Department of Neurosurgery, University of Geneva Medical Center & Faculty of Medicine, University of Geneva, Swiss Foundation for Innovation & Training in Surgery (SFITS), Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland.
Black Forest Medical Group, Freiburg, Germany.
Acta Neurochir (Wien). 2021 Apr;163(4):885-893. doi: 10.1007/s00701-021-04728-z. Epub 2021 Jan 29.
At this juncture, there is no consensus in the literature for the use and the safety of pin-type head holders in cranial procedures.
The present analysis of the bone response to the fixation of the instrument provides data to understand its impact on the entire skull as well as associated complications. An experimental study was conducted on fresh-frozen human specimens to analyze the puncture hole due to the fixation of each single pin of the pin-type head holder. Cone-beam CT images were acquired to measure the diameter of the puncture hole caused by the instrument according to several parameters: the pin angle, the clamping force, and different neurosurgical approaches most clinically used.
The deepest hole, 2.67 ± 0.27 mm, was recorded for a 35° angle and a clamping force of 270 N at the middle fossa approach. The shallowest hole was 0.62 ± 0.22 mm for the 43° angle with a pinning force of 180 N in the pterional approach. The pterional approach had a significantly different effect on the depth of the puncture hole compared with the middle fossa craniotomy for 270 N pinning at 35° angle. The puncture hole measured with the 43° angle and 180 N force in prone position is significantly different from the other approaches with the same force.
These results could lead to recommendations about the use of the head holder depending on the patient's history and cranial thickness to reduce complications associated with the pin-type head holder during clinical applications.
目前，文献中对于在颅部手术中使用和确保 pin 型头架的安全性尚无共识。
本研究对头架固定器的骨反应分析提供了数据，以了解其对整个颅骨的影响以及相关并发症。对新鲜冷冻的人标本进行了一项实验研究，以分析由于 pin 型头架的每个单独的 pin 固定而导致的穿刺孔。采集锥形束 CT 图像，根据几个参数（pin 角度、夹持力以及最常用于临床的不同神经外科入路）测量仪器引起的穿刺孔的直径：针角度、夹持力以及不同神经外科入路。
在中颅窝入路中，记录到 35°角和 270 N 夹持力时最深的孔为 2.67 ± 0.27mm。在翼点入路中，当 pin 力为 180 N 且角度为 43°时，记录到最浅的孔为 0.62 ± 0.22mm。与 35°角和 270 N pin 力的中颅窝开颅术相比，翼点入路对穿刺孔深度的影响明显不同。在俯卧位以 43°角和 180 N 力测量的穿刺孔与具有相同力的其他入路明显不同。
这些结果可能会根据患者的病史和颅骨厚度提出有关使用头架的建议，以减少在临床应用中与 pin 型头架相关的并发症。
