Sakakibara Fumihiro
Department of Neurosurgery, Chibune General Hospital.
No Shinkei Geka. 2021 Jan;49(1):24-30. doi: 10.11477/mf.1436204357.
Patient positioning and head fixation are two of the most important aspects of cerebral aneurysm surgery. These procedures require an accurate understanding of the anatomy of the scalp and skull and of the process for approaching aneurysms. We describe the basics of this procedure in frontotemporal craniotomy, which is most frequently used in cerebral aneurysm surgery, with a focus on head fixation using the MAYFIELD three-pin skull clamp(Integra LifeSciences). The insertion sites of the head pins should be avoided in areas with thin bone, such as the frontal sinus and temporal squama, and just above the arteries of the scalp and venous sinuses. The position of the head should be determined based on three factors: rotation, vertex up or down, and tilt. The head should be elevated to reduce intracranial pressure, and cervical hyperflexion should be avoided to prevent increased venous pressure.
患者体位和头部固定是脑动脉瘤手术中两个最重要的方面。这些操作需要准确了解头皮和颅骨的解剖结构以及接近动脉瘤的过程。我们描述了额颞开颅术中该操作的基础，这是脑动脉瘤手术中最常用的方法，重点是使用MAYFIELD三针颅骨夹（Integra LifeSciences）进行头部固定。应避免在骨质薄的区域插入头钉，如额窦和颞鳞，以及头皮动脉和静脉窦上方。头部位置应根据三个因素确定：旋转、顶点向上或向下以及倾斜。头部应抬高以降低颅内压，应避免颈椎过度屈曲以防止静脉压升高。
