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Head holder for microsurgical dissection
Journal of Clinical Neuroscience (2004) 11(3), 300–301 0967-5868/$ - see front matter ª 2003 Elsevier Ltd. All rights reserved. doi:10.1016/j.jocn.2003.09.009
Technical note
Head holder for microsurgical dissection A. Goel
MD MCH,
D.P. Muzumdar
MCH,
U. Phalke MCH
Department of Neurosurgery, Seth G.S. Medical College & King Edward VII Memorial Hospital, Parel, Mumbai, India
Summary A new apparatus to hold cadaveric head is described. The apparatus has a ring with the possibility of attaching multiple screws. The assembly is attached to a heavy rectangular base. The apparatus provides wide manoeuverability and firm stabilisation of the head in the desired optimal surgical position. ª 2003 Elsevier Ltd. All rights reserved. Keywords: cadaveric dissection, head holder, microsurgery
INTRODUCTION Cadaver dissections form an essential part of training of the residents and neurosurgeons.1 Rigid head stabilisation in the optimally desired surgical position is important in the performance of cadaveric dissection, particularly when it is carried out under a microscope. We designed a compact appliance for supporting and safe multidirectional manoeuvring of the fixed cadaveric head that is sectioned at the level of the lower part of the neck. The apparatus and its advantages are described.
INSTRUMENT DESIGN The device consists of a heavy rectangular base plate weighing 8000 g (Fig. 1). There are two vertical arms on the sides of the rectangle. The two side arms provide attachment to an adjustable screw system, which grips and stabilises a metal ring. The ring can be turned in the vertical and horizontal plane in these screws. The ring can also be easily removed from the screws and can be placed in the desired position or even upside down. The ring has a provision for placement of 10 screws. The screw will then fix the cadaveric head a shown in Fig. 2. The head positions can be given and circumferentially altered by altering the location of the screws and tilting the ring in the desired angle. A window drape can be used in conjunction with the head holder to obtain the ‘craniototomy’ effect.
Fig. 1 Photograph showing the rectangular base plate with two vertical arms and the ring mounted in between them. The ring has a provision for placement of 10 screws.
DISCUSSION There is a need to learn the anatomy in an actual surgery type setting. Comfortable and erect sitting position of the surgeon is essential when dissection is done under the microscope. Head clamps and holders are used during an actual neurosurgical operation to stabilise the head in a particular desired position so that the surgery on the brain can be performed with minimal discomfort to the surgeon and in the optimum brain position.2;3 The same principle is necessary when one is analysing, learning or practicing a particular surgery. We could not locate a similar head holder designed for laboratory use to hold and sta-
Received 16 September 2003 Accepted 30 September 2003 Correspondence to: Atul goel MD, Department of Neurosurgery, King Edward Medical Hospital, Parel, Mumbai 400 012, India. Tel.: +91-22-241-29884; fax: +91-22-241-43435; E-mail: [email protected]
300
Fig. 2 Photograph showing the cadaveric head fixed with help of screws in a circumferential manner.
Head holder for microsurgical dissection 301
bilise the cadaveric head. We had earlier described two laboratory apparatuses for holding formalin fixed cadaveric brains.4;5 Our apparatus provides a possibility of turning the specimen in a wide range of directions and even turning it upside down. The extensive angular mobility of the ring and the options provided by multiple screws ensure that the head can be placed and supported in any desired anatomical and operative position. The described head holder is simple yet effective during laboratory dissection. The heavy base provides stability to the entire system. The ease of disassembly ensures easy cleaning of the apparatus. Due to the incorporation of commonly used and available stainless steel material, the apparatus is not expensive.
ª 2003 Elsevier Ltd. All rights reserved.
REFERENCES 1. Quinlan DK, deVillers KQ. The organisation of the microsurgical unit. S Afr Med J 1982; 62: 281–284. 2. Lee S, Diez-Pardo J, Olszewski W et al. An improved microsurgical course for a mixed group of surgeons. World J Surg 1981; 5: 285–294. 3. Weir B, McDonald R. Intracranial aneurysm and subarachnoid haemorrhage: an overview. In: Wilkins RH, Rengachary SS (eds) Neurosurgery. McGraw-Hill, New York 1985; 704–719. 4. Goel A, Panchwagh J. Brain holder for microsurgical dissections. Neurol India 2000; 48: 193–194. 5. Bhatjiwale MG, Goel A, Muzumdar DP. A multiposition brain holder: a versatile appliance for microneurosurgical laboratory. J Postgrad Med 2001; 47: 82–83.
