Neurosurgeon Surgical instruments /syrgical instruments all operative

Neurological surgery instruments

2. The Neurosurgical Instrument Guide

4. The Neurosurgical Instrument Guide
Christopher S. Eddleman, MD, PhD
Neurosurgeon
Department of Neurological Surgery and Radiology
University of Texas Southwestern Medical School
Dallas, Texas
Thieme
New York · Stuttgart

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6. v
Foreword .................................................................................................................................................................................................................................................................... vii
Preface
............................................................................................................................................................................................................................................................................. ix
Acknowledgments
.................................................................................................................................................................................................................................... xiii
Chapter 1: The Operating Room
......................................................................................................................................................................................... 1
Chapter 2: Operating Room Equipment
............................................................................................................................................................. 11
Chapter 3: Basic Neurosurgical Trays
..................................................................................................................................................................... 17
Chapter 4: Basic Neurosurgical Instrumentation
................................................................................................................................. 25
General
.......................................................................................................................................................................................................................... 26
Blades, Knife Holders, Cautery
.................................................................................................................................................. 48
Scissors, Needles, Needle Holders
........................................................................................................................................ 60
Forceps, Clamps, Retractors
........................................................................................................................................................... 76
Dissectors, Elevators
............................................................................................................................................................................. 142
Drills, Bits, Rongeurs, Curettes
.............................................................................................................................................. 158
Cranial Plates
.................................................................................................................................................................................................... 190
Contents

7. viContents
Chapter 5: Basic Microsurgical/Microvascular/Skull Base Instrumentation
.......................................... 193
General
...................................................................................................................................................................................................................... 194
Scissors, Knives, Needle Holders
........................................................................................................................................ 198
Forceps, Clamps, Retractors
....................................................................................................................................................... 224
Dissectors, Elevators
............................................................................................................................................................................. 248
Bits, Rongeurs
.................................................................................................................................................................................................. 292
Specifi c Procedures
................................................................................................................................................................................. 300
Chapter 6: Spinal Procedures
.......................................................................................................................................................................................... 317
General
...................................................................................................................................................................................................................... 318
Dilators, Retractors
.................................................................................................................................................................................. 348
Dissectors, Elevators, Curettes
............................................................................................................................................... 376
Impactors, Rongeurs, Drill Bits, Drill Guides
................................................................................................... 392
Spine Fusion Instrumentation
............................................................................................................................................... 416
Chapter 7: Transsphenoidal/Endonasal
........................................................................................................................................................... 445
Retractors
.............................................................................................................................................................................................................. 446
Forceps, Rongeurs, Needle Holders
................................................................................................................................ 450
Scissors, Knives
............................................................................................................................................................................................. 462
Dissectors, Elevators, Miscellaneous
............................................................................................................................ 474
Endoscopic Instruments
................................................................................................................................................................. 488
Appendix
............................................................................................................................................................................................................................................................... 497
Index
............................................................................................................................................................................................................................................................................ 499

8. vii
Neurosurgical instrumentation is a complex mix
of traditional tools shared by multiple surgical
disciplines, coupled with instruments unique
to neurosurgery dating back to the dawn of our
specialty. This basic armamentarium is topped
by a vast, confusing panorama of subspecialty
tools whose individual structure and function re-
main opaque to most of us not initiated into the
rites of that particular surgical cult. As confusing
as this hodgepodge collection is to residents and
fellows relatively new to neurosurgery, it is infi -
nitely more diffi cult to navigate for our nursing
staff and surgical tech partners on whom we and
our operative procedures depend for rapid and
reliable instrument identifi cation and exchange.
Dr. Christopher Eddleman has done all of
us involved in neurosurgery—surgeons, nurses,
instrument technicians, etc.—a great favor by
collating a common spectrum of neurosurgi-
cal instruments into a systematically presented
text that not only visually identifi es each tool,
but concisely explains its function and common
usage, details the multiple names by which it is
often (and sometimes erroneously) called, and
explains its usual place in the generic “sets” used
by most operating suites. This innovative format
facilitates the rapid identifi cation of any instru-
ment by sight, title, “nick-name,” function, or
normal association and is the essence of “user
friendly.”
Foreword

9. viiiForeword
Despite the fact that instrumentation is un-
deniably “faddish,” out on the far borders of sub-
specialization, the core tools of our neurosurgical
trade enjoy a remarkable longevity. That durability,
added to Dr. Eddleman’s compulsive exploration of
even slight design modifications, and the thought-
ful accessibility mentioned above, promise to
make this unique, detailed guide a “must read” for
young neurosurgeons and the gold standard refer-
ence for all neurosurgical operative services.
Duke S. Samson, MD
Lois C. A. and Darwin E. Smith
Distinguished Chair in Neurological Surgery
Kimberly-Clark Distinguished Chair
in Mobility Research
Professor and Chairman
Department of Neurological Surgery
University of Texas–Southwestern Medical School
Dallas, Texas

10. ix
I vividly remember the days, both as a medical
student and a junior neurosurgical resident, when
the chief resident or attending neurosurgeon
would ask for an instrument in the operating
room, I thought they were speaking another lan-
guage, especially when muffl ed behind their sur-
gical masks. I can also remember surgical techs in
training who had the very same look on their fac-
es when the neurosurgeon’s hand opened up for
an instrument and they said, “ehofpiwefuiwdbcv-
pi.” After some time, the neurosurgeons’ voices
became more understandable and the names of
the instruments became clearer. However, some
instruments were called three diff erent names
by three diff erent people on three diff erent occa-
sions. How is one to learn these instruments and
their names? Was it time and experience? Was
there a neurosurgical instrument instructional
text? Was there something I was missing in terms
of instructional learning?
For neurosurgical residents, time and experi-
ence are how one learns the tools of the trade in
the neurosurgical operating room. For surgical
scrub nurses and techs, there are countless text-
books and guides that usually cover all surgical
instrumentation (not just for neurosurgery) and
with personalized instruction to boot. So yes,
over time, and with a little experience, it is obvi-
ously possible to learn surgical instrumentation
and all of their accompanying, quirky names.
However, for neurosurgical instrumentation spe-
cifi cally, I thought there must be a better way
Preface

11. xPreface
or at least a way to facilitate the learning expe-
rience. Much to my dismay, there did not exist
a book that was only neurosurgery centric. I
thought that had to change and, ultimately, this
instrument guide was what I envisioned.
The Guide’s purpose is to take the basic neu-
rosurgical operating room principles and instru-
ments and give them some organization from a
neurosurgical prospective. I also wanted to give
a face to the names of the instruments called out
in the operating room for the people who will not
only be handing them out, but who will also be
on the receiving end. Will this Guide allow one
to walk into a neurosurgical operating room and
know every instrument and its uses? Of course
not. Does this Guide include every instrument in
existence? Again, of course not. Does this Guide
cover all of the subspecialty instrumentation for
every minimally invasive spine, endonasal endo-
scopic, cerebral revascularization, and/or func-
tional case? Definitely not! What it is intended
to do, however, is to cover the basics—the neu-
rosurgical instruments most often used day in
and day out. Keep in mind, though, that some
instruments can be used in many different pro-
cedures. As such, some instruments are includ-
ed in more than one chapter. This only serves to
reinforce the importance of that instrument and
how it can be used in multiple areas.
The Guide begins with basic principles of the
operating room, including arrangements, basic
staffing, and equipment. Subsequently, basic
instrument sets will be covered just to give the
reader a feel for what could be included. Finally,
each instrument is described from the perspec-
tive of a neurosurgeon. Each instrument page
contains a photo of the instrument, an enlarged
view of the working end(s), other alternative
names, variations, and its general purpose dur-
ing neurosurgical procedures.
What is not covered in this Guide is who
makes them, where to get them, what they cost,
and what they are made of. Several companies
manufacture and/or distribute these instru-
ments, and a consolidated list of the most popu-
lar companies is available at the end of this book.

12. xiPreface
Lastly, and most importantly, this Guide is
meant as a learning tool, not a promotional one.
Every institution has their pet set of instruments
and/or companies which they prefer, and no one
instrument is the “be all, end all.” This guide is
completely commercial-free and no company or
manufacturer has been involved at any point in
its construction. As such, any reference to any
company or manufacturer that may appear here-
in is merely a byproduct of its production and is
in no way meant as a promotion, as there are an
infinite number of companies that have similar
instruments available.
I hope this Neurosurgical Instrument Guide
not only facilitates the basic knowledge of neu-
rosurgical instrumentation, but also provides a
lasting and progressively stronger comfort level
in the neurosurgical operating room.

14. xiii
This Neurosurgical Instrument Guide has spent a
long time milling around in my head. However,
the living, breathing entity that you hold could
not have been made possible without the con-
tributions of many people. Signifi cant time, en-
ergy, and tolerance have come from Lois Price,
CST, Raechelle Robertson, RN, BSN, and Brad
McGowan, MD. Of course, there are many oth-
ers. Accordingly, and for fear of leaving someone
unnamed, I will simply give those, and they know
who they are, the grandest of gratitude. I am
merely one member of a large team, for without
any one of the other team members, this idea
would still just be milling around in my head.
Acknowledgments

16. 1
No guide to neurosurgical instrumentation would
be complete without fi rst discussing the operating
room itself. While the instruments covered in this
guide are used in the performance of neurosurgi-
cal procedures, the equipment in the operating
room itself can also be thought of as instrumen-
tation, involved in the workfl ow of the operation
(Fig. 1.1). Knowledge of the operating room, its
setup, and the basic equipment in the room before
the patient rolls into the room will always improve
the effi ciency of the operating process.
Most operating rooms have a basic set of
equipment and areas where the diff erent per-
sonnel of the operating room staff complete
their intended tasks before, during, and after ev-
ery surgical procedure. That knowledge, along
with awareness of the roles of each person in the
operating room, further improves the workfl ow
so that communication and tasks can be per-
formed without delay, especially in times of po-
tential crisis. In this chapter, we will review some
of the basics regarding the operating room staff ,
general equipment in the operating room, and
fi nally, basic operating room setups that are
commonly used for neurosurgical procedures.
Operating Room Personnel
Most neurosurgical procedures that take place in
the operating room, or “theatre” as it is called in
the United Kingdom, Australia, and other coun-
tries, involve a team of people with defi ned roles,
so that every need encountered during the pro-
cedure is met. Most operating room staff include
a circulating nurse, a surgical technician or nurse,
an anesthesia team (some with neuroanesthesia
specialists) that may consist of an attending, fel-
Chapter 1: The Operating Room

17. 2 The Neurosurgical Instrument Guide
low, CRNA, medical student, resident, and/or an-
esthesia technician, and finally, the surgical team
itself, which may have several members, such as
neurosurgery attending(s), residents, medical
students, fellows, etc. Other accessory personnel
who may be in attendance in the operating room
include other medical students and residents not
directly involved in the case, equipment or oth-
er industry representatives aiding in the use of
specialized equipment, neurological monitoring
technicians or staff, X-ray technicians, and pathol-
ogy or laboratory staff awaiting tissue samples.
The placement of each team member must be
carefully considered before the procedure be-
gins, so that no member hinders the operation
or other workflow processes during the case.
Operating Room Setup
To ensure an efficient operating room, including
all of the personnel mentioned above, the oper-
ating room must be set up so that all the team
members and the equipment involved have
specific places in the room. There are an infinite
number of arrangements for the operating room,
but a fundamental set of considerations must be
addressed. Most operating rooms have supply
rooms or closets that are located either in an ad-
jacent room(s) or in cabinets within the operat-
ing room itself. These equipment areas should be
accessible during the case without disturbing the
surgeons and their team. The operating room ta-
ble should also be set up to ensure that the trans-
fer of surgical instruments between the surgeon
and the surgical tech/nurse is comfortable and
unhindered. The operating room setup should
also place the anesthesiologists so that they have
unfettered access to the patient’s airway and
vascular access lines. Further, the handedness of
the surgeon must also be considered when the
room is set up for a particular neurosurgical pro-
cedure to ensure that the exchange of surgical
instruments can occur with precision and with-
out obstruction. Lastly, and certainly important
for the purposes of this guide, is the placement

18. 3Chapter 1: The Operating Room
Fig. 1.1 Operating room.

