Alissa Visentin1, Kristina van Dooren2, Jan Mertens3, Olivier Brina4, Karl Schaller2. 1. 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. Alissa.visentin@etu.unige.ch. 2. 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. 3. Black Forest Medical Group, Freiburg, Germany. 4. Division of Neuroradiology, University of Geneva Medical Center & Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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.
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.
Entities:
Keywords:
Bone response; Fresh-frozen human specimen; Neurosurgery; Pin-type head fixation device; Skull clamp
Authors: Stefan Unger; Unger Stefan; Michael Blauth; Blauth Michael; Werner Schmoelz; Schmoelz Werner Journal: Bone Date: 2010-08-21 Impact factor: 4.398
Authors: Lennart Henning Stieglitz; Jens Fichtner; Robert Andres; Philippe Schucht; Ann-Kathrin Krähenbühl; Andreas Raabe; Jürgen Beck Journal: Neurosurgery Date: 2013-05 Impact factor: 4.654