Sakakura Kazuki, Fujimoto Ayataka, Ishikawa Eiichi, Enoki Hideo, Okanishi Tohru
Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Department of Neurosurgery, University of Tsukuba, Tsukuba, Japan.
Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.
World Neurosurg. 2020 Oct;142:e453-e457. doi: 10.1016/j.wneu.2020.07.051. Epub 2020 Jul 16.
During neurosurgery, we use a head clamp system for firm head fixation. However, we have encountered slippage using the head clamp system, although this has not been adequately studied. In the present study, to increase the reliability of the analysis using a more homogeneous type of patient data, we conducted a prospective study of patients who had undergone epileptic surgery. We examined the potential risk factors for head slippage and postulated that the location of the pins might be important.
We reviewed and compared the positions of the fixed head of the patients on fused preoperative and postoperative computed tomography images. We measured the distance between the corresponding head pins to determine the association with head slippage. We statistically compared the relationship between each head pin and the nasion-inion line. We also assessed age, sex, body weight, body mass index, surgical position, surgical duration, and craniotomy volume as potential risk factors for slippage.
Head slippage was observed in 3 of 21 patients (14%) in the present prospective study. The most caudal head pin position was not associated with head slippage in the present study. However, the center point between the most caudal point and the most cranial point was significant (P = 0.014). A center point between the most caudal and most cranial pins from the nasion-inion line that was >6.5 cm was more likely to result in slippage.
We should consider that head clamp slippage could occur intraoperatively.
在神经外科手术中，我们使用头部固定夹系统来牢固地固定头部。然而，尽管尚未对此进行充分研究，但我们在使用头部固定夹系统时遇到了滑动情况。在本研究中，为了使用更均质的患者数据类型提高分析的可靠性，我们对接受癫痫手术的患者进行了一项前瞻性研究。我们检查了头部滑动的潜在风险因素，并推测销钉的位置可能很重要。
我们在术前和术后融合的计算机断层扫描图像上回顾并比较了患者固定头部的位置。我们测量了相应头部销钉之间的距离，以确定与头部滑动的关联。我们对每个头部销钉与鼻根 - 枕骨线之间的关系进行了统计学比较。我们还评估了年龄、性别、体重、体重指数、手术位置、手术持续时间和开颅体积作为滑动的潜在风险因素。
在本前瞻性研究中，21例患者中有3例（14%）出现头部滑动。在本研究中，最尾端的头部销钉位置与头部滑动无关。然而，最尾端点和最颅端点之间的中心点具有显著意义（P = 0.014）。鼻根 - 枕骨线与最尾端和最颅端销钉之间的中心点距离>6.5 cm更有可能导致滑动。
我们应该考虑到术中可能会发生头部固定夹滑动。