19. 4 The Neurosurgical Instrument Guide
and setup of the surgical instruments that will
be accessed by the surgical scrub technician or
nurse throughout the procedure. Other minor
considerations that must also be addressed are
the placement of the surgical microscope, the
cauterization power supply and pedals, the surgi-
cal drill pedal, suction tubing, and similar equip-
ment. In the next section, several basic operating
room setups will be reviewed.
Basic Operating Room Arrangements
As stated above, the arrangement of the equip-
ment and personnel in the operating room is
very important for an efficient workflow during
neurosurgical procedures. The diagrams below
are very cursory and certainly do not cover ev-
ery acceptable or conceivable variation. They are
meant as suggestions and as a guide to teach
how the operating room can be arranged to
maximize efficiency. Both right- and left-handed
setups are represented for general cranial, gen-
eral spinal, and endonasal/transsphenoidal cas-
es. More specific arrangements for specialized
neurosurgical procedures are not covered but
can be gleaned from the principles illustrated by
the diagrams.
In all cases, the neurosurgeon’s handedness
is addressed by having the scrub nurse or tech-
nician immediately next to the surgeon’s domi-
nant hand, so passage of instruments proceeds
without obstruction. However, as mentioned
above, variations can and do exist. Two particu-
lar variations worth mentioning are prone and
lateral decubitus positions. In prone cases, the
scrub nurse or technician may be across the pa-
tient from the surgeon, so that instruments are
passed directly to the neurosurgeon instead of
from the side. Some feel this may allow better
visual communication between the scrub nurse/
technician and the neurosurgeon. In the lateral
decubitus position, the position of the patient’s
face, and hence access to the airway, is fixed,

20. 5Chapter 1: The Operating Room
giving the anesthesiologist limited positioning,
even after extended ventilation tubing is put
into place. The surgical scrub nurse or technician
and the surgical assistant will more than likely
be placed on the same side of the body. The im-
portant characteristic here is to always give the
anesthesiologist a route to the airway such that
crises can be averted. In the end, the arrange-
ment is up to you or the facility that employs
you. The important thing is to realize that there
is a basis for where equipment and personnel are
placed in the operating room (Table 1.1) (Figs.
1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8 and 1.9).
Table 1.1
 Operating Room Setup Legend
A – Anesthesia
Ae – Anesthesia Equipment
C – Accessory Equipment
I – Surgical Instruments
M – Microscope
S – Neurosurgeon
s – Assistant Neurosurgeon
Sn – Scrub Nurse or Tech

21. 6 The Neurosurgical Instrument Guide
Fig. 1.2 General right-handed surgeon supine or posterior
fossa craniotomy setup (cranial approach).
Fig. 1.3 General right-handed surgeon
posterior fossa craniotomy setup (caudal
approach).

22. 7Chapter 1: The Operating Room
Fig. 1.4 General right-handed surgeon
spine procedure setup.
Fig. 1.5 General right-handed surgeon endonasal/
transsphenoidal setup.

23. 8 The Neurosurgical Instrument Guide
Fig. 1.6 General left-handed surgeon supine or
posterior fossa craniotomy setup (cranial approach).
Fig. 1.7 General left-handed surgeon posterior
fossa craniotomy setup (caudal approach).

24. 9Chapter 1: The Operating Room
Fig.1.8 G
dure setup.
Fig.1.9 General left-handed surgeon endonasal/
transsphenoidal setup.

26. 11
While neurosurgical instruments are the main
focus in this guide, there is certainly a myriad of
equipment in the operating room that should
also be considered essential pieces of neurosur-
gical equipment knowledge.
One of the most important pieces of equip-
ment is the operating room table. Several dif-
ferent kinds of operating room tables are used,
and the choice is often dependent on the type
of neurosurgical procedure involved. The stan-
dard operating room table (Fig. 2.1) has many
sections that allow a wide range of patient posi-
tions. Most people should be familiar with the
tables’ controls and the diff erent positions that
these tables make possible. Most tables will also
rotate to allow “airplaning” (lateral turning) the
patient in either direction, so that more precise
positioning can be obtained before and during
most neurosurgical procedures. Most neuro-
surgical procedures involving patients in the
supine, sitting, and lateral positions can utilize a
similar table. When a head holder is needed for
supine patients, the most common are the May-
fi eld-Keys (Fig. 2.2) or the “horseshoe” (Fig. 2.3 )
head holders. For those patients undergoing a
prone position procedure involving the head or
cervical spine, this same table can be used with
chest rolls and a stabilizing head holder, most
commonly the Mayfi eld-Keys head holder. Spine
procedures involving opening the disc spaces
utilizing this general operating room table can
utilize a Wilson frame added to the top of this
operating room table. The Wilson frame arches
the back and facilitates access to the disc spaces.
For more extensive spine procedures, a diff erent
type of table is often used, which has an open
construction, so the table does not compress
the patient’s abdomen. A Jackson table, one of
Chapter 2: Operating Room Equipment

27. 12 The Neurosurgical Instrument Guide
Fig. 2.1 Basic operating room table.

28. 13Chapter 2: Operating Room Equipment
attachments serve the purposes of positioning,
padding, and providing points for securing other
pieces of equipment, such as arms or retractors.
Of particular note, many different attach-
ments to the operating room table or head hold-
er are retraction systems. Several of them are
used throughout the world, but the three most
common are the Leyla-Yasargil, Budde Halo, and
Fig. 2.2
 Mayfield-Keys headholder.
many of this type, has adjustable padding attach- ments on the sides to support the bony aspects of the pelvis while also padding the upper chest and providing flat panels for the knees. These tables are highly diverse in terms of what attach- ments can be added as well as how the table can be positioned. Most can be rotated, raised, or put in Trendelenburg positions. Other types of
Fig. 2.3 Horseshoe.

29. 14 The Neurosurgical Instrument Guide
the Greenberg retraction systems. The Leyla-
Yasargil retraction system is connected to the
Leyla bar, which is stabilized to the operating
room table. A connector box affixed at the end
of the bar serves as the centerpiece to which all
of the retraction arms are connected. The Budde
Halo and the Greenberg retraction systems can
be connected to the operating room table or to
the head holder. These retraction systems afford
the neurosurgeon hands-free retraction. Further,
the Budde Halo can provide the neurosurgeon
an arm rest while working.
Another important piece of equipment in
the operating room is the cart containing the
power sources for the electrocautery devices,
electric drills, and other equipment that re-
quires a power source (Fig. 2.4). It is important
to know the placement of such equipment so
that the cables needed to connect to them can
be placed properly in the operative field. While
the operating room staff will normally perform
this task, setting up the operating room in the
Fig. 2.4
 A

30. 15Chapter 2: Operating Room Equipment
middle of the night might require you to do this
task, making it very important to sustain an ef-
ficient workflow.
The overhead operating room lights are
often overlooked pieces of equipment that are
highly important to performance of neurosurgi-
cal procedures. It is important to know the range
of mobility of the lights and to have them set up
at the beginning of the case. This ensures that
you are not fumbling around at the beginning to
position the lights with a sterile field in the way.
Lastly, as shown in the diagrams in Chapter
1, the microscope is an important piece of equip-
ment that one should become very familiar with
before the start of a case. It is very important
to place the microscope so it does not impede
the symphony of neurosurgical instrument ex-
changes. Further, it is of paramount importance
to place the observer scopes in positions where
the assistant does not impede the surgical tech-
nician when exchanging instruments.
Many more pieces of equipment are found
in the operating room, and one should be famil-
iar with them before beginning a neurosurgical
case. If you are not sure of something, do not be
afraid to ask. Once this knowledge is set and un-
derstood, then the process of learning the neu-
rosurgical instruments can begin.

32. 17
Despite the vast array of neurosurgical proce-
dures that are performed from head to toe, most
neurosurgical procedures can be done with the
use of basic instrument sets, which may be
somewhat tailored to the procedure. The three
most common neurosurgical instrument sets
are cranial, spine, and transsphenoidal. At some
institutions, a trauma instrument tray may be
available, but often the cranial set can be used
in its place. Academic institutions, at least in the
United States, will often have a litany of more
specifi c instrument trays available for more
specifi c procedures, e.g., functional, peripheral
nerve, CSF shunts, neurovascular, carotid, cere-
bral revascularization, minimally invasive, com-
plex spine, and others.
The following lists of basic neurosurgical in-
strument sets are only meant as a starting point
and are not meant to defi ne what these sets
should be, but to illustrate what they could be. Ev-
ery conceivable instrument that could be placed
in a “basic” set is not listed here. Images and
descriptions of these instruments are contained
throughout the rest of this guide. The numbers
of instruments to include frequently depend on
the allotted and available budget. Normally, each
set can contain one of each variety of scissors,
curettes, dissectors, and rongeurs, while clamps,
forceps, suction tips, retractors, and elevators
are usually present in multiple numbers of the
same type. Several companies and worldwide
distributors off er start-up sets that are able to fi t
most budgets. The World Federation of Neuro-
surgeons also has basic neurosurgical instrument
sets available to parts of the world that lack suf-
fi cient supply and capital.
Chapter 3: Basic Neurosurgical Trays

33. 18 The Neurosurgical Instrument Guide
Basic Cranial or Trauma Instrument Set
Scissors
Adson ganglion 6¼"
Malis neurological 7" curved
Mayo 6¾" curved beveled
Metzenbaum 7" curved
Potts-DeMartel 7¼" 45°
Shark Edge Mayo-Stille 6¾" straight
Needle holders
Mayo-Hegar 6" heavy
Ryder 6" X-Del
Ryder 7" X-Del
Clamps
Allis 6" straight
Foerster sponge stick 9½" straight
Halstead mosquito 5" straight
Kelly 5½" curved
Kocher 6" straight
Rochester-Pean 7¼" Curved
Dissectors/hooks
Dandy nerve hook 9" straight
Frazier dura hook 5¼"
Joseph double hook 6½"
Penfield 1–4
Woodson dural separator 7"
Elevators
Langenbeck 7½" 16 mm
Quervain 7¾" 6 mm
Knife handles
#3 with ruler
#7 without ruler
Forceps
Adson 4¾" with teeth
Gerald 7" with teeth
Gruenwald Bayo 8"
Tissue 5¾" straight with teeth
Yasargil rumor 8¾"

34. 19Chapter 3: Basic Neurosurgical Trays
Suction tips
Poppen 5½" angled 7 Fr, 9–12 Fr
(Frazier)
Dental irrigator
Miscellaneous
Army-Navy retractor
Backhaus towel clips 5¼", 3½"
Beyer rongeur 7" Curved double action
4.5×19 mm (Ruskin)
Cushing retractor 8⅜"
Fish hooks with Songer cables
Freiburg spatula 8" mall flat 7/8, 10/11,
13/14, 16/17 mm
Gelpi retractor 7¼"
Hemoclip applier traditional 8" curved,
medium
Hemoclip applier traditional 6" curved,
small
Kerrison rongeur 2–3 mm
Leksell-Stille rongeur 9½" angled
double-action 7.5×22 mm
Mastoid retractor 7⅞" 4×4 Prong sharp
Raney appliers
Screwdriver with blades
Spinal fusion curette 6¾" angled
Stille rongeur 9¼" double action
(duckbill)
Volkmann bone curette 6¾" 3.6 mm
Weitlaner retractor 6½" blunt 3×4

35. 20 The Neurosurgical Instrument Guide
Basic Spinal Instrument Set
Scissors
Adson ganglion 6¼" straight
Angular wire 4¾"
Mayo 6¾" curved
Mayo 6¾" straight
Metzenbaum 5" curved
Metzenbaum 7" curved
Potts 7¼", angled 45°
Needle holders
Crile Wood 6"
Mayo-Hegar 6"
Mayo-Hegar 8" heavy
Clamps
Adson 7½" straight
Allis 6"
Crile 5¾" curved
Foerster sponge stick 9½" straight
Halstead mosquito 5" straight
Hemoclip applier traditional 8" curved,
medium
Lewin bone 7"
Mayo-Pean 7" curved
Ochsner 6¼" straight
Right angle
Forceps
Adson 4¾" with teeth
Cushing with teeth
Gerald 7" with teeth
Gruenwald Bayo 8½" without teeth
Smooth pickup
Knife handles
#3 with ruler
#7 without ruler
Dissectors
Dandy nerve hook 9" straight
Penfield 1,2,3,4
Woodson dural separator 7"
Suction
Frazier 7Fr, 9Fr, 12Fr

