J Neurosurg 48:656-657, 1978
A newly designed multipurpose mieroneurosurgieal head frame Technical note
KENICHIRO SUGITA, M.D., TOSHIYUKI HIROTA, M.D., TETSURO MIZUTANI, M.D., NAOMI MUTSUGA, M.D., MASATO SHIBUYA, M.D., AND RYIICHI TSUGANE, M.D. Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Japan A new multipurpose head frame has been designed for microneurosurgery. It consists of a head holder with a frame to hold self-retaining brain retractors, hand rests, instrument holders, a plate for cotton patties, and skin-flap retractors. It has been satisfactorily used in 100 operations for 1 year.
KEY WORDS
microsurgery
T
HE development and improvement of various microneurosurgical instruments have played an important role in improving the results of surgery, by shortening operating time and reducing the surgeon's physical fatigue. We have developed a new microneurosurgical assembly consisting of a head holder with a frame attached to it to hold flexible self-retaining retractors (LeylaYasargil), hand rests, microsurgical instrument holders, a plate for cotton patties, and skin-flap spring retractors.
Description of Device The assembly is shown in Fig. 1. The semicircular basal frame (A) is fixed at 90 ~ on top of the head holder (H) over the drapes. Five screws are placed 35 ~ apart on the frame for holding conventional flexible selfretaining retractors (Leyla-Yasargil). Two holes are placed at each end of the frame to support the hand rests (B) and instrument holders (C). The angle and height of the hand rests (B) can be adjusted to suit the surgeon. 656
9 instrumentation
An arm rest can be used to hold a microretractor, suction tube, or glass fiber illuminator as the third hand of the surgeon (C). A box (D) is attached to each end of the basal frame to hold bipolar coagulation forceps, a suction tube, or other instruments. A smaller semicircular frame (E) fixed on the basal frame is used for retaining the skin flap (F); it also supports the plate for surgical cotton patties (G) and occasionally holds the self-retaining retractor. The patient's head can be fixed in diverse operating positions on the head holder by means of four skull pins (H). The patient's head can be easily rotated at any time during the operation. The major advantage of this head holder is that it is strong enough to hold both the accessories described above and the patient's head.
Discussion We have employed this multipurpose frame satisfactorily in 100 cases for over 1 year, and the head holder for 6 years, without any complications.
J. Neurosurg. / Volume 48 / April, 1978
Multipurpose microneurosurgical head frame
FIG. 1. Photograph (left) and schematic drawing (right) of the head frame with microneurosurgical accessories and hand rests in operation. A: basal fixation frame, B: hand rest, C: hand rest used as a base of instrument retainer, D: instrument holder, E: smaller semicircular frame, F: spring retractors for the skin flap, G: plate for patties, and H: head holder with four skull pins. The conventional self-retaining retractor is usually fixed along the bone edge in the operating field. This method often has the following disadvantages: 1) there may be bleeding from the dura beneath the bone edge, 2) the protrusion of the knob frequently interferes with the surgeon's hand, and 3) the retractor m a y not be held firmly enough to prevent twisting. In order to resolve these problems, Yasargil and Fox 2 developed a long holding rod which is fixed at the side of the operating table. Kanshepolsky 1 invented a similar apparatus. In their methods the base of the rod is too far from the top of the brain retractor and there are too m a n y joints along the head rest, o p e r a t i n g table, and accessories. In our apparatus, the brain retractors can be kept in exactly the same position, even when the patient's head is rotated during surgery. The self-retaining retractor can be applied at almost any angle around the operating field and can be attached to five places on the basal frame, one of the hand rests, or the smaller semicircular frame. When our a p p a r a t u s is used, the flexible arm of the self-retaining retractors are passed under the semicircular basal frame and the hand rest in order to prevent accidental movement of the retractors by the surgeon's hand. N o t all neurosurgeons prefer to use a hand rest; some stabilize their hands by placing the tip of their outstretched little finger on the J. Neurosurg. / Volume 48 / April. 1978
patient's head. However, the hand rest is especially helpful in fine maneuvers, such as clipping of the neck of an a n e u r y s m , microsuturing, or resecting tumors in a critical area. A disadvantage of the hand rest is that it can disturb quick m o v e m e n t s of the hand. In our apparatus, the hand rest can be easily applied and quickly removed. In addition, the basal frame can be used as the surgeon's a r m rest. While using the microscope, the surgeon should try to keep his eyes in the microscope in order to stay oriented and avoid unnecessary a c c o m m o d a t i o n of the eyes in and out of the microscope. Accessory instrument holders are especially useful for this purpose, because he can keep or pick up those instruments he needs without looking at them. References
1. Kanshepolsky J: Extracranial holder for brain retractors. Technical note. J Neurasurg 46:835-836, 1977 2. Yasargil MG, Fox JL: The microsurgical approach to acoustic neurinomas. Surg Neurol 2:393-398, 1974 Address for Dr. Tsugane: Department of Neurosurgery, Tokai University School of Medicine, Isehara 259-11 Kanagawa, Japan. Address reprint requests to: Kenichiro Sugita, M.D., Department of Neurosurgery, Shinshu University School of Medicine, Asahi 3-1, Matsumoto 390, Japan. 657
A newly designed multipurpose mieroneurosurgieal head frame Technical note
KENICHIRO SUGITA, M.D., TOSHIYUKI HIROTA, M.D., TETSURO MIZUTANI, M.D., NAOMI MUTSUGA, M.D., MASATO SHIBUYA, M.D., AND RYIICHI TSUGANE, M.D. Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Japan A new multipurpose head frame has been designed for microneurosurgery. It consists of a head holder with a frame to hold self-retaining brain retractors, hand rests, instrument holders, a plate for cotton patties, and skin-flap retractors. It has been satisfactorily used in 100 operations for 1 year.
