decisions before the intervention. METHODS A prospective analysis was performed on patients with refractory epilepsy who underwent neuronavigation-assisted callosotomy (BRAIN LAB Dual). RESULTS A total of 10 neuronavigation-assisted callosotomies were performed in the year 2014. The ages of the patients (4 males and 6 females) were between 4 and 13 years (mean 7; SD 3.02). The most common indication for callosotomy in our sample was Lennox Gastoux (5 patients). A right parasagittal craniotomy was performed in 8 patients. An anterior two-thirds callosotomy was performed in 8 patients and anterior three-quarters in 2 patients. The mean accuracy of the neuronavigation procedure was less than 2mm. In no cases were there significant intraoperative surgical complications. CONCLUSION Callosotomy using frameless guided neuronavigation is an accurate and safe technique in patients with epilepsy refractory to surgical resection.
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Boop FA, Bate B, Choudhri AF, Burkholder B, Klimo P. Preliminary experience with an intraoperative MRI-compatible infant headholder: technical note. J Neurosurg Pediatr 2015; 15:539-43. [PMID: 25679382 DOI: 10.3171/2014.10.peds14447] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The development of high-quality intraoperative MRI (iMRI) capability has offered a major advance in the care of patients with complex intracranial disease. To date, this technology has been limited by the need for pin fixation of the calvaria. The authors report their preliminary experience with an MRI-compatible horseshoe headrest that allows for the following: 1) iMRI in patients too young for pin fixation; 2) iMRI in patients with large calvarial defects; 3) the ability to move the head during iMRI surgery; and 4) the use of neuronavigation in such cases. The authors report 2 cases of infants in whom the Visius Surgical Theatre horseshoe headrest (IMRIS Inc.) was used. Image quality was equivalent to that of pin fixation. The infants suffered no skin issues. The use of neuronavigation with the system remained accurate and could be updated with the new iMRI information. The Visius horseshoe headrest offers a technical advance in iMRI technology for infants, for patients with cranial defects or prior craniotomies in whom pin fixation may not be safe, or for patients in whom the need to move the head during surgery is required. The image quality of the system remains excellent, and the ability to merge new images to the neuronavigation system is helpful.
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Frame-based stereotactic neurosurgery in children under the age of seven: Freiburg University's experience from 99 consecutive cases. Clin Neurol Neurosurg 2014; 130:42-7. [PMID: 25576884 DOI: 10.1016/j.clineuro.2014.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/02/2014] [Accepted: 12/20/2014] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Stereotactic frame-based procedures proved to be precise, safe and are of widespread use among adult patients. Regarding pediatric patients few data is available, therefore the use of the stereotactic frame remains controversial in this population. This motivated us to report our experience in stereotactic procedures in the youngest patients and review the literature concerning this subject. METHODS All frame-based procedures performed in patients younger than seven years in the University of Freiburg during the last 10 years were retrospectively analyzed and discussed under the light of the current literature. RESULTS The studied population was composed of 72 patients under the age of seven (mean 3.4±2.1 years-old), in whom 99 stereotactic procedures were performed. Brain tumor was present in 60 patients, hydrocephalus in five, cystic lesions in three, intracranial abscess in three and epilepsy in one patient. Stereotactic surgery was performed in 36 cases for brachytherapy, in 29 for biopsy, in 20 cases for cyst puncture, in eight for stereotactically guided endoscopic ventriculostomy, in five for catheter placement and in one case for depth electrode insertion. The overall complication rate was 5%. There were three cases of pin penetration through the skull, one case of frame dislocation after extensive cyst drainage and two skull fractures. Neurologic deficit related to frame fixation was observed in none of the cases. In disagreement with other authors, no case of pin related infection, air embolism, hematoma or CSF leak was observed. CONCLUSION Frame-based stereotactic neurosurgery is a safe technique also in the youngest patients. Rather than the simple use of torque-limiting devices training and experience in the manual adjustment of the stereotactic frame in children have been proven to be crucial factors that contribute to reducing pin related complications.