36. 21Chapter 3: Basic Neurosurgical Trays
Curette
Spinal fusion 9" straight (multiple sizes)
Spinal fusion 9" angled (multiple sizes)
Retractor
Army-Navy
Collis-Taylor 7¼" 76 mm
Collis-Taylor 7¼" 64 mm
Gelpi 7½"
Love nerve root 8¼", angled 90°
Weitlaner 6½" 3×4 sharp
Miscellaneous
Backhaus towel clip 5¼"
Backhaus towel clip 3½"
Cobb spinal elevator ⅜",½",¾"
Langenbeck periosteal elevators
Leksell rongeur 9" wide 8 mm
Leksell rongeur 8½" full curved
8×16 mm
Dental irrigators

37. 22 The Neurosurgical Instrument Guide
Basic Transsphenoidal Instrument Set
Retractors
Army-Navy
Cottle speculum short 9×30 mm, 5¾" 2
mm, 10×70 mm
Hardy bivalve speculum 2¾", 3½", 3⅛"
Killian nasal speculum 5" extra-large
85×8.5 mm
Rhoton transsphenoidal speculum
small
Weitlaner 5½" 3×4 blunt
Clamps
Allis 6"
Backhaus towel clips 3, 5½"
Halstead mosquito 5" straight
Kelly 5½" curved
Kocher Ochsner 7¼" straight
Micro Halstead 5" curved
Needle holders
Jacobson Bayo 6⅜"
Mayo Hegar 6", 7" heavy
Webster 5¾"
Scissors
Adson ganglion 6½" straight
Becker septum 7" straight
Knapp iris
Knight nasal
Mayo 6¾" curved, straight, beveled
Metzenbaum 7" curved
Micro cut up-angled, straight
Nasal sinus right, left, 8¾" straight
Forceps
Adson with teeth
Brown-Adson 4¾"
Gruenwald Bayo 8" without teeth
Jansen-Middleton 7" angled down
4×11 mm, 8¼" angled down
Sinus cup (Takahashi pituitary Oldberg)
Takahashi 6¾" straight 3 mm, 6¾" 4 mm

38. 23Chapter 3: Basic Neurosurgical Trays
Knives and handles
#7 knife handles
#3 knife handle with ruler
Sickle knife 7½" straight sharp tip adult
Freer knife 6" round
Ballenger swivel knife 7½" straight 4 mm
Rongeurs
Kerrison 7" 40°, 45°, 90° thin foot
1–3 mm, 2–3 mm
Decker micro 6" 2×6 mm
Beyer rongeur 7" curved double action
4.5×19 mm (Ruskin)
Ostrum Antrum straight
Blakesley Wilde Rhinoforce 45°
Yasargil pituitary 7½" straight 3.5 mm
Oldberg pituitary 7" straight 7 mm
Miscellaneous
Cottle mallet 8" 30 mm
Poppen (Frazier) suction 5–11 Fr
Dental irrigator
Foerster sponge stick 9¾" straight
Converse osteotome 7" straight 4 mm,
6 mm, 8 mm
Cottle elevator
Boles elevator 7" blunt
Fomon retractor ball
Joseph skin hook 6½" single, double
prong
Freer elevator 7½" 4.5 mm
Gorney septum elevator suction
Maxillary ostium seeker 7½"

40. 25General | Chapter 4: Basic Neurosurgical Instrumentation
Chapter 4: Basic Neurological Instrumentation
General.......................................................................................26
Blade
s, Knife Holders, Cautery
....................................................48
S
cissors, Needles, Needle Holders
...............................................60
F
orceps, Clamps, Retractors
........................................................76
Dis
sectors, Elevators
.................................................................142
Dr
ills, Bits, Rongeurs, Curettes
..................................................158
Cr
anial Plates
.............................................................................190

41. 26 The Neurosurgical Instrument Guide

42. 27
Brain Needle
Alternative Name: None
Category: General
Purposes: Used to establish a trajectory in the brain toward a particular target, e.g., ventricle for
CSF drainage or mass for biopsy. Smooth end and shaft allow less traumatic trajectory through
brain tissue. Stylet can be removed to confirm position or can be used with navigation systems for
stereotactic guidance.
Varieties: Lengths of shaft.
General | Chapter 4: Basic Neurosurgical Instrumentation

43. 28 The Neurosurgical Instrument Guide

44. 29
Cotton Patty
Alternative Names: Patty, strip, called out by the measurement of the patty (e.g., half by half),
cotton strip or patty
Category: General
Purposes: Multipurpose cotton patties, more commonly used in hemostasis maneuvers involving
Gelfoam, Surgicel, or other hemostatic agents. The patty is placed over the agent and the suction
draws either blood or fluid, facilitating coagulation. Can be used to apply bone wax atraumatically.
Also used as either a wick to draw fluid away or as a protection barrier over vital structures. Many
other uses exist. Has a radiopaque strip down the middle.
Varieties: Square and rectangular shapes. Multiple sizes.
General | Chapter 4: Basic Neurosurgical Instrumentation

45. 30 The Neurosurgical Instrument Guide

46. 31
Cotton Sponge
Alternative Names: Ray-tec, sponge, 4×4
Category: General
Purposes: Cotton sheets serving a multitude of purposes, e.g., cleaning, hemostasis, wicking,
holding tissue, placement under skin flaps, etc. Filament in sponge allows X-ray detection.
Varieties: Various sizes.
General | Chapter 4: Basic Neurosurgical Instrumentation

47. 32 The Neurosurgical Instrument Guide

48. 33
Frazier Suction
Alternative Name: Poppen suction
Category: General
Purposes: Used for suction of fluids in confined spaces. Thumb hole allows on-and-off style of suc-
tion. Also used as a retractor, protection device, and blunt dissection tool, when removing tumor
or brain parenchyma.
Varieties: Straight or angled. Various diameters of tips.
General | Chapter 4: Basic Neurosurgical Instrumentation

49. 34 The Neurosurgical Instrument Guide

50. 35
Hemoclip Applier
Alternative Names: Ligaclip applier, vascular clip applier, vessel clip applier
Category: General
Purposes: Used for applying small metal clips for occlusion of vessels. Multiple sizes of clips are
available for a diverse range of vessel sizes.
Varieties: Accommodation of various sized clips. Variable lengths.
General | Chapter 4: Basic Neurosurgical Instrumentation

51. 36 The Neurosurgical Instrument Guide

52. 37
Irrigator
Alternative Names: Asepto, Asepto syringe, bulb syringe, water, big irrigation, flush
Category: General
Purposes: Refillable bulb syringes used for directed irrigation of the surgical site.
Varieties: Multiple sizes and shapes of syringes.
General | Chapter 4: Basic Neurosurgical Instrumentation

53. 38 The Neurosurgical Instrument Guide

54. 39
Kittner
Alternative Name: Peanut
Category: General
Purposes: Small rolled-up gauze usually held by a Kelly, Crile, or mosquito clamp and used to dis-
sect tissue bluntly or to clear area for improved visualization. Often used to clean tissue off bone,
e.g., prevertebral tissue in ACDFs, lamina for screw placement, etc.
Varieties: Single or multi-packs.
General | Chapter 4: Basic Neurosurgical Instrumentation

55. 40 The Neurosurgical Instrument Guide

56. 41
Raney Applier
Alternative Names: Raney clip appliers, skin/scalp clip appliers
Category: General
Purposes: Application of Raney clips to skin flap edges during craniotomy for hemostasis.
Varieties: Reusable or disposable.
General | Chapter 4: Basic Neurosurgical Instrumentation

57. 42 The Neurosurgical Instrument Guide

58. 43
Shunt Passer
Alternative Name: None
Category: General
Purposes: Designed for subcutaneous passage of shunt catheters. Caution is always advised when
using this passer, as it can pass through fascia, putting vascular and vital tissue structures at risk
of injury. Hole in tip allows catheter to be sutured and secured to passer. Is often accompanied by
a plastic sheath. Shorter lengths can also be used to pass electrodes in functional cases or for the
creation of subcutaneous tunnels for bypass grafts.
Varieties: Various lengths. Reusable or disposable.
General | Chapter 4: Basic Neurosurgical Instrumentation

59. 44 The Neurosurgical Instrument Guide

60. 45
Suture Boots
Alternative Names: Rubber shod, clamp boots, catheter holders
Category: General
Purposes: Small rubber tips for clamps that prevent the serrations from damaging what is being
held. Often used to handle shunt or pump catheters. Also used to clamp sutures, since the suture
can slip through the serrations of most clamps.
Varieties: Single or multi-packs. Various colors.
General | Chapter 4: Basic Neurosurgical Instrumentation

61. 46 The Neurosurgical Instrument Guide

62. 47
Yankauer Suction
Alternative Name: Tonsil suction tip
Category: General
Purposes: Large-bore suction useful in large surgical exposures. Tip designed to minimize sur-
rounding tissue damage when suctioning.
Varieties: Straight or angled. Protected or non-protected tip. Metal or plastic. Reusable or disposable.
General | Chapter 4: Basic Neurosurgical Instrumentation

63. 48 The Neurosurgical Instrument Guide

64. 49
10 Blade
Alternative Name: Skin knife
Category: Blades
Purposes: Large knife blade often used to make skin incisions.
Varieties: None. Various handle types.
Blades, Knife Holders, Cautery | Chapter 4: Basic Neurosurgical Instrumentation

65. 50 The Neurosurgical Instrument Guide

66. 51
11 Blade
Alternative Name: None
Category: Blades
Purposes: Cutting knife used for fine, precise cutting and dissection of tissues. Often used for ini-
tial 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.
Varieties: None. Various handle types.
Blades, Knife Holders, Cautery | Chapter 4: Basic Neurosurgical Instrumentation

67. 52 The Neurosurgical Instrument Guide

68. 53
15 Blade
Alternative Name: None
Category: Blades
Purposes: Cutting knife used for fine and precise cutting and dissection of tissues. Often used in
pediatrics, skin revisions, harvesting pericranium, and initiating dural incisions.
Varieties: None. Various handle types.
Blades, Knife Holders, Cautery | Chapter 4: Basic Neurosurgical Instrumentation

69. 54 The Neurosurgical Instrument Guide

70. 55
Knife Holder #3
Alternative Name: Often called by the blade type attached
Category: Knife Holders
Purposes: Smaller knife handle used when cutting is required in a small or confined space. Holds
10, 11, 12, and 15 blades.
Varieties: Various shaft lengths.
Blades, Knife Holders, Cautery | Chapter 4: Basic Neurosurgical Instrumentation

71. 56 The Neurosurgical Instrument Guide

72. 57
Knife Holder #7
Alternative Name: Often called by the blade type attached
Category: Knife Holders
Purposes: Knife handle used for general cutting needs, most often used for skin incisions. Holds
10, 11, 12, and 15 blades.
Varieties: Various shaft lengths. With and without ruler.
Blades, Knife Holders, Cautery | Chapter 4: Basic Neurosurgical Instrumentation

73. 58 The Neurosurgical Instrument Guide

74. 59
Monopolar
Alternative Names: Bovie, electric knife, cutter, pen knife, cauterizer
Category: Cautery
Purposes: 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 pres-
ent, one for cutting and the other for cauterization.
Varieties: Universal design. Multiple types of tips, e.g., ring, pinpoint, insulated, etc.
Blades, Knife Holders, Cautery | Chapter 4: Basic Neurosurgical Instrumentation

75. 60 The Neurosurgical Instrument Guide

76. 61
Curved Metzenbaum Scissors
Alternative Names: Metz, curved Metz, Ragnell, tissue scissors, curved tissue scissors
Category: Scissors
Purposes: Useful for macroscopic cutting, dissecting, or undermining delicate soft tissues. Should
only be used to cut tissues. Common uses include cutting dura, fascia, ligated vessels, and muscle.
Varieties: Straight or curved blades. Variable lengths of arms.
Scissors, Needles, Needle Holders | Chapter 4: Basic Neurosurgical Instrumentation

