Surgical Positioning | ScienceGate

Intraoperative neuromonitoring during thyroid surgery has been used to successfully prevent permanent neurological injury by early identification of anatomical variants. Proper interpretation of neuromonitoring data requires knowledge of what factors might affect the data. In this study, we examined the effect of surgical positioning on the latency and amplitude of neural recordings made from the vocalis muscle during thyroid surgery. A retrospective review was performed of 145 patients who underwent thyroid surgery. Eighty-three had open cervical procedures, and 62 had robotic-assisted transaxillary procedures. Intraoperative neuromonitoring recordings were made by stimulation of the vagus and recurrent laryngeal nerves for both groups. Ultrasound measurements were made of a subset of the transaxillary patients immediately before and after arm positioning. Groups differed only on right-sided recordings. Patients with transaxillary surgeries had significantly shorter latencies evoked from the vagus nerve. We found that vagus nerve–evoked latencies were also correlated to ultrasound measurements of the nerves. Surgical positioning during thyroid surgery is a factor that may affect intraoperative neuromonitoring data and should be taken into account by the surgeon during interpretation.

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General Urological and Endourological Considerations in the Care for Transgender Patients: Catheters, Scopes and Haematuria, UTI, Stones and Surgical Positioning

Urological Care for the Transgender Patient ◽

10.1007/978-3-030-18533-6_13 ◽

2021 ◽

pp. 185-192

Author(s):

Nim Christopher

Keyword(s):

Surgical Positioning

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Operative Technique and Lessons Learned From Surgical Implantation of the NeuroPace Responsive Neurostimulation® System in 57 Consecutive Patients

Operative Neurosurgery ◽

10.1093/ons/opaa300 ◽

2020 ◽

Author(s):

Max O Krucoff ◽

Thomas A Wozny ◽

Anthony T Lee ◽

Vikram R Rao ◽

Edward F Chang

Keyword(s):

Operative Technique ◽

Focal Epilepsy ◽

Intraoperative Imaging ◽

Case Series ◽

Lessons Learned ◽

Seizure Freedom ◽

Operative Techniques ◽

Surgical Positioning ◽

Intracerebral Hemorrhages

Abstract BACKGROUND The Responsive Neurostimulation (RNS)® System (NeuroPace, Inc) is an implantable device designed to improve seizure control in patients with medically refractory focal epilepsy. Because it is relatively new, surgical pearls and operative techniques optimized from experience beyond a small case series have yet to be described. OBJECTIVE To provide a detailed description of our operative technique and surgical pearls learned from implantation of the RNS System in 57 patients at our institution. We describe our method for frame-based placement of amygdalo-hippocampal depth leads, open implantation of cortical strip leads, and open installation of the neurostimulator. METHODS We outline considerations for patient selection, preoperative planning, surgical positioning, incision planning, stereotactic depth lead implantation, cortical strip lead implantation, craniotomy for neurostimulator implantation, device testing, closure, and intraoperative imaging. RESULTS The median reduction in clinical seizure frequency was 60% (standard deviation 63.1) with 27% of patients achieving seizure freedom at last follow up (median 23.1 mo). No infections, intracerebral hemorrhages, or lead migrations were encountered. Two patients experienced lead fractures, and four lead exchanges have been performed. CONCLUSION The techniques set forth here will help with the safe and efficient implantation of these new devices.

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C.07 Door to decompression should be the benchmark in trauma craniotomies

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.73 ◽

2016 ◽

Vol 43 (S2) ◽

pp. S12-S13

Author(s):

J Marcoux ◽

D Bracco

Keyword(s):

Emergency Department ◽

System Performance ◽

Trauma System ◽

Surgical Time ◽

Delivery Of Care ◽

Surgical Positioning ◽

Anesthesia Time ◽

The Brain ◽

Decompression Time

Background: Quality control indicators for mass lesion in TBI use the delay between emergency department (ED) and OR arrival to measure quality of care. It does not provide the timing of brain decompression. The goals of this study are to observe step by step where delays occur from hospital admission until effective decompression of the brain. Methods: A prospective observational data collection of timing from ED admission to decompression was conducted for all emergency trauma craniotomies over a period of 15 months. Results: Sixty-five patients were included. Doing a CT at the outside institution instead of transferring the patient prior to CT resulted in a 112min delay in care. Neurosurgery team notification prior to patient’s arrival to ED shortened delivery of care by 51min. The time elapsed between OR arrival and brain decompression was 50min: anesthesia time 3min, surgical positioning/preparation 29min and surgical time 17min. Burrhole decompression followed by craniotomy (9min) shortened the decompression time by 17min compared to standard 4 holes craniotomy approach (26min). Conclusions: Benchmark for trauma system performance in emergency craniotomies should be door to decompression time. Bypassing CT in local hospitals, pre-alerting neurosurgeons, and burrhole decompression followed by standard craniotomy significantly decrease door to decompression time.

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Comparison of Ossicular Replacement Materials in a Mouse Ear Model

Otolaryngology ◽

10.1177/019459988209000417 ◽

1982 ◽

Vol 90 (4) ◽

pp. 461-469 ◽

Cited By ~ 27

Author(s):

Gerald E. Merwin ◽

James S. Atkins ◽

June Wilson ◽

Larry L. Hench

Keyword(s):

Bioactive Glass ◽

Animal Study ◽

Glass Ceramic ◽

The Other ◽

Short Term ◽

Nitrogen Gas ◽

Replacement Surgery ◽

Surgical Positioning ◽

Ossicular Replacement ◽

Mouse Ear

Four biomaterials, UF45S5 Bioglass, Silastic, Plasti-Pore, and Proplast, were used to replace the incus in a mouse ear model. Bioglass, a bioactive glass ceramic, compared favorably with the other test materials in maintaining surgical positioning between malleus and stapes and remaining stable to a blast of nitrogen gas and to pick manipulation. In a short-term animal study, Bioglass showed histocompatibility comparable to that of these other implant materials now used in ossicular replacement surgery in humans.

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