General Principles of Cr...
Highlights
- General principles of cranial stabilization for neurosurgical procedures – a thread 🧵
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- Intraoperative head stabilization is often performed by pinning. Careful & thoughtful consideration is required to
-avoid complications
-optimize access to surgical target & minimize steric hindrances
-support devices for stereotactic neuronavigation or retraction
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- First, review neurosurgical hx & imaging:
-Any prior craniotomy/hardware/implants (e.g., shunt, DBS leads, etc)
-Relevant anatomy (e.g., frontal sinus, mastoid aeration, skull thinning from chronic hydrocephalus)
-Need for future bypass/donor scalp vessel (e.g, STA or OA)?
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- You also don’t want to place the pins in the squamosal temporal bone/pterion (overlies MMA; fracture can cause epidural hematoma).
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- The skull clamp is comprised of two arms: one with 1 pin, & the other with 2 pins. Pin placement should be
-out of the way of the incision & surgeon's hands
-optimized for anchoring neuronavigation or retraction devices
-cosmetic (if possible)
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- When you are ready to place pins:
-Confirm with anesthesia
-Apply antiseptic gel to pins (sealant to prevent venous air embolism)
-Palpate the scalp/skull to confirm no defects or hardware
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- By convention, pins are inserted along an imaginary equator for optimal mechanical support, & the single pin should bisect the double pins.
After placement of pins, check for:
-head stability (no movement of head in pins)
-skin strangulation
-skull purchase
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- SUMMARY:
-These are general principles/concepts (nuances notwithstanding).
-Pins should not go in bad places.
-Pins should not be in the surgeon’s way.
-Always check to ensure all connections of the device are secure/locked – and check multiple times ✅
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