77. 62 The Neurosurgical Instrument Guide

78. 63
Fine Metzenbaum Scissors
Alternative Names: Metz, fine Metz, fine tissue scissors
Category: Scissors
Purposes: Useful for macroscopic cutting, dissecting, or undermining delicate soft tissues. Should
only be used to cut tissues. Common uses include cutting dura, fascia, ligated vessels, and muscle.
Varieties: Straight or curved blades. Variable lengths of arms.
Scissors, Needles, Needle Holders | Chapter 4: Basic Neurosurgical Instrumentation

79. 64 The Neurosurgical Instrument Guide

80. 65
Long Curved Metzenbaum Scissors
Alternative Names: Long Metz, curved Metz, tissue scissors, curved tissue scissors
Category: Scissors
Purposes: Useful for macroscopic cutting, dissecting, or undermining delicate soft tissues. Should
only be used to cut tissues. Common uses include cutting dura, fascia, ligated vessels, and muscle.
Varieties: Straight or curved blades. Variable lengths of arms.
Scissors, Needles, Needle Holders | Chapter 4: Basic Neurosurgical Instrumentation

81. 66 The Neurosurgical Instrument Guide

82. 67
Mayo Scissors
Alternative Name: Suture scissors
Category: Scissors
Purposes: Mainly used for cutting sutures or other non-delicate material.
Varieties: Various lengths of blades and handles.
Scissors, Needles, Needle Holders | Chapter 4: Basic Neurosurgical Instrumentation

83. 68 The Neurosurgical Instrument Guide

84. 69
Cutting Suture Needle
Alternative Name: Rarely referred to by their name based on their size
Category: Needles
Purposes: Triangular-shaped needle tip that cuts through tissue as it is placed through tissue.
Varieties: Straight or curved. Various sizes and diameters of the needle. Various types of suture
attached.
Scissors, Needles, Needle Holders | Chapter 4: Basic Neurosurgical Instrumentation

85. 70 The Neurosurgical Instrument Guide

86. 71 Scissors, Needles, Needle Holders | Chapter 4: Basic Neurosurgical Instrumentation
Tapered Suture Needle
Alternative Names: Rarely referred to by their name based on their size
Category: Needles
Purposes: Rounded needle displaces tissue as it is placed through tissue.
Varieties: Straight or curved. Various sizes and diameters of the needle. Various types of suture
attached.

87. 72 The Neurosurgical Instrument Guide

88. 73
Mayo-Hegar Needle Holder
Alternative Names: Cooley needle holder, DeBakey needle holder, Crile-Wood needle holder,
needle driver
Category: Needle holders
Purposes: Locking needle holder used for a multitude of needle sizes. Most common needle
holder.
Varieties: Smooth or serrated jaws. Various lengths. Various materials.
Scissors, Needles, Needle Holders | Chapter 4: Basic Neurosurgical Instrumentation

89. 74 The Neurosurgical Instrument Guide

90. 75
Ryder Needle Holder
Alternative Names: Cooley needle holder, DeBakey needle holder, Crile-Wood needle holder,
needle driver
Category: Needle holders
Purposes: Locking needle holder used for a multitude of needle sizes.
Varieties: Smooth or serrated jaws. Various lengths. Various materials.
Scissors, Needles, Needle Holders | Chapter 4: Basic Neurosurgical Instrumentation

91. 76 The Neurosurgical Instrument Guide

92. 77 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Adson Forceps
Alternative Names: Adson with teeth, Bunny forceps, pickups with teeth, skin forceps, skin pick-
ups
Category: Forceps
Purposes: Used for grasping and holding superficial tissues, especially during closing superficial
wounds. Allows precise grabbing of skin edges for improved tissue approximation with minimal
tissue injury. Sharp teeth can penetrate fragile tissue, surgical materials (shunt valves, catheters),
and gloves.
Varieties: The number of teeth, 1×2 or 2×3. No variety in length.

93. 78 The Neurosurgical Instrument Guide

94. 79 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Adson Brown Forceps
Alternative Names: Brown-Adson forceps or pickups, Brown forceps or pickups
Category: Forceps
Purposes: Used for grasping and holding superficial and/or delicate tissues. The interlocking teeth
reduce tissue injury. Sharp teeth can penetrate fragile tissue, surgical materials (shunt valves, cath-
eters), and gloves.
Varieties: None.

95. 80 The Neurosurgical Instrument Guide

96. 81 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Bayonet Tissue Forceps
Alternative Names: Bayonet, bayonet Cushing, bayonet Cushing tissue forceps, Jansen tissue
forceps
Category: Forceps
Purposes: Multitude of uses involving grasping or holding delicate tissue. Allows better visualiza-
tion of targeted tissue due to bayonet feature. Long arms allow use in deep spaces.
Varieties: Length of arms. The handle will have either a rounded end (Jansen) or edged end (Cush-
ing) that allows scraping abilities.

97. 82 The Neurosurgical Instrument Guide

98. 83 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
DeBakey Forceps
Alternative Names: DeBakeys, DeBakey pickups, tissue pickups, tissue forceps, vascular forceps,
vascular tissue forceps
Category: Forceps
Purposes: Non-traumatic grasping and holding forceps designed for very delicate tissue or vessels.
Often used in macroscopic vascular cases. Can also be used for handling tubing and other surgical
implants and their cables.
Varieties: Variable instrument lengths.

99. 84 The Neurosurgical Instrument Guide

100. 85 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
General Bayonet Bipolar Forceps
Alternative Names: Cushing bipolars, Rhoton forceps, Malis bipolars, bayonet, bipolar forceps,
bipolars
Category: Forceps
Purposes: Coagulation of tissue between the tips of the forceps, which must be in close contact to
allow current to flow through tissue. Variable current allows highly tailored effectiveness. Can be
used as a dissection instrument or for general grasping of delicate tissues.
Varieties: Straight, curved, or angled tips. Insulated tips or not. Irrigating or not. Short and long.
Blunt or fine tips.

101. 86 The Neurosurgical Instrument Guide

102. 87 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
General Tissue Forceps
Alternative Names: Cushing forceps, Semken forceps, forceps without teeth, smooth forceps
Category: Forceps
Purposes: Multipurpose atraumatic forceps used for grasping, holding, retracting, countertraction,
and stabilizing various tissue types.
Varieties: Various lengths.

103. 88 The Neurosurgical Instrument Guide

104. 89 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Gerald with Teeth
Alternative Names: Pickups with teeth, Gerald with, Cushing with teeth (incorrect)
Category: Forceps
Purposes: Grasping and holding forceps designed for very delicate tissue or vessels. Great for hold-
ing hearty tissue, e.g., dura, fascia, etc., for stabilization during suturing or retraction.
Varieties: None.

105. 90 The Neurosurgical Instrument Guide

106. 91 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Large Tissue Forceps
Alternative Names: Semken forceps with teeth, rat tooth forceps, forceps with teeth
Category: Forceps
Purposes: Multipurpose sharp-toothed forceps used for grasping, holding, retracting, countertrac-
tion, and stabilizing moderate to heavy tissue types. Most often used in wound closures, except
not directly on the skin.
Varieties: Various lengths.

107. 92 The Neurosurgical Instrument Guide

108. 93 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Takahashi Forceps
Alternative Names: Pituitary, tissue forceps
Category: Forceps
Purposes: Grasping and manipulating tissue during endonasal/transsphenoidal cases. Can be used
for tissue grasping and biopsy samples in cranial and spinal cases.
Varieties: Straight or angled jaws. Various jaw sizes. Variable length of instrument.

109. 94 The Neurosurgical Instrument Guide

110. 95 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Yasargil Bayonet Tissue Forceps
Alternative Names: Bayonet, bayonet Cushing, bayonet Cushing tissue forceps, Jansen tissue for-
ceps
Category: Forceps
Purposes: Multitude of uses involving grasping or holding delicate tissue. Cupped jaws allow more
secure tissue purchase. Long arms allow use in deep spaces. Good for grasping biopsy samples and
fat grafts.
Varieties: Length of arms. Size of jaws.

111. 96 The Neurosurgical Instrument Guide

112. 97 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Allis Clamp
Alternative Names: Clamp with teeth, tissue clamp
Category: Clamps
Purposes: Used in securing, lifting or holding masses or tissue destined for resection, e.g., spinal
lipoma, large intracranial meningioma, or fat for fat graft. The interlocking teeth reduce tissue
injury. Also used for securing cords, cables, and suction tubing to the surgical drapes.
Varieties: The number of teeth, 4×5, 5×6, or 9×10. May be curved or straight and come in a vari-
ety of lengths.

113. 98 The Neurosurgical Instrument Guide

114. 99 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Classic Clamp
Alternative Names: Clamp, Crile clamp, Lahey clamp, Halstead clamp, Adson clamp, Mixter clamp,
obtuse clamp, snap, hemostat
Category: Clamps
Purposes: 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.
Varieties: Straight, curved, and angled. Variable lengths of handles.

115. 100 The Neurosurgical Instrument Guide

116. 101 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Crile Clamp
Alternative Names: Clamp, Lahey clamp, Halstead clamp, Adson clamp, Mixter clamp, obtuse
clamp, snap, hemostat
Category: Clamps
Purposes: The most commonly used clamp. Clamping or occluding vessels or delicate tissue. Used
also to dissect tissue planes. Used commonly to grasp and occlude vessels. Also can be used to
secure items to the surgical drape.
Varieties: Straight, curved, and angled. Variable lengths of handles.

117. 102 The Neurosurgical Instrument Guide

118. 103 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Foerster Sponge Stick
Alternative Names: Sponge stick, ringed forceps, Fletcher sponge stick (incorrect)
Category: Clamps
Purposes: Large forceps good for grasping and holding tissues. Most commonly used with a 4×4
mounted, and used for surgical prepping, blunt dissection, and improving visualization by soaking
up blood in large wounds.
Varieties: Straight or curved. Variable lengths of arms. Smooth or serrated jaws.

119. 104 The Neurosurgical Instrument Guide

120. 105 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Halstead Mosquito Clamp
Alternative Names: Clamp, mosquito, Halstead, Hartman, hemostat, mini snap, snap
Category: Clamps
Purposes: Often used for clamping or occluding vessels and/or delicate tissue. Also can be used to
secure items to the surgical drape or to hold sutured tissues for retraction, e.g., dura.
Varieties: Straight or curved jaws.

121. 106 The Neurosurgical Instrument Guide

122. 107 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Kelly Clamp
Alternative Names: Clamp, Crile clamp, Rochester clamp, Pean clamp, hemostat
Category: Clamps
Purposes: The most commonly used clamp. Used to clamp or occlude vessels or delicate tissue.
Used also to dissect tissue planes. Used commonly to grasp and occlude vessels. Also can be used
to secure items to the surgical drape.
Varieties: Straight, curved, and angled. Variable lengths of handles.

123. 108 The Neurosurgical Instrument Guide

124. 109 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Kocher Clamp
Alternative Names: Koch clamp, Ochsner clamp, Rochester-Ochsner clamp, clamp with teeth,
bone clamp
Category: Clamps
Purposes: Used in securing, lifting, or holding masses or tissue destined for resection, e.g., spinal
lipoma, large intracranial meningioma, fat for fat graft, and fascia for approximation. Also used for
stabilizing bony fragments, e.g., fibula for graft molding, spinous processes for lifting and removal,
etc.
Varieties: Straight or curved jaws. Variable lengths.

125. 110 The Neurosurgical Instrument Guide

126. 111 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Straight Halstead Mosquito Clamp
Alternative Names: Clamp, mosquito, Halstead, Hartman, hemostat, mini snap, snap
Category: Clamps
Purposes: Often used for clamping or occluding vessels and/or delicate tissue. Also can be used to
secure items to the surgical drape or to hold sutured tissues for retraction, e.g., dura.
Varieties: Straight or curved jaws.