Journal of Clinical Neuroscience (2004) 11(3), 300–301
Technical note
Head holder for microsurgical dissection A. Goel
MD MCH,
D.P. Muzumdar
MCH,
U. Phalke MCH
Department of Neurosurgery, Seth G.S. Medical College & King Edward VII Memorial Hospital, Parel, Mumbai, India
Summary A new apparatus to hold cadaveric head is described. The apparatus has a ring with the possibility of attaching multiple screws. The assembly is attached to a heavy rectangular base. The apparatus provides wide manoeuverability and firm stabilisation of the head in the desired optimal surgical position. ª 2003 Elsevier Ltd. All rights reserved. Keywords: cadaveric dissection, head holder, microsurgery
INTRODUCTION Cadaver dissections form an essential part of training of the residents and neurosurgeons.1 Rigid head stabilisation in the optimally desired surgical position is important in the performance of cadaveric dissection, particularly when it is carried out under a microscope. We designed a compact appliance for supporting and safe multidirectional manoeuvring of the fixed cadaveric head that is sectioned at the level of the lower part of the neck. The apparatus and its advantages are described.
INSTRUMENT DESIGN The device consists of a heavy rectangular base plate weighing 8000 g (Fig. 1). There are two vertical arms on the sides of the rectangle. The two side arms provide attachment to an adjustable screw system, which grips and stabilises a metal ring. The ring can be turned in the vertical and horizontal plane in these screws. The ring can also be easily removed from the screws and can be placed in the desired position or even upside down. The ring has a provision for placement of 10 screws. The screw will then fix the cadaveric head a shown in Fig. 2. The head positions can be given and circumferentially altered by altering the location of the screws and tilting the ring in the desired angle. A window drape can be used in conjunction with the head holder to obtain the ‘craniototomy’ effect.
Fig. 1 Photograph showing the rectangular base plate with two vertical arms and the ring mounted in between them. The ring has a provision for placement of 10 screws.
DISCUSSION There is a need to learn the anatomy in an actual surgery type setting. Comfortable and erect sitting position of the surgeon is essential when dissection is done under the microscope. Head clamps and holders are used during an actual neurosurgical operation to stabilise the head in a particular desired position so that the surgery on the brain can be performed with minimal discomfort to the surgeon and in the optimum brain position.2;3 The same principle is necessary when one is analysing, learning or practicing a particular surgery. We could not locate a similar head holder designed for laboratory use to hold and sta-
Received 16 September 2003 Accepted 30 September 2003 Correspondence to: Atul goel MD, Department of Neurosurgery, King Edward Medical Hospital, Parel, Mumbai 400 012, India. Tel.: +91-22-241-29884; fax: +91-22-241-43435; E-mail: [email protected]
300
Fig. 2 Photograph showing the cadaveric head fixed with help of screws in a circumferential manner.
Head holder for microsurgical dissection 301
bilise the cadaveric head. We had earlier described two laboratory apparatuses for holding formalin fixed cadaveric brains.4;5 Our apparatus provides a possibility of turning the specimen in a wide range of directions and even turning it upside down. The extensive angular mobility of the ring and the options provided by multiple screws ensure that the head can be placed and supported in any desired anatomical and operative position. The described head holder is simple yet effective during laboratory dissection. The heavy base provides stability to the entire system. The ease of disassembly ensures easy cleaning of the apparatus. Due to the incorporation of commonly used and available stainless steel material, the apparatus is not expensive.
ª 2003 Elsevier Ltd. All rights reserved.
REFERENCES 1. Quinlan DK, deVillers KQ. The organisation of the microsurgical unit. S Afr Med J 1982; 62: 281–284. 2. Lee S, Diez-Pardo J, Olszewski W et al. An improved microsurgical course for a mixed group of surgeons. World J Surg 1981; 5: 285–294. 3. Weir B, McDonald R. Intracranial aneurysm and subarachnoid haemorrhage: an overview. In: Wilkins RH, Rengachary SS (eds) Neurosurgery. McGraw-Hill, New York 1985; 704–719. 4. Goel A, Panchwagh J. Brain holder for microsurgical dissections. Neurol India 2000; 48: 193–194. 5. Bhatjiwale MG, Goel A, Muzumdar DP. A multiposition brain holder: a versatile appliance for microneurosurgical laboratory. J Postgrad Med 2001; 47: 82–83.
Journal of Clinical Neuroscience (2004) 11(3), 300–301