Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts.
Department of Industrial Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania.
Neurosurgery. 2018 May 1;82(5):678-685. doi: 10.1093/neuros/nyx315.
Head immobilization devices (HIDs) are a staple of neurosurgical procedures, including in the intraoperative magnetic resonance imaging (iMRI) operating rooms (ORs) where material modifications were necessary for compatibility with the magnets utilized.
To present the experience in this OR environment and discuss the multifactorial nature of the observed adverse events.
A retrospective chart review was performed, utilizing the Department of Neurosurgery and iMRI OR databases to identify patients who suffered complications related to HIDs between November 2007 and March 2016. A literature review was also done to identify the magnitude of the problem and the availability of safety guidelines.
Nine hundred and forty patients underwent surgery in the iMRI OR requiring head immobilization. Seven (0.7%) suffered complications related to the HID-depressed skull fractures (n = 7) and epidural hematomas (n = 6). Age at surgery ranged from 1.6 to 10.3 yr. All patients had posterior fossa neoplasms and associated obstructive hydrocephalus. Four patients (57%) suffered permanent neurological deficits. Six patients (86%) underwent a surgical procedure to evacuate the epidural hematomas and repair the depressed skull fracture. In contrast, 1 out of 445 patient (0.2%) suffered HID-related adverse events in the conventional ORs, aged 10.2 yr.
HIDs are important to provide stability and support during neurosurgical procedures. Modifications in the material or the shape of the pins can significantly change the pressure exerted. Most of these complications are preventable if certain precautionary measures are taken especially in certain high-risk patients, and the overall benefits of HIDs continue to outweigh the risks. There is a need for consensus on guidelines for the safe use of these devices.
头固定装置（HID）是神经外科手术的重要组成部分，包括在术中磁共振成像（iMRI）手术室中，为了与使用的磁铁兼容，需要对材料进行修改。
介绍在该手术室环境中的经验，并讨论观察到的不良事件的多因素性质。
回顾性图表审查，利用神经外科和 iMRI 手术室数据库，确定 2007 年 11 月至 2016 年 3 月期间因 HID 引起并发症而接受治疗的患者。还进行了文献回顾，以确定问题的严重程度和安全指南的可用性。
940 名患者在 iMRI 手术室接受了需要头部固定的手术。7 名（0.7%）患者因 HID 导致的颅骨凹陷性骨折（n = 7）和硬膜外血肿（n = 6）而出现并发症。手术时的年龄从 1.6 岁到 10.3 岁不等。所有患者均患有后颅窝肿瘤和相关的梗阻性脑积水。4 名患者（57%）遭受永久性神经功能缺损。6 名患者（86%）接受了手术以清除硬膜外血肿并修复凹陷性颅骨骨折。相比之下，在常规手术室中，445 名患者中有 1 名（0.2%）发生了与 HID 相关的不良事件，年龄为 10.2 岁。
HID 在神经外科手术中提供稳定性和支撑非常重要。材料或针的形状的修改会显著改变施加的压力。如果采取某些预防措施，这些并发症中的大多数是可以预防的，尤其是在某些高危患者中，并且 HID 的整体益处仍然大于风险。需要就这些设备的安全使用达成共识指南。