127. 112 The Neurosurgical Instrument Guide

128. 113 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Towel Clamps
Alternative Names: Backhaus clamp, Edna clamp, Jones clamp, Peers towel clamp
Category: Clamps
Purposes: Multipurpose instrument for securing items to surgical drapes, grasping thick tissue,
tumor, or bone for retraction or countertraction.
Varieties: Perforating/non-perforating or sharp/blunt ends. Variable lengths of arms. Hinged or
spring self-retaining mechanism.

129. 114 The Neurosurgical Instrument Guide

130. 115 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Army-Navy Retractor
Alternative Names: US, Army, US Army, or Navy retractor
Category: Retractors
Purposes: Maintaining retraction in small wounds. Alternatively, these retractors can be used to
push tissue out of the way as well. Good for anterior fat harvest, initial parts of MIS (posterior and
lateral) cases, and functional implant cases.
Varieties: None.

131. 116 The Neurosurgical Instrument Guide

132. 117 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Cushing Retractor
Alternative Names: Curved tissue retractor, Cushing nerve retractor, curved Cushing retractor
Category: Retractors
Purposes: Retraction of skin or muscle flaps, especially during craniotomies. Also used when
making burr holes for protection from surrounding tissue interference by pushing away tissue and
placing the drill bit within the curve of the instrument tip.
Varieties: None.

133. 118 The Neurosurgical Instrument Guide

134. 119 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Fish hooks with Songer cables
Alternative Names: Fish hooks, flap hooks, dural fish hooks, Songer hooks
Category: Retractors
Purposes: Retraction of skin, muscle, or dural flaps. The hooks attach to cables (springed or not),
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.

135. 120 The Neurosurgical Instrument Guide

136. 121 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Gelpi Retractor
Alternative Names: Angled Gelpi, short Gelpi
Category: Retractors
Purposes: Used for retraction of surface tissue to allow for improved visualization of the surround-
ing area. Sharp ends provide point retraction of wound. Used throughout neurosurgical procedures
for superficial and deep tissue retraction.
Varieties: Curved and angled ends. Various lengths. Locking and not.

137. 122 The Neurosurgical Instrument Guide

138. 123 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Joseph Skin Hooks
Alternative Names: Cottle skin hook, Gilles skin hook, Freer skin hook, skin hook, single hook
Category: Retractors
Purposes: Retraction of skin and muscle for increasing wound exposure. Useful for holding pericra-
nium during harvesting or for holding up skin flaps.
Varieties: Sharp or blunt hook. Various lengths.

139. 124 The Neurosurgical Instrument Guide

140. 125 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Joseph Skin Hooks 2-Prong
Alternative Names: Blunt Joseph hook, blunt Cottle double hook, skin hook
Category: Retractors
Purposes: Retraction of skin and muscle for increasing wound exposure. Useful for holding pericra-
nium during harvesting or for holding up skin flaps.
Varieties: Various lengths.

141. 126 The Neurosurgical Instrument Guide

142. 127 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Joseph Skin Hooks 2-Prong Sharp
Alternative Names: Joseph hook, Guthrie hook, Cottle double hook, skin hook
Category: Retractors
Purposes: Retraction of skin and muscle for increasing wound exposure. Useful for holding pericra-
nium during harvesting or for holding up skin flaps.
Varieties: Various lengths.

143. 128 The Neurosurgical Instrument Guide

144. 129 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Long Gelpi Retractor
Alternative Names: Angled Gelpi, short Gelpi
Category: Retractors
Purposes: Used for retraction of surface tissue to allow for improved visualization of the surround-
ing area. Sharp ends provide point retraction of wound. Used throughout neurosurgical procedures
for superficial and deep tissue retraction.
Varieties: Curved and angled ends. Various lengths. Locking and not.

145. 130 The Neurosurgical Instrument Guide

146. 131 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Malleable Brain Retractor
Alternative Names: Malleable retractor, brain ribbon, brain retractor
Category: Retractors
Purposes: Flexible handheld or mountable brain retractor. Can be shaped for custom retraction
angles.
Varieties: Various widths, shapes, and materials.

147. 132 The Neurosurgical Instrument Guide

148. 133 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Mastoid Retractor
Alternative Names: Jansen-mastoid, Weitlaner-Mollison, Weitlaner, small Weitlaner, mastoid
Category: Retractors
Purposes: Self-retaining retraction system for skin and soft tissue. Can be used for any small skin
incisions, percutaneous screw placement, or any other procedure utilizing only small incisions.
Varieties: Straight, curved, or angled arms. Sharp or blunt teeth. Single or multi-toothed jaws.

149. 134 The Neurosurgical Instrument Guide

150. 135 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Miskimon Retractor
Alternative Names: D’Errico-Adson, Mollison, curved Weitlaner, curved cerebellar
Category: Retractors
Purposes: Self-retaining retraction of skin and soft tissue, especially in larger and deeper wounds,
particularly spine and posterior fossa cases.
Varieties: Sharp or blunt teeth. Single or multi-toothed jaws.

151. 136 The Neurosurgical Instrument Guide

152. 137 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Senn Retractor
Alternative Names: Miller-Senn, skin rake, rake
Category: Retractors
Purposes: Double-ended instrument for retraction of skin and muscle for increasing wound expo-
sure. Useful for holding pericranium during harvesting or for holding up skin flaps. Also good for
retracting small amounts of tissue or skin in confined spaces.
Varieties: Sharp or blunt teeth.

153. 138 The Neurosurgical Instrument Guide

154. 139 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Small Toothed Retractor
Alternative Names: Heiss retractor, wound spreader, small skin retractor
Category: Retractors
Purposes: Used for retraction of small openings in the skin. Can be used for any burr holes, percu-
taneous screw placement, or any other procedure utilizing only small incisions.
Varieties: Single or multi-toothed jaws.

155. 140 The Neurosurgical Instrument Guide

156. 141 Forceps, Clamps, Retractors | Chapter 4: Basic Neurosurgical Instrumentation
Weitlaner Retractor
Alternative Names: D’Errico-Adson, Mollison, cerebellar, curved cerebellar
Category: Retractors
Purposes: Self-retaining retraction of skin and soft tissue. One of the most common retractors
used in neurosurgery.
Varieties: Sharp or blunt teeth. Single or multi-toothed jaws.

157. 142 The Neurosurgical Instrument Guide

158. 143 Dissectors, Elevators | Chapter 4: Basic Neurosurgical Instrumentation
Penfield #1
Alternative Names: Number 1, large pancake dissector
Category: Dissectors
Purposes: Double-ended instrument for dissecting, scraping, and separating soft tissue from bone,
e.g., nasal septum, skull base, dura, etc., and even as a protection device when drilling. The blunt
end is smaller and less curved than the Penfield 2 but still can be used to separate bone from dura.
Varieties: None.

159. 144 The Neurosurgical Instrument Guide

160. 145 Dissectors, Elevators | Chapter 4: Basic Neurosurgical Instrumentation
Penfield #2
Alternative Name: Two dissector
Category: Dissectors
Purposes: Double-ended instrument for dissecting, scraping, and separating soft tissue from bone,
e.g., nasal septum, skull base, dura, etc., and even as a protection device when drilling or placing
bone wax for hemostasis in narrow spaces. The blunt end is less curved than the Penfield 3 but still
can be used to separate bone from dura.
Varieties: None.

161. 146 The Neurosurgical Instrument Guide

162. 147 Dissectors, Elevators | Chapter 4: Basic Neurosurgical Instrumentation
Penfield #3
Alternative Name: Three dissector
Category: Dissectors
Purposes: Double-ended instrument for dissecting, scraping, and separating soft tissue from bone,
e.g., nasal septum, skull base, dura, etc., and even as a protection device when drilling or placing
bone wax for hemostasis in narrow spaces. The curved end is most often used to separate bone
from dura through burr holes.
Varieties: None.

163. 148 The Neurosurgical Instrument Guide

164. 149 Dissectors, Elevators | Chapter 4: Basic Neurosurgical Instrumentation
Penfield #4
Alternative Name: Four dissector
Category: Dissectors
Purposes: Multipurpose tool used for dissecting and scraping. Frequent uses include separating
soft tissue from bone, e.g., nasal septum, skull base, dura, etc., and even as a protection device
when drilling or placing bone wax for hemostasis in narrow spaces. Also used for deepening corti-
cectomy incisions and exploration for intraparenchymal hematomas. The back of the handle can
also be used to place bone wax in particular areas, e.g., screw holes, bleeding bone edges, etc., for
hemostasis.
Varieties: None.

165. 150 The Neurosurgical Instrument Guide

166. 151 Dissectors, Elevators | Chapter 4: Basic Neurosurgical Instrumentation
Boles Elevator
Alternative Names: Periosteal, Langenbeck elevator (incorrect), Cobb elevator (incorrect)
Category: Elevators
Purposes: Scraping tissue off fascia and bone, e.g., periosteum. Can also be used to retract or pro-
tect soft tissue when drilling through bone (dural tack-up sutures during craniotomy).
Varieties: Sharp/blunt or narrow/wide ends. Curved or straight. Variable length of shaft.

167. 152 The Neurosurgical Instrument Guide

168. 153 Dissectors, Elevators | Chapter 4: Basic Neurosurgical Instrumentation
Cottle Crani Elevator
Alternative Names: Periosteal, Cobb elevator
Category: Elevators
Purposes: Scraping tissue, in particular periosteum and dura, off bone. Can also be used to retract
or protect soft tissue when drilling through bone (dural tack-up sutures during craniotomy).
Varieties: Sharp/blunt or narrow/wide ends. Curved or straight. Variable length of shaft.

169. 154 The Neurosurgical Instrument Guide

170. 155 Dissectors, Elevators | Chapter 4: Basic Neurosurgical Instrumentation
Cottle Elevator
Alternative Names: Septal elevator, mucosa elevator
Category: Elevators
Purposes: Double-ended instrument with a sharp, flat end and the other with a teardrop shape,
allowing the dissection of delicate soft tissue off, most commonly, the septum. However, it can be
used to separate the dura, ligament, or other soft tissue from bone.
Varieties: None.

171. 156 The Neurosurgical Instrument Guide

172. 157 Dissectors, Elevators | Chapter 4: Basic Neurosurgical Instrumentation
Langenbeck Elevator
Alternative Names: Periosteal, Cottle crani elevator, Chandler elevator, Cobb elevator
Category: Elevators
Purposes: Very useful in scraping tissue off both fascia and bone, in particular periosteum. Can
also be used to retract or protect soft tissue when drilling through bone (dural tack-up sutures dur-
ing craniotomy).
Varieties: Sharp/blunt or narrow/wide ends. Curved or straight. Variable length of shaft.

173. 158 The Neurosurgical Instrument Guide

174. 159 Drills, Bits, Rongeurs, Curettes | Chapter 4: Basic Neurosurgical Instrumentation
Drill Handle
Alternative Name: Dependent on the drill bit attached
Category: Drills
Purposes: Mechanism for housing drill bits and attachments.
Varieties: Pneumatic or electric power source. Ergonomic or more cylindrical housing. Straight or
curved.

175. 160 The Neurosurgical Instrument Guide

176. 161 Drills, Bits, Rongeurs, Curettes | Chapter 4: Basic Neurosurgical Instrumentation
Drill Handle Attachments
Alternative Name: Dependent on the drill bit attached
Category: Drills
Purposes: Drill attachment that is held by the operator. Various attachments to accommodate
variable drill bits. Guarded tips usually reserved for craniotome while open-ended tips can accom-
modate other bits, such as diamond burr, acorn, or screw tip bits.
Varieties: Straight or curved. Open-ended or guarded.

177. 162 The Neurosurgical Instrument Guide

178. 163 Drills, Bits, Rongeurs, Curettes | Chapter 4: Basic Neurosurgical Instrumentation
Perforator Drill Bit
Alternative Name: Burr hole bit
Category: Bits
Purposes: Used for placement of burr holes. Spring-loaded bit releases upon experiencing low
resistance, resulting in cessation of drilling.
Varieties: Various diameters of cutting bit.

179. 164 The Neurosurgical Instrument Guide

180. 165 Drills, Bits, Rongeurs, Curettes | Chapter 4: Basic Neurosurgical Instrumentation
Twist Drill Bit
Alternative Names: Twist drill, screw bit, tap
Category: Bits
Purposes: Tapping holes in bone before screw placement.
Varieties: Various diameters and lengths of bit.