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Goto T, Hongo K. Difference between conventional head-pin and Dispo-pin in the Sugita multipurpose head frame system. Neurol Med Chir (Tokyo) 2013; 53:21-5. [PMID: 23358165 DOI: 10.2176/nmc.53.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Head fixation devices are commonly used in neurosurgical procedures and are considered essential tools for microneurosurgery. The Sugita multipurpose head frame system is one of such systems and has been used for more than 30 years worldwide. It is important to understand how to fix a patient's head with head-pins safely, because there are no numerical parameters for head-pin screwing in the Sugita frame. Recently, the Dispo-pin has been available for disposable use as a head-pin in the Sugita frame. In contrast to the conventional head-pin, the tip of the Dispo-pin is separable from the body. Although their appearance is similar, the torque for adequate fixation is different. The relationships between torque and vertical force were analyzed. The torque of the head-pin was linearly correlated with vertical force for both types of head-pin. Different conditions caused different torque increase against a specific increase of vertical force with the conventional head-pin. In contrast, torque increase against a specific increase of vertical force with the Dispo-pin was the same regardless of the situation. The torque originates from friction between the scalp and tip of the conventional head-pin. As friction is different for each patient's condition, the torque at this part is different. The friction between the tip and body of the Dispo-pin is lower than that between the scalp and tip of the head-pin. In consequence, the torque generated from the tip of the Dispo-pin is the same in each situation. It is important to understand the difference between the Dispo-pin and conventional head-pin.
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Affiliation(s)
- Tetsuya Goto
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
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Roth J, Galeano E, Milla S, Hartmannsgruber MW, Weiner HL. Multiple epidural hematomas and hemodynamic collapse caused by a subgaleal drain and suction-induced intracranial hypotension: case report. Neurosurgery 2011; 68:E271-5; discussion E276. [PMID: 21099705 DOI: 10.1227/neu.0b013e3181fe6165] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Subgaleal drains are commonly used in neurosurgery. Rare complications attributed to these drains have been described. We present a rare complication of hemodynamic collapse and multiple epidural hematomas attributed to intracranial hypotension induced by a subgaleal drain connected to suction during wound closure. CLINICAL PRESENTATION A 3.5-year-old boy underwent an uneventful occipital lobectomy and titanium mesh cranioplasty for resection of a recurrent choroid plexus carcinoma. The child had undergone 2 uneventful previous resections and cranial irradiation. During skin closure, a subgaleal drain was connected to suction to keep the surgical bed dry. Immediately after completion of the subgaleal layer closure, there was an acute hemodynamic collapse, accompanied by bradycardia and a drop in the hematocrit. After successful resuscitation, the child underwent a brain computed tomography scan that showed a large bifrontal epidural hematoma and multiple additional small epidural hematomas. The large hematoma was surgically evacuated, and the child had an uneventful recovery. CONCLUSION Acute negative intracranial hypotension may cause bradycardia, epidural hematomas, and hemodynamic collapse. Subgaleal drains should not be connected to suction systems, and care should be taken when these drains are connected to vacuum bulbs in high-risk cases such as after cranial irradiation, large resections, and mesh cranioplasties.
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Affiliation(s)
- Jonathan Roth
- Department of Neurosurgery, Division of Pediatric Neurosurgery, NYU Langone Medical Center, New York, New York 10016, USA.
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Harrigan MR, Weinberg JA, Peaks YS, Taylor SM, Cava LP, Richman J, Walters BC. Management of blunt extracranial traumatic cerebrovascular injury: a multidisciplinary survey of current practice. World J Emerg Surg 2011; 6:11. [PMID: 21477304 PMCID: PMC3097147 DOI: 10.1186/1749-7922-6-11] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Accepted: 04/08/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extracranial traumatic cerebrovascular injury (TCVI) is present in 1-3% of all blunt force trauma patients. Although options for the management of patients with these lesions include anticoagulation, antiplatelet agents, and endovascular treatment, the optimal management strategy for patients with these lesions is not yet established. OBJECTIVE Multidisciplinary survey of clinicians about current management of TCVI. METHODS A six-item multiple-choice survey was sent by electronic mail to a total of 11,784 neurosurgeons, trauma surgeons, stroke neurologists, and interventional radiologists. The survey included questions about their choice of imaging, medical management, and the use of endovascular techniques. Survey responses were analyzed according to stated specialty. RESULTS Seven hundred eighty-five (6.7%) responses were received. Overall, a total of 325 (42.8%) respondents favored anticoagulation (heparin and/or warfarin), 247 (32.5%) favored antiplatelet drugs, 130 (17.1%) preferred both anticoagulation and antiplatelet drugs, and 57 (7.5%) preferred stenting and/or embolization. Anticoagulation was the most commonly preferred treatment among vascular surgeons (56.9%), neurologists (50.2%) and neurosurgeons (40.7%), whereas antiplatelet agents were the most common preferred treatment among trauma surgeons (41.5%). Overall, 158 (20.7%) of respondents recommended treatment of asymptomatic dissections and traumatic aneurysms, 211 (27.7%) did not recommend it, and 39.4% recommended endovascular treatment only if there is worsening of the lesion on follow-up imaging. CONCLUSIONS These data demonstrate the wide variability of physicians' management of traumatic cerebrovascular injury, both on an individual basis, and between specialties. These findings underscore the need for multicenter, randomized trials in this field.
