3. INTRODUCTION
Surgical removal of a section of the skull in order to access the
intracranial compartment.
“STEREOTACTIC” craniotomies.
That involve the use of a 3-dimensional coordinates system With the aid of
imaging and computer-based navigational software.
"KEYHOLE” craniotomies are used in situations that require less bony removal.
The smallest type of craniotomy is referred to as a “burr hole,” also known as
trephination.
5. THE ESSENTIAL INSTRUMENTS:
Scalpel : Number 10
Suction devices
Raney clips and tissue retractors
Monopolar Electrosurgical Unit: Cuts and Coagulates
Bipolar Electrosurgical Unit
Periosteal Elevator
High Speed Air drills
Bone Flap Elevator
Craniotomy mini plate and screw set
6. Positioning
Head fixation is achieved with 3 skull pins that are situated in a head clamp (eg , Mayfield head-
holder)
Skull block before application
Placed in a band like area just above orbits & pinna
Avoid over thin temporal bone
Not <3 yrs ; 3-10 yrs paediatrics pins
Coated with antibiotic ointment
Clamp squeezed together, allowing gears to slide, until pins are seated in skull
Each ring 20lbs; adult- 60-80lbs; paediatric : 30-40lbs
Radiolucent pins if intraoperative CT/MRI used eg: Titanium, Silicon nitride
Complications
Malposition: Poor fixation-}movement
Over tightening, Incorrect Pin-Injury, Hematoma, Delayed abscess, Epidural Hematoma
Skin Necrosis
Skull Fracture
Bleeding
7.
8. Blade
The skin is incised with a no. 10 blade down through the galea onto bone.
Incisions are not carried beyond the zygomatic arch so as to prevent injury
to the facial nerve
No. 11 Blade
Uses: For fine, precise cutting and dissection of tissues. Often used for
initial arteriotomies, opening dura through burr holes, harvesting
pericranium, etc.
Can be used with the monopolar to make precise holes in the dura when
in contact with the monopolar.
10. Fish hook with Songer Cables
Used to retract skin, muscle, or dural flaps.
The hooks attach to cables which are secured to the drapes.
Minimally traumatic retraction system for craniotomy flaps.
Varieties: Sharp or dull hooks. Springed or not cables. Single or double hooks.
11. Joseph Skin Hooks
Alternative Names: Cottle skin hook, Gilles skin hook, Freer skin hook,
skin hook, single hook
Uses: Retraction of skin and muscle for increasing wound exposure. Useful
for holding pericranium during harvesting or for holding up skin flaps.
12. Monopolar
Alternative Names: Bovie, electric knife, cutter, pen
knife, cauterizer
Uses:
Allows cauterization using high-frequency electrical current
through a single electrode that serves as the knife end. The
patient’s body serves as a ground.
Two settings are usually present, yellow for cutting and blue
for coagulation.
Varieties: Universal design. Multiple types of tips, e.g.,
ring, pinpoint, insulated, etc.
13. Bipolar Forceps
Uses: Coagulation of tissue between the tips of the
forceps, which must be in close contact to allow current to
flow through tissue.
Can be used as a dissection instrument or for general
grasping of delicate tissues.
14. Bayonet Tissue Forceps
Alternative Names: Bayonet, bayonet Cushing,
bayonet Cushing tissue forceps, Jansen tissue
forceps
Uses:
grasping or holding delicate tissue.
Allows better visualization of targeted tissue due to
bayonet feature. Long arms allow use in deep spaces.
15. Perforator
Used to make burr holes.
Craniotome
a special saw with a footplate that allows cutting of
the skull without cutting the dura mater.
16.
17. Yankauer Suction
Uses: Large-bore suction useful in large surgical
exposures. Tip designed to minimize
surrounding tissue damage when suctioning.
18. Penfield Dissector
Various types
Penfield 1: For manipulating tissue & scooping bone.
Penfield 2 & 3: To press bone wax into bleeding bone.
Penfield 3: Also used to remove bone flap.
19. Bone flap elevator
To elevate bone flap.
Peiosteal elevator
To elevate periosteal membrane from the skull in craniotomy.
21. Dura cutting scissors
used for making an incision in the tough outermost membrane
surrounding the brain and spinal cord.
May be used in micro-neurosurgical procedures such as craniotomy as well
as post mortem examinations such as autopsy.
22. Forceps
Plain Tissue Forceps
Uses: Multipurpose atraumatic forceps used for
grasping, holding, retracting, countertraction, and
stabilizing various tissue types.
Toothed Tissue Forceps
Uses: For grasping, holding, retracting,
countertraction, and stabilizing moderate to heavy
tissue types.
23. Clamps
Allis Clamp
Uses: Used in securing, lifting or holding masses or tissue destined for
resection, e.g., spinal lipoma, large intracranial meningioma, or fat for
fat graft.
Also used for securing cords, cables, and suction tubing to the surgical
drapes
Classic Clamp
Alternative Names: Clamp, Crile clamp, Lahey clamp, Halstead clamp,
Adson clamp, Mixter clamp, obtuse clamp, snap, hemostat
Uses: Clamping or occluding vessels or delicate tissue. Used also to
dissect tissue planes. Used commonly to grasp and occlude vessels.
May be used to pass a suture tie around occluded vessels.
Also can be used to secure items to the surgical drape.
24. Halstead Mosquito Clamp
Alternative Names: Clamp, mosquito,
Halstead, Hartman, hemostat, mini snap,
snap
Uses: For clamping or occluding vessels and/or
delicate tissue. Also can be used to secure
to the surgical drape or to hold sutured tissues
for retraction, e.g., dura.
Towel Clamps
Alternative Names: Backhaus clamp, Edna
clamp, Jones clamp, Peers towel clamp
Uses: Multipurpose instrument for securing
items to surgical drapes, grasping thick
tissue, tumor, or bone for retraction or
countertraction.