181. 166 The Neurosurgical Instrument Guide

182. 167 Drills, Bits, Rongeurs, Curettes | Chapter 4: Basic Neurosurgical Instrumentation
Craniotome Bit
Alternative Names: Footed bit, tapered bit, tapered spiral bit
Category: Bits
Purposes: Usually used with protective footplate that protects the drill bit from tissue below. Most
often used to cut bone between burr holes, to make limited and specific lamina cuts, and to per-
form other types of custom bone work. Without the footplate, this bit can be used to make holes
in bone, e.g., the bone flap for sutures, so long as the bit is protected from soft tissue by other
means.
Varieties: Various diameters and lengths of bit.

183. 168 The Neurosurgical Instrument Guide

184. 169 Drills, Bits, Rongeurs, Curettes | Chapter 4: Basic Neurosurgical Instrumentation
Cutting Drill Bits
Alternative Names: Fluted ball, acorn, round cutter
Category: Bits
Purposes: Allows removal of large amounts of bone in a short amount of time through coarse
drilling. Can also be used to thin out bone in preparation for punch removal. Caution should be
used around delicate structures, as these drill bits have no protective features when they come into
contact with tissue.
Varieties: Various sizes and shapes of drill bit.

185. 170 The Neurosurgical Instrument Guide

186. 171 Drills, Bits, Rongeurs, Curettes | Chapter 4: Basic Neurosurgical Instrumentation
Diamond Burr
Alternative Names: Diamond, coarse diamond bit
Category: Bits
Purposes: Drill bit that allows more precise drilling but requires more time and generates more
heat. Often used when drilling around vital structures and in more confined spaces, e.g., clinoidec-
tomies, transverse foramina, etc. Heat generated can be used for hemostasis in more vascularized
bone, e.g., sphenoid ridge. Otherwise, copious irrigation is recommended.
Varieties: Fine or coarse bits. Various diameters. Various lengths of the shaft. Various materials.

187. 172 The Neurosurgical Instrument Guide

188. 173 Drills, Bits, Rongeurs, Curettes | Chapter 4: Basic Neurosurgical Instrumentation
Match Head Drill Bit
Alternative Name: Tapered side cutting, M8
Category: Bits
Purposes: Drill bit that allows precision drilling in a side-to-side fashion. The bit is designed not to
cut when placed directly on top of structures. Often used for trimming or removing small amounts
of undesired bone or thinning out bone above vital structures.
Varieties: Various diameters and lengths of bit.

189. 174 The Neurosurgical Instrument Guide

190. 175 Drills, Bits, Rongeurs, Curettes | Chapter 4: Basic Neurosurgical Instrumentation
Adson Rongeur
Alternative Names: Bone rongeur, Juers-Lempert or Lempert rongeur (although incorrect), aneu-
rysm rongeur or bone cutter
Category: Rongeurs
Purposes: Removal of bone and soft tissue, often used for removing temporal squamous bone,
sphenoid wing, and occipital bone.
Varieties: None.

191. 176 The Neurosurgical Instrument Guide

192. 177 Drills, Bits, Rongeurs, Curettes | Chapter 4: Basic Neurosurgical Instrumentation
Beyer Rongeur
Alternative Names: Bone rongeur, Ruskin rongeur, small double-action rongeur
Category: Rongeurs
Purposes: Removal of bone and soft tissue. Often used for removing temporal squamous bone,
sphenoid wing, and occipital bone. Also good for removing calcified tissue or other adherent soft
tissue in open spine cases.
Varieties: Straight or curved jaws. Variable sized cups at the tips.

193. 178 The Neurosurgical Instrument Guide

194. 179 Drills, Bits, Rongeurs, Curettes | Chapter 4: Basic Neurosurgical Instrumentation
Kerrison Rongeur
Alternative Names: Ruggles, punch, spine rongeur, up or down biting rongeur
Category: Rongeurs
Purposes: Allows precise bone removal by guillotine cutting of small pieces of bone and soft tis-
sue, e.g., ligaments. Foot plate allows stabilization or non-traumatic placement of instrument over
vital tissue.
Varieties: Up or down biting. 40°, 45°, or 90° angled tip. Various widths of biting jaw. Coated or
non-coated.

195. 180 The Neurosurgical Instrument Guide

196. 181 Drills, Bits, Rongeurs, Curettes | Chapter 4: Basic Neurosurgical Instrumentation
Leksell Stille Rongeur
Alternative Names: Leksell, double-action, large rongeur, Beyer rongeur (incorrect), Luer-Echlin
rongeur (incorrect), Sklar-Ruskin rongeur (incorrect), Adson rongeur (incorrect)
Category: Rongeurs
Purposes: Double-action bone rongeur used for removal of bone and soft tissue. Often used for
removing temporal squamous bone, sphenoid wing, spinous processes, lamina, and osteophytes,
and for shaping bone flaps. Double action allows more force to be applied to bone.
Varieties: Straight or curved jaws. Variable width of jaws.

197. 182 The Neurosurgical Instrument Guide

198. 183 Drills, Bits, Rongeurs, Curettes | Chapter 4: Basic Neurosurgical Instrumentation
Lempert Rongeur
Alternative Names: Small bone rongeur, Adson rongeur (incorrect), Luer-Friedman, Juers-Lempert,
aneurysm rongeur, small bone cutter
Category: Rongeurs
Purposes: Single-action rongeur good for removing small amounts of soft tissue and bone. Often
used in confined spaces, e.g., along sphenoid ridge during pterional craniotomies, small amounts
of C1 lamina in posterior fossa cases, etc.
Varieties: None.

199. 184 The Neurosurgical Instrument Guide

200. 185 Drills, Bits, Rongeurs, Curettes | Chapter 4: Basic Neurosurgical Instrumentation
Luer Friedmann Rongeur
Alternative Names: Small bone rongeur, Adson rongeur (incorrect), Juers-Lempert, Lempert ron-
geur, aneurysm rongeur, small bone cutter
Category: Rongeurs
Purposes: Single-action rongeur good for removing small amounts of soft tissue and bone. Often
used in confined spaces, e.g., along sphenoid ridge during pterional craniotomies, small amounts
of C1 lamina in posterior fossa cases, etc.
Varieties: None.

201. 186 The Neurosurgical Instrument Guide

202. 187 Drills, Bits, Rongeurs, Curettes | Chapter 4: Basic Neurosurgical Instrumentation
Stille Rongeur
Alternative Names: Duckbill, Sklar-Stille rongeur, Leksell (incorrect), double-action, Beyer rongeur
(incorrect), Sklar-Ruskin rongeur (incorrect), Adson rongeur (incorrect)
Category: Rongeurs
Purposes: Double-action bone rongeur used for removal of bone and soft tissue. Often used for
removing temporal squamous bone, sphenoid wing, spinous processes, lamina, and osteophytes,
and for shaping bone flaps. Double action allows more force to be applied to bone. More narrow
jaws allow bone biting in more confined spaces.
Varieties: None.

203. 188 The Neurosurgical Instrument Guide

204. 189 Drills, Bits, Rongeurs, Curettes | Chapter 4: Basic Neurosurgical Instrumentation
Volkmann Bone Curette
Alternative Names: Spine curette, Brun, bone, oval, round, straight/curved curette
Category: Curettes
Purposes: Multipurpose instrument good for scraping tissue off bone (lateral recess and ligament),
debriding and removing debris, and/or harvesting bone. Curved curettes are used to free or sepa-
rate disc fragments and can also be used as dural separators.
Varieties: Straight or angled varieties. The angles can be right, left, upgoing, downgoing, etc. Mul-
tiple sizes for cutting end. Can be open or cupped. Various lengths of shaft.

205. 190 The Neurosurgical Instrument Guide

206. 191 Cranial Plates | Chapter 4: Basic Neurosurgical Instrumentation
Cranial Plates
Alternative Names: Fixation plates, plates, burr hole covers, dog bone, or other named plate
Category: Cranial Plates
Purposes: Used to join bony surfaces together, most often used to affix a bone plate, plate lamina
or zygoma, or other bone surfaces to be joined together.
Varieties: Various shapes and sizes of plates and screws.

208. 193General | Chapter 5: Basic Microsurgical Instrumentation
Chapter 5: Basic Microsurgical/Microvascular/Skull Base
Instrumentation
General.....................................................................................194
S
cissors, Knives, Needle Holders
...............................................198
F
orceps, Clamps, Retractors
......................................................224
Dis
sectors, Elevators
.................................................................248
Bit
s, Rongeurs
...........................................................................292
Specific Proc
edures
...................................................................300

209. 194 The Neurosurgical Instrument Guide

210. 195
Cottle Mallet
Alternative Names: Mallet, hammer
Category: General
Purposes: Used for application of force, usually on another instrument, e.g., osteotome, bone
graft impactor, chisel, etc.
Varieties: Variable weights. Variable material of mallet and handle.
General | Chapter 5: Basic Microsurgical Instrumentation

211. 196 The Neurosurgical Instrument Guide

212. 197
Japanese Suction
Alternative Names: Fukishima, variable suction, regulated suction tip
Category: General
Purposes: Used for suction of fluids in confined spaces. Teardrop-shaped thumb hole allows regu-
lated style of suction. Also used as a retractor, protection device, and blunt dissection tool when
removing tumor or brain parenchyma.
Varieties: Straight or angled. Various diameters of tips.
General | Chapter 5: Basic Microsurgical Instrumentation

213. 198 The Neurosurgical Instrument Guide

214. 199
Bayonet Micro Scissors
Alternative Names: Yasargil micro scissors, micro scissors
Category: Scissors
Purposes: Used for cutting delicate soft tissue in confined spaces. Also used for micro dissection of
arachnoid bands and adhesions in deep cranial and spinal cases.
Varieties: Straight, curved, or angled blades. Various lengths of arms.
Scissors, Knives, Needle Holders | Chapter 5: Basic Microsurgical Instrumentation

215. 200 The Neurosurgical Instrument Guide

216. 201
Ins Scissors
Alternative Names: Lexer-Baby, Bonn, Kelly, iris scissors, micro dissecting scissors
Category: Scissors
Purposes: Useful for cutting very fine, delicate tissue, including vessels. Can be used to extend
arteriotomies, isolate bypass grafts, etc.
Varieties: Straight or curved blades. Various arm lengths.
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217. 202 The Neurosurgical Instrument Guide

218. 203
Jameson Tenotomy Scissors
Alternative Names: Jameson-Potts, Jamison-Metz, Jamison-Reynolds, tenotomies, long iris scissors
Category: Scissors
Purposes: Useful for cutting very fine, delicate tissue, including vessels. Can be used to extend
arteriotomies, to isolate bypass grafts, in pediatric cases, etc.
Varieties: Straight or curved blades. Various arm lengths.
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219. 204 The Neurosurgical Instrument Guide

220. 205
Knapp Iris Scissors
Alternative Names: Lexer-Baby, Bonn, Kelly, iris scissors, micro dissecting scissors
Category: Scissors
Purposes: Useful for cutting very fine, delicate tissue, including vessels. Can be used to extend
arteriotomies, to isolate bypass grafts, in pediatric cases, etc.
Varieties: Straight or curved blades. Various arm lengths.
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221. 206 The Neurosurgical Instrument Guide

222. 207
Potts-DeMartel Scissors
Alternative Names: Potts scissors, Potts-Smith, angled scissors, vascular scissors
Category: Scissors
Purposes: Used for cutting vessels, e.g., extending an arteriotomy or venotomy. Can also be used
to cut fine, delicate tissue in deep, closed spaces, e.g., to extend dural opening in intramedullary
spine or peripheral nerve cases.
Varieties: Variable instrument lengths. Variable blade lengths and angles.
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223. 208 The Neurosurgical Instrument Guide

224. 209
Vannas Micro Scissors
Alternative Names: Hoyes micro scissors, Westcott scissors, micro scissors
Category: Scissors
Purposes: Used for cutting delicate soft tissue in confined spaces. Also used for micro dissection of
arachnoid bands and adhesions in deep cranial and spinal cases.
Varieties: Straight, curved, or angled blades. Various lengths of arms.
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225. 210 The Neurosurgical Instrument Guide