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Affiliation(s)
- Mark R Harrigan
- Division of Neurosurgery, University of Alabama, Birmingham, Birmingham, Alabama, USA.
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Depressed skull fracture by a three-pin head holder: a case illustration. Childs Nerv Syst 2011; 27:163-5. [PMID: 20574740 DOI: 10.1007/s00381-010-1213-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Accepted: 06/14/2010] [Indexed: 10/19/2022]
Abstract
UNLABELLED BACKGROUND AND CASE REPORT: Many surgical procedures require a rigid immobilization of the patients' head, which is usually achieved by using a pin-type head holder. We briefly illustrate the case of a 4-year-old girl who sustained a depressed skull fracture by penetration of a pin of the head holder. The fracture was noted at the end of the surgery performed for treatment of a cerebellar astrocytoma and was managed conservatively. DISCUSSION Several factors seem to be involved in the production of this complication as are faulty application of the pins, excessive pin pressure, skull thinning, young patient's age, and pathological conditions that evolve with long-standing raised intracranial pressure. Prevention and management measures are briefly discussed.
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Rowell J, Lynn AM, Filardi TZ, Celix J, Ojemann JG. Acute unilateral enlargement of the parotid gland immediately post craniotomy in a pediatric patient: a case report. Childs Nerv Syst 2010; 26:1239-42. [PMID: 20512498 DOI: 10.1007/s00381-010-1186-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Accepted: 05/11/2010] [Indexed: 11/26/2022]
Abstract
A temporary acute unilateral enlargement of the parotid gland or "anesthesia mumps" has been described in both surgical and anesthesia literature. It has been described in elderly, dehydrated, poorly nourished, and post-operative patients. We present a 5-year-old patient who underwent a left temporal craniotomy for seizure focus resection and quadriceps muscle biopsy. Immediately post procedure, he was noted to have an acute unilateral enlargement of the right parotid gland. We report acute unilateral parotitis as a possible, but uncommon, complication of positioning in the pediatric population and to discuss possible pathophysiology and prevention, as well as a review of the available literature.
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Affiliation(s)
- Jonathan Rowell
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA 98105, USA
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Hermann EJ, Rittierodt M, Krauss JK. Combined Transventricular and Supracerebellar Infratentorial Approach Preserving the Vermis in Giant Pediatric Posterior Fossa Midline Tumors. Oper Neurosurg (Hagerstown) 2008. [DOI: 10.1227/01.neu.0000316853.47780.b9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Objective:
Giant pediatric midline tumors of the posterior fossa involving the fourth ventricle and the tectal region are difficult to approach and present a high risk of postoperative neurological deficits. Children with sequelae such as cerebellar mutism and ataxia experience a compromise in their quality of life. Here, we present our combined transventricular and supracerebellar infratentorial approach to avoid complications of vermian splitting.
Methods:
The combined transventricular and supracerebellar infratentorial approach described here was used in a total of four pediatric patients. A medial suboccipital craniotomy with opening of the foramen magnum and resection of the C1 lamina was performed with the patient in the semisitting position. The tumor mass filling the fourth ventricle was removed via a transventricular telovelar route through the foramen of Magendie, preserving the vermis. The rostral tumor portions in the peritectal region extruding up to the thalami were exposed and resected via an infratentorial supracere-bellar route to preserve the venous drainage of the cerebellum.
Results:
There were no new neurological deficits postoperatively. Two patients had low-grade astrocytomas, and two patients had malignant tumors. Complete tumor resection was achieved in two patients, and near-total tumor removal in the two others. CONCLUSION: The combined transventricular and supracerebellar infratentorial approach offers a unique possibility of safely removing giant pediatric midline tumors. Splitting of the cerebellar vermis is not necessary for removal of such tumors.
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Affiliation(s)
- Elvis J. Hermann
- Department of Neurosurgery, Medical School Hannover, Hannover, Germany
| | - Marion Rittierodt
- Department of Neurosurgery, Medical School Hannover, Hannover, Germany
| | - Joachim K. Krauss
- Department of Neurosurgery, Medical School Hannover, Hannover, Germany
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