KEY WORDS
microsurgery
T
HE development and improvement of various microneurosurgical instruments have played an important role in improving the results of surgery, by shortening operating time and reducing the surgeon's physical fatigue. We have developed a new microneurosurgical assembly consisting of a head holder with a frame attached to it to hold flexible self-retaining retractors (LeylaYasargil), hand rests, microsurgical instrument holders, a plate for cotton patties, and skin-flap spring retractors.
Description of Device The assembly is shown in Fig. 1. The semicircular basal frame (A) is fixed at 90 ~ on top of the head holder (H) over the drapes. Five screws are placed 35 ~ apart on the frame for holding conventional flexible selfretaining retractors (Leyla-Yasargil). Two holes are placed at each end of the frame to support the hand rests (B) and instrument holders (C). The angle and height of the hand rests (B) can be adjusted to suit the surgeon. 656
9 instrumentation
An arm rest can be used to hold a microretractor, suction tube, or glass fiber illuminator as the third hand of the surgeon (C). A box (D) is attached to each end of the basal frame to hold bipolar coagulation forceps, a suction tube, or other instruments. A smaller semicircular frame (E) fixed on the basal frame is used for retaining the skin flap (F); it also supports the plate for surgical cotton patties (G) and occasionally holds the self-retaining retractor. The patient's head can be fixed in diverse operating positions on the head holder by means of four skull pins (H). The patient's head can be easily rotated at any time during the operation. The major advantage of this head holder is that it is strong enough to hold both the accessories described above and the patient's head.
Discussion We have employed this multipurpose frame satisfactorily in 100 cases for over 1 year, and the head holder for 6 years, without any complications.
J. Neurosurg. / Volume 48 / April, 1978
Multipurpose microneurosurgical head frame
FIG. 1. Photograph (left) and schematic drawing (right) of the head frame with microneurosurgical accessories and hand rests in operation. A: basal fixation frame, B: hand rest, C: hand rest used as a base of instrument retainer, D: instrument holder, E: smaller semicircular frame, F: spring retractors for the skin flap, G: plate for patties, and H: head holder with four skull pins. The conventional self-retaining retractor is usually fixed along the bone edge in the operating field. This method often has the following disadvantages: 1) there may be bleeding from the dura beneath the bone edge, 2) the protrusion of the knob frequently interferes with the surgeon's hand, and 3) the retractor m a y not be held firmly enough to prevent twisting. In order to resolve these problems, Yasargil and Fox 2 developed a long holding rod which is fixed at the side of the operating table. Kanshepolsky 1 invented a similar apparatus. In their methods the base of the rod is too far from the top of the brain retractor and there are too m a n y joints along the head rest, o p e r a t i n g table, and accessories. In our apparatus, the brain retractors can be kept in exactly the same position, even when the patient's head is rotated during surgery. The self-retaining retractor can be applied at almost any angle around the operating field and can be attached to five places on the basal frame, one of the hand rests, or the smaller semicircular frame. When our a p p a r a t u s is used, the flexible arm of the self-retaining retractors are passed under the semicircular basal frame and the hand rest in order to prevent accidental movement of the retractors by the surgeon's hand. N o t all neurosurgeons prefer to use a hand rest; some stabilize their hands by placing the tip of their outstretched little finger on the J. Neurosurg. / Volume 48 / April. 1978
patient's head. However, the hand rest is especially helpful in fine maneuvers, such as clipping of the neck of an a n e u r y s m , microsuturing, or resecting tumors in a critical area. A disadvantage of the hand rest is that it can disturb quick m o v e m e n t s of the hand. In our apparatus, the hand rest can be easily applied and quickly removed. In addition, the basal frame can be used as the surgeon's a r m rest. While using the microscope, the surgeon should try to keep his eyes in the microscope in order to stay oriented and avoid unnecessary a c c o m m o d a t i o n of the eyes in and out of the microscope. Accessory instrument holders are especially useful for this purpose, because he can keep or pick up those instruments he needs without looking at them. References
1. Kanshepolsky J: Extracranial holder for brain retractors. Technical note. J Neurasurg 46:835-836, 1977 2. Yasargil MG, Fox JL: The microsurgical approach to acoustic neurinomas. Surg Neurol 2:393-398, 1974 Address for Dr. Tsugane: Department of Neurosurgery, Tokai University School of Medicine, Isehara 259-11 Kanagawa, Japan. Address reprint requests to: Kenichiro Sugita, M.D., Department of Neurosurgery, Shinshu University School of Medicine, Asahi 3-1, Matsumoto 390, Japan. 657