226. 211
Yasargil Bayonet Scissors
Alternative Names: Bayonet scissors, aneurysm scissors
Category: Scissors
Purposes: Used for cutting delicate soft tissue in confined spaces. Also used for gross removal of
large tumors or initial cuts in giant aneurysm sacs.
Varieties: Straight, curved, or angled blades. Various lengths of arms.
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227. 212 The Neurosurgical Instrument Guide

228. 213
Yasargil Bayonet Micro Scissors
Alternative Names: Micro scissors, bayonet micro scissors
Category: Scissors
Purposes: Used for cutting delicate soft tissue in confined spaces. Also used for micro dissection of
arachnoid bands and adhesions in deep cranial and spinal cases.
Varieties: Straight, curved, or angled blades. Various lengths of arms.
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229. 214 The Neurosurgical Instrument Guide

230. 215
Arachnoid Knife
Alternative Name: Beaver blade
Category: Knives
Purposes: Used to isolate aneurysmal lesion from the parent circulation. Can also be used to ligate
bleeding vessels unable to be cauterized, e.g., AVM cases or fistulous lesions, or for temporary oc-
clusion of larger vessels during revascularization procedures, endarterectomies, and tumor resec-
tions. For aneurysms, clips can be loaded in various positions, e.g., curve down, angle up, legs up,
etc. Newer appliers have adjustable, flexible, or rotating ends, making virtually all clip positions
possible. A review of all available systems is beyond the scope of this guide.
Varieties: Infinite. Straight, curved, angled, fenestrated, bayoneted, mini, temporary, and any com-
bination of the above. Several new materials and alloys have been recently introduced. Opening/
closing mechanism is also variable. The standard spring compression is demonstrated here. Please
see manufacturer’s information guide for more specific mechanics of utilized system.
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231. 216 The Neurosurgical Instrument Guide

232. 217
Diamond Knife
Alternative Name: None
Category: Knives
Purposes: Used for fine dissection or cutting of delicate tissues. Useful in dissecting aneurysmal or
other vascular lesions and adherent tumors, or in generalized sharp dissection. A sleeve is pulled
over the blade for protection, given its delicate nature.
Varieties: Variable types of handles. Triangular or square diamond blades.
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233. 218The Neurosurgical Instrument Guide

234. 219
Castroviejo Needle Holder
Alternative Names: Micro needle holder, micro locking needle holder
Category: Needle holders
Purposes: Microsurgical needle holder with locking mechanism reducing pressure required to hold
needle. Spring-like opening of jaws when not locked. Used most commonly for microsuturing.
Varieties: Straight or curved jaws. Rounded and flat side arms.
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235. 220 The Neurosurgical Instrument Guide

236. 221
Micro Needle Holder
Alternative Names: Barraquer needle holder, Patton needle holder, Sklar micro needle holder,
micro needle driver
Category: Needle holders
Purposes: Non-locking needle holder used for holding and manipulating small needles and suture
in confined spaces. Most often used in microvascular, peripheral nerve, and intradural cases.
Varieties: Various lengths of arms. Various sizes of jaws.
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237. 222 The Neurosurgical Instrument Guide

238. 223
Yasargil Bayonet Needle Holder
Alternative Names: Bayonet needle holder, bayonet micro needle holder
Category: Needle holders
Purposes: Non-locking bayonet needle holder used for holding and manipulating small needles
and sutures in confined spaces. Most often used in microvascular, intradural, and peripheral nerve/
re-anastomoses cases.
Varieties: Various lengths of arms. Various sizes of jaws.
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239. 224 The Neurosurgical Instrument Guide

240. 225
Gerald Forceps without Teeth
Alternative Names: Pickups without teeth, Gerald without, Cushing forceps (incorrect)
Category: Forceps
Purposes: Non-traumatic grasping and holding forceps designed for very delicate tissue or vessels.
Can be used to hold vessels or open the vessel lumen. Can also be used for handling tubing and
other surgical implants and their cables.
Varieties: None.
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241. 226 The Neurosurgical Instrument Guide

242. 227
Micro Suture Forceps
Alternative Names: Jewelers, micro forceps
Category: Forceps
Purposes: Used to grasp and manipulate fine, delicate tissue, e.g., nerve or vessels, or as a micro-
needle holder. Often used in microvascular, intradural, and peripheral nerve/re-anastomosis proce-
dures.
Varieties: Straight or curved tips. Various lengths of arms.
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243. 228 The Neurosurgical Instrument Guide

244. 229
Round Body Forceps
Alternative Names: Round jeweler’s forceps, round micro forceps
Category: Forceps
Purposes: Used for grasping and manipulating fine, delicate tissue, e.g., nerve or vessels, or as a
micro-needle holder. Often used in microvascular, intradural spine, and peripheral nerve/re-anasto-
mosis procedures. Round shaft allows rotation of instrument.
Varieties: Straight or curved tips. Various lengths of arms.
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245. 230 The Neurosurgical Instrument Guide

246. 231
Yasargil Bayonet Bipolar Forceps
Alternative Names: Cushing bipolars, Rhoton forceps, Malis bipolars, bayonet, bipolar forceps,
bipolars
Category: Forceps
Purposes: Coagulation of tissue between the tips of the forceps, which must be in close contact to
allow current to flow through tissue. Variable current allows highly tailored effectiveness. Can be
used as a dissection instrument or for general grasping of delicate tissue.
Varieties: Straight, curved, or angled tips. Insulated tips or not. Irrigating or not. Short and long.
Blunt or fine tips.
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247. 232 The Neurosurgical Instrument Guide

248. 233
Yasargil Bipolar Forceps Straight
Alternative Names: Straight Cushing bipolars, straight Rhoton forceps, straight Malis bipolars,
straight bipolar forceps, straight bipolars
Category: Forceps
Purposes: Coagulation of tissue between the tips of the forceps, which must be in close contact to
allow current to flow through tissue. Variable current allows highly tailored effectiveness. Can be
used as a dissection instrument or for general grasping of delicate tissue.
Varieties: Insulated tips or not. Short and long. Blunt or fine tips.
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249. 234 The Neurosurgical Instrument Guide

250. 235
Cooley Clamp
Alternative Names: DeBakey clamp, carotid clamp, bulldog clamp, angled clamp
Category: Clamps
Purposes: Used for temporary occlusion of large blood vessels. Most commonly used for common
carotid artery occlusion during endarterectomies, intraoperative internal carotid artery access, etc.
Varieties: None.
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251. 236 The Neurosurgical Instrument Guide

252. 237
Mixter Right Angle Clamp
Alternative Names: Right angle, right angle hemostat, right angle snap, right angle Adson clamp,
right angle Crile clamp
Category: Clamps
Purposes: Used for dissecting and isolating delicate soft tissues, especially around vessels and
nerves. Often used to grasp tying sutures to pull them underneath these structures in preparation
for ligation. Also used for dissecting tissue underneath or around structures.
Varieties: Variable lengths of arms and handles.
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253. 238 The Neurosurgical Instrument Guide

254. 239
Cushing Vein Retractor
Alternative Names: Vein retractor, Cushing retractor, Sachs retractor
Category: Retractors
Purposes: Retraction, lifting, or isolation of delicate soft tissue and vessels.
Varieties: Solid or fenestrated blade. Variably sized end.
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255. 240 The Neurosurgical Instrument Guide

256. 241
Frazier Dural Retractor
Alternative Names: Dural hook, dural elevator, micro hook, Adson hook, Fisch hook (incorrect)
Category: Retractors
Purposes: Used for retraction and sharp dissection of fine, delicate soft tissue. Most often used to
elevate tissues, especially dura. Very sharp and should be handled and exchanged with care.
Varieties: None.
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257. 242 The Neurosurgical Instrument Guide

258. 243
Henly Retractor
Alternative Names: Mayo-Adams retractor, cervical retractor
Category: Retractors
Purposes: Used for retraction of skin and soft tissues to allow for improved visualization. Used
most commonly in cervical spine exposures, but can be used in any small exposure.
Varieties: Sharp or blunt blades. Various lengths, widths, and number of teeth on the blades.
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259. 244 The Neurosurgical Instrument Guide

260. 245
Leyla-Yasargil Retractor Arm
Alternative Names: Fixation base, snake holder, snake charmer
Category: Retractors
Purposes: Fits on the end of the Leyla bar and allows the attachment of one to three flexible arms.
Varieties: Number of attachment sites for flexible arms.
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261. 246 The Neurosurgical Instrument Guide

262. 247
Yasargil Box Connector
Alternative Names: Fixation base, snake holder, snake charmer
Category: Retractors
Purposes: Fits on the end of the Leyla bar and allows the attachment of one to three flexible arms.
Varieties: Number of attachment sites for flexible arms.
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263. 248 The Neurosurgical Instrument Guide

264. 249
Dandy Nerve Hook
Alternative Names: Nerve hook, Dandy hook
Category: Dissectors
Purposes: Used in exploring, probing, and dissecting fine, delicate soft tissue and nerves. Also
used to inspect or find dissection planes underneath and within structures, e.g., thecal sac, disc in-
terspace, etc. The rounded handle allows a rolling, twisting action to sweep tissue away or to work
the instrument through tissue planes.
Varieties: None.
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265. 250 The Neurosurgical Instrument Guide

