Positioning for supratentoria surgery

POSITIONING FOR SUPRATENTORIAL SURGERY

ADETUNMBI. BNeurosurgery 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

contd

• 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

contd

• Horse shoe head rest

contd

• Doughnut head ring

Contd

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

American Society of Anesthesiologists Task 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