POSITIONING FOR SUPRATENTORIAL SURGERY

ADETUNMBI. B

Neurosurgery unit LUTH

OUTLINE

• Introduction • Relevant anatomy • Aims• Principle of neurosurgery positioning• Accessories for positioning• Types of positioning for supratentorial lesions• Complications • Conclusion • References

INTRODUCTION

• Positioning can be defined as the arrangement of bodily parts or to place into an advantageous location

• Neurosurgery procedures are usually lengthy

• First obligatory step in proper planning

• Depends on indication for surgery, approach, patients body habitus and surgeons preference

Diagram Showing the Skull

AIMS

• Prevent post operative complications due to positioning

• Best access to the pathological site

• Comfort to the surgeon

• Provision of space to other team members and efficient ergonomics

PRINCIPLES OF NEUROSURGICAL POSITIONING

• Final choice of position should made known as early as possible to the operating team

• Position chosen should ensure patients safety, surgeons comfort, good airway access and adequate mobility

• It should be done typically after induction

• It is sometimes necessary to disconnect ventilator

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• Body positioned before head

• Positioning done to minimise brain retraction, highest point to pathology site shortest distance, craniotomy side parallel to ground

• Eye protection , lubrication and tapping.

• Adequate padding and relief of pressure points must be ensured

• Ultimately risk/benefit ratio should considered

ACCESSORIES FOR POSITIONING

• Mayfield head clamp

Principle of use

• Must be an indication

• Avoided in aneurysm and ICH procedures, air sinus, sutures, temporalis muscle

• Single pin usually in front while double pin opposite.

• Usually fixed in axial plane below the equator of the head.

Complications

• Heamorrhage: extracranial and intracranial

• Skin and eye avulsion

• Skull fracture

• Brain parenchymal injury

• Pin site infection

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• Horse shoe head rest

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• Doughnut head ring

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• Others include bean bags , handrest, gel pads, pillows

American Society of AnesthesiologistsTask Force on the Prevention of

Perioperative Peripheral Neuropathies

TYPES OF POSITIONING

• Supine

• Lateral

• Park bench

• Three quarter prone

SUPINE

LATERAL

LATERAL

PARK BENCH

THREE QUARTER PRONE

Complications of positioning

• Pressure necrosis

• Peripheral neuropathy

• Venous air embolism

• Facial oedema

• Macroglossia

• Blindness

CONCLUSION

• Positioning in neurosurgery cannot be overemphasized

• Positioning is team work

• Ideal positioning gives good post operative outcome

• A well planned surgical procedure can be catastrophic if patient is not well positioned

REFERENCES

• Principles of Neurological Surgery 3rd edition

• Youmans Neurological Surgery 6th edition

• Images from wilkepeadia

• Safe positioning for neurosurgical patients : Danielle st Arnaud

• Management of positioning in neurosurgical patient : Lam A.M

THANK YOU