Advertisement

Endoscopic microvascular decompression without the use of rigid head fixation

Published:November 10, 2022DOI:https://doi.org/10.1016/j.jocn.2022.10.030

      Highlights

      • Pinless head fixation is a reasonable option for select patients undergoing microvascular decompression.
      • Surgical complications and operative times are similar between patients undergoing rigid head fixation and pinless head fixation.
      • Communication with the anesthetics team to ensure no patient movement is essential when using pinless head fixation.

      Abstract

      Background

      Rigid fixation using a three-point skull clamp is a common practice during cranial surgery. Despite its frequency of use, rigid fixation is not without risk of complications including hemodynamic changes, skull fractures and venous thromboembolism. Given this, alternative head fixation should be considered when clinically appropriate.

      Objective

      We sought to demonstrate a safe and effective “pinless” head fixation system during endoscopic microvascular decompression (E-MVD).

      Methods

      Patients undergoing E-MVD were placed in the lateral position with a doughnut pillow under the head, providing support and reducing lateral neck flexion. The vertex of the cranium was angled 10 degrees downward and tape placed circumferentially in an X-shaped fashion around the head, avoiding direct pressure on the ears or eyes. The ipsilateral shoulder was pulled caudally away from the operative field and taped in place to ensure a maximal working corridor.

      Results

      Fifty-two patients underwent the E-MVD procedure with pinless head fixation without any clinical complications. Indications included trigeminal neuralgia type 1 (63.5%), trigeminal neuralgia type 2 (5.8%), hemifacial spasm (19.2%), geniculate neuralgia (7.7%) and glossopharyngeal neuralgia (3.8%). There were no intraoperative or post operative complications and operative time for patients with three-point skull clamp fixation were similar compared to pinless head fixation.

      Conclusions

      Pinless head fixation is a suitable alternative for certain patients undergoing E-MVD and provides a way to minimize complications that can occur secondary to rigid fixation. If pinless fixation is used, diligent and continued communication with the anesthetist is necessary to ensure there is no intraoperative patient movement.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Clinical Neuroscience
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Li Y, Mao F, Cheng F, Peng C, Guo D, Wang B. A Meta-Analysis of Endoscopic Microvascular Decompression versus Microscopic Microvascular Decompression for the Treatment for Cranial Nerve Syndrome Caused by Vascular Compression. World Neurosurg. 2019;126:647-655 e647.

        • Arshad A.
        • Shamim MuhammadShahzad
        • Waqas M.
        • Enam H.
        • Enam SyedAther
        How effective is the local anesthetic infiltration of pin sites prior to application of head clamps: A prospective observational cohort study of hemodynamic response in patients undergoing elective craniotomy.
        Surg Neurol Int. 2013; 4: 93
        • 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
        • Beuriat P.A.
        • 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
        • Erbayraktar S.
        • Gokmen N.
        • Acar U.
        Intracranial penetrating injury associated with an intraoperative epidural haematoma caused by a spring-laden pin of a multipoise headrest.
        Br J Neurosurg. 2001; 15: 425-428
        • Jha N.K.
        • Ebrahim S.
        • Fallah A.
        • Cenic A.
        • De Villiers R.A.
        Pin-site epidural hematoma in an adult case of chronic hydrocephalus with associated thinning of the cranium.
        Br J Neurosurg. 2009; 23: 211-212
        • Prabhakar H.
        • Ali Z.
        • Bhagat H.
        Venous air embolism arising after removal of Mayfield skull clamp.
        J Neurosurg Anesthesiol. 2008; 20: 158-159
        • El-Zenati H.
        • Faraj J.
        • Al-Rumaihi G.I.
        Air embolism related to removal of Mayfield head pins.
        Asian J Neurosurg. 2012; 7: 227-228
      2. Berry C, Sandberg DI, Hoh DJ, Krieger MD, McComb JG. Use of cranial fixation pins in pediatric neurosurgery. Neurosurgery. 2008;62(4):913-918; discussion 918-919.

        • Vitali A.M.
        • Steinbok P.
        Depressed skull fracture and epidural hematoma from head fixation with pins for craniotomy in children.
        Childs Nerv Syst. 2008; 24 (discussion 925): 917-923
        • Wong W.B.
        • Haynes R.J.
        Osteology of the Pediatric Skull: Considerations of Halo Pin Placement.
        Spine. 1994; 19: 1451-1454
      3. Rabbani CC, Patel JM, Nag A, et al. Association of Intracranial Hypertension with Calvarial and Skull Base Thinning. Otol Neurotol. 2019;40(6):e619-e626.

        • Bhananker S.M.
        • Posner K.L.
        • Cheney F.W.
        • Caplan R.A.
        • Lee L.A.
        • Domino K.B.
        Injury and liability associated with monitored anesthesia care: a closed claims analysis.
        Anesthesiology. 2006; 104: 228-234