266. 251
Fisch Sharp Nerve Hook
Alternative Names: Sharp nerve hook, micro hook, Adson hook, Frazier hook (incorrect)
Category: Dissectors
Purposes: Primarily for retraction and sharp dissection of fine, delicate soft tissue. Can also be
used to elevate tissues, e.g., dura. Very sharp and should be handled and exchanged with care.
Varieties: Length of tip. Straight or bayonet.
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Malis Nerve Hook
Alternative Names: Dandy nerve hook, nerve hook
Category: Dissectors
Purposes: Used for exploring, probing, and dissecting fine, delicate soft tissue and nerves. Used to
inspect underneath and within structures. The rounded handle allows a rolling, twisting action to
sweep tissue away or to work the instrument between tissue planes.
Varieties: Sharp or blunt tip. Length and angle of tip. Length of shaft.
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Malleable Micro Dissector
Alternative Names: Dagger, malleable dissector, dissector
Category: Dissectors
Purposes: Used for dissection and mobilization of delicate soft tissue structures, most often used
in microsurgical procedures. Often used with vascular lesions, cranio-spinal tumors, skull base
procedures, or other entities requiring fine dissection and manipulation.
Varieties: Variable blade width.
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Rhoton #1
Alternative Names: Number 1, small pancake, Janetta dissector, small round dissector
Category: Dissectors
Purposes: Used for microscopic manipulation and dissection of tissues. Sharp dissector edge al-
lows scraping of tissue off other structures, sharp cutting of adherent tissue adhesions, and focal
retraction.
Varieties: Straight or angled shaft.
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Rhoton #2
Alternative Names: Number 2, medium pancake, pancake, Janetta dissector, medium round dis-
sector
Category: Dissectors
Purposes: Used for microscopic manipulation and dissection of tissues. Sharp dissector edge al-
lows scraping of tissue off other structures, sharp cutting of adherent tissue adhesions, and focal
retraction.
Varieties: Straight or angled shaft.
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Rhoton #3
Alternative Names: Number 3, large pancake, pancake, Janetta dissector, large round dissector
Category: Dissectors
Purposes: Used for microscopic manipulation and dissection of tissues. Sharp dissector edge allows
scraping of tissue off other structures, sharp cutting of adherent tissue adhesions, and focal retraction.
Varieties: Straight or angled shaft.
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Rhoton #4
Alternative Names: Number 4, small elevator, micro elevator, Janetta elevator
Category: Dissectors
Purposes: Used for microscopic manipulation and dissection of delicate tissues, e.g., nerves, ves-
sels, etc. Also used for blunt dissection and exploration of microscopic tissue planes.
Varieties: Straight or angled shaft.
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Rhoton #5
Alternative Names: Number 5, large micro elevator, micro elevator, Janetta elevator
Category: Dissectors
Purposes: Used for microscopic manipulation and dissection of delicate tissues, e.g., nerves, ves-
sels, etc. Also used for blunt dissection and exploration of microscopic tissue planes.
Varieties: Straight or angled shaft.
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Rhoton #6
Alternative Names: Number 6, micro dissector, Janetta elevator, spatula dissector, micro spatula
Category: Dissectors
Purposes: Used for microscopic manipulation and dissection of delicate tissues, e.g., nerves, ves-
sels, etc. Also used for blunt dissection and exploration of microscopic tissue planes.
Varieties: Straight or angled shaft.
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Rhoton #7
Alternative Names: Number 7, micro dissector, Janetta elevator, spatula dissector, micro spatula,
medium micro spatula
Category: Dissectors
Purposes: Used for microscopic manipulation and dissection of delicate tissues, e.g., nerves, ves-
sels, etc. Also used for blunt dissection and exploration of microscopic tissue planes.
Varieties: Straight or angled shaft.
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Rhoton #8
Alternative Names: Number 8, micro dissector, Janetta elevator, spatula dissector, micro spatula,
large micro spatula
Category: Dissectors
Purposes: Used for microscopic manipulation and dissection of delicate tissues, e.g., nerves, ves-
sels, etc. Also used for blunt dissection and exploration of microscopic tissue planes.
Varieties: Straight or angled shaft.
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Rhoton #9
Alternative Names: Number 9, micro nerve hook, micro nerve dissector
Category: Dissectors
Purposes: Used for microscopic manipulation and dissection of delicate tissues, e.g., nerves, ves-
sels, etc. Semi-sharp hook allows blunt dissection and exploration of microscopic tissue planes.
Varieties: Straight or angled shaft.
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Rhoton #10
Alternative Names: Number 10, micro nerve hook, micro blunt hook, micro nerve dissector
Category: Dissectors
Purposes: Used for microscopic manipulation and dissection of delicate tissues, e.g., nerves, ves-
sels, etc. Blunt hook allows dissection and exploration of microscopic tissue planes.
Varieties: Straight or angled shaft.
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Rhoton #11
Alternative Names: Number 11, micro nerve hook, micro angled hook, micro nerve dissector
Category: Dissectors
Purposes: Used for microscopic manipulation and dissection of delicate tissues, e.g., nerves, ves-
sels, etc. Angled semi-sharp hook allows dissection and exploration of microscopic tissue planes.
Varieties: Straight or angled shaft.
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Rhoton #12
Alternative Names: Number 12, micro dissector, micro nerve dissector
Category: Dissectors
Purposes: Used for microscopic manipulation and dissection of delicate tissues, e.g., nerves, ves-
sels, etc. Micro point allows dissection and exploration of microscopic tissue planes.
Varieties: Straight or angled shaft.
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Rhoton #13
Alternative Names: Number 13, micro curette, micro small curette
Category: Dissectors
Purposes: Used for microscopic multipurpose instruments. Scraping tissue off bone, e.g., optic
strut, cavernous sinus, foramina, etc., and removing debris. Microcurettes can also be used as dural
separators.
Varieties: Straight or angled shaft.
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Rhoton #14
Alternative Names: Number 14, micro curette, micro large curette
Category: Dissectors
Purposes: Used for microscopic multipurpose instruments. Scraping tissue off bone, e.g., optic
strut, cavernous sinus, foramina, etc., and removing debris. Microcurettes can also be used as dural
separators.
Varieties: Straight or angled shaft.
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300. 285
Freer Elevator
Alternative Names: Cottle elevator, Pierce elevator, submucosal elevator
Category: Elevators
Purposes: Multipurpose tool used for separating soft tissue from bone, e.g., nasal septum, skull
base, dura, etc.; to dissect vascular plaque in endarterectomies; and even as a protection device
when drilling or placing bone wax for hemostasis in narrow spaces.
Varieties: Single- or double-ended. Sharp or blunt blades.
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Halle Elevator
Alternative Names: Elevator, tissue elevator, septal elevator (incorrect), Penfield 4 (incorrect)
Category: Elevators
Purposes: Multipurpose tool used in separating soft tissue from bone, e.g., nasal septum, skull
base, dura, etc., and even as a protection device when drilling or placing bone wax for hemostasis
in narrow spaces.
Varieties: None.
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304. 289
Quervain Elevator
Alternative Names: de Quervain, narrow elevator, periosteal
Category: Elevators
Purposes: Used for scraping tissue from fascia or bone, e.g., periosteum.
Varieties: None.
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Woodson Dural Separator
Alternative Names: Adson-Woodson (incorrect), dural elevator, groove director, dental instrument
Category: Elevators
Purposes: Double-ended instrument most often used to find tissue planes above dura, e.g.,
through burr holes, under lamina, etc. Can also be used as a protective instrument when drilling
around delicate tissues, e.g., drilling holes for dural tack-up sutures.
Varieties: None.
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Diamond Burr
Alternative Names: Diamond, coarse diamond bit
Category: Bits
Purposes: Drill bit that allows more precise drilling but requires more time and generates more
heat. Often used when drilling around vital structures and in more confined spaces, e.g., clinoidec-
tomies, transverse foramina, etc. Heat generated can be used for hemostasis in more vascularized
bone, e.g., sphenoid ridge. Otherwise, copious irrigation is recommended.
Varieties: Fine or coarse bits. Various diameters. Various lengths of the shaft. Various materials.
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Match Head Drill Bit
Alternative Name: Tapered side cutting, M8, small burr hole bit
Category: Bits
Purposes: Drill bit that allows precision drilling in a side-to-side fashion. The bit is designed not to
cut when placed directly on top of structures. Often used for trimming or removing small amounts
of undesired bone or thinning out bone above vital structures.
Varieties: Various diameters and lengths of bit.
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Twist Drill Bit
Alternative Names: Twist drill, screw bit, tap
Category: Bits
Purposes: Tapping holes in bone before screw placement.
Varieties: Various diameters and lengths of bit.
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Lempert Rongeur
Alternative Names: Small bone rongeur, Adson rongeur (incorrect), Luer-Friedman, Juers-Lempert,
aneurysm rongeur, small bone cutter
Category: Rongeurs
Purposes: Single-action rongeur good for removing small amounts of soft tissue and bone. Often
used in confined spaces, e.g., along sphenoid ridge during pterional craniotomies, small amounts
of C1 lamina in posterior fossa cases, etc.
Varieties: None.
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Aneurysm Clips
Alternative Name: None
Category: Specific procedures
Purposes: Used to isolate aneurysmal lesion from the parent circulation. Can also be used to ligate
bleeding vessels unable to be cauterized, e.g., AVM cases or fistulous lesions, or for temporary oc-
clusion on larger vessels during revascularization procedures and tumor resections. For aneurysms,
clips can be loaded in various positions, e.g., curve down, angle up, legs up, etc. The newest appli-
ers have adjustable, flexible, or rotating jaws, making virtually all clip positions possible.
Varieties: Infinite. Straight, curved, angled, fenestrated, bayoneted, mini, temporary, and any com-
bination above. Several new materials and alloys have been recently introduced. Opening/closing
mechanism is also variable. The standard spring compression is shown.
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Chisel
Alternative Names: Hibbs chisel, Hoke chisel, osteotome
Category: Specific procedures
Purposes: Used for any modification or sculpting of bone. Selected cranial or spinal cuts, bone
graft harvest, and/or molding. Should be used with a mallet.
Varieties: The cutting end can be straight or curved. The lengths of the shaft and width of the cutting
blade come in many combinations. The more common are 15 to 25 cm in length and 4 to 25 mm in
width.
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Converse Osteotome
Alternative Names: Osteotome, Lambottle
Category: Specific procedures
Purposes: Any modification or sculpting of bone. Selected cranial or spinal cuts, bone graft har-
vest, and/or molding. Should be used with a mallet. Usually come as a set.
Varieties: Straight or curved ends. Variable widths of blades.
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Glover Bulldog Clamp
Alternative Names: Large vessel clamp, Cooley clamp
Category: Specific procedures
Purposes: Occlusion of large vessels, used most frequently in procedures requiring occlusion of
large vessels, e.g., endarterectomies, suction decompression for skull base or large ophthalmic/
hypophyseal vascular lesions, etc.
Varieties: Various lengths. Smooth or serrated jaws.
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324. 309
Heparin Needles
Alternative Name: Vessel needles
Category: Specific procedures
Purposes: Attached to syringe to permit the infusion of solutions into vessels, e.g., dilating bypass
graft with heparin solution, administration of vasodilators in open-ended vessels, etc.
Varieties: Various sizes.
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Micro Doppler Probe
Alternative Names: Microvascular Doppler, mini Doppler, bayonet Doppler, vascular Doppler
Category: Specific procedures
Purposes: Allows insonation of the vessels. Often used in determining blood flow after aneurysm
clipping, revascularization procedures, fistulae occlusion, and other procedures when the blood
flow through particular vessels needs to be determined qualitatively.
Varieties: Bayonet or not. Various diameters of probe tip. Reusable or disposable.
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328. 313
Yasargil Bayonet Aneurysm Clip Applier
Alternative Names: Aneurysm clip applier, large clip applier
Category: Specific procedures
Purposes: Used to secure and apply aneurysm clips. Instrument without locking mechanism is
used for clip removal.
Varieties: Straight, curved, or adjustable jaws. With locking mechanism or without.
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330. 315
Yasargil Bayonet Aneurysm Mini Clip Applier
Alternative Names: Mini clip applier, small aneurysm clip applier
Category: Specific procedures
Purposes: Used to secure and apply aneurysm clips. Instrument without locking mechanism is
used for clip removal.
Varieties: Straight, curved, or adjustable jaws. With locking mechanism or without.
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332. 317General | Chapter 6: Spinal Procedures
Chapter 6: Spinal Procedures
General.....................................................................................318
Dila
tors, Retractors
...................................................................348
Dis
sectors, Elevators, Curettes
..................................................376
Im
pactors, Rongeurs, Drill Bits, Drill Guides
..............................392
Spine F
usion Instrumentation
...................................................416

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Adson Forceps
Alternative Names: Adson with teeth, Bunny forceps, pickups with teeth, skin forceps, skin pickups
Category: General
Purposes: Used for grasping and holding superficial tissues, especially during closing superficial
wounds. Allows precise grabbing of skin edges for improved tissue approximation with minimal
tissue injury. Sharp teeth can penetrate fragile tissue, surgical materials (shunt valves, catheters),
and gloves.
Varieties: The number of teeth, 1×2 or 2×3. No variety in length.
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336. 321
Allis Clamp
Alternative Names: Clamp with teeth, tissue clamp
Category: General
Purposes: Used in securing, lifting, or holding masses or tissue destined for resection, e.g., spinal
lipoma, large intracranial meningioma, or fat for fat graft. The interlocking teeth reduce tissue
injury. Can also be used for securing cords, cables, and suction tubing to the surgical drapes.
Varieties: The number of teeth, 4×5, 5×6, or 9×10. May be curved or straight and comes in a vari-
ety of lengths.
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338. 323
Caspar Screwdriver
Alternative Names: Pin screwdriver, screwdriver
Category: General
Purposes: Allows placement and removal of Caspar pins. Screwdriver end is hollow for placement
of Caspar pin into screw guard.
Varieties: Wood or plastic handle.
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Classic Clamp
Alternative Names: Clamp, Crile clamp, Lahey clamp, Halstead clamp, Adson clamp, Mixter clamp,
obtuse clamp, snap, hemostat
Category: General
Purposes: 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.
Varieties: Straight, curved, and angled. Variable lengths of handles.
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342. 327
Cottle Mallet
Alternative Names: Mallet, hammer
Category: General
Purposes: Used for application of force, usually on another instrument, e.g., osteotome, bone
graft impactor, chisel, etc.
Varieties: Variable weights. Variable material of mallet and handle.
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Cotton Patty
Alternative Names: Patty, strip, called out by the measurement of the patty (e.g., half by half),
cotton strip or patty
Category: General
Purposes: Multipurpose cotton patties, more commonly used in hemostasis maneuvers involving
Gelfoam, Surgicel, or other hemostatic agents. The patty is placed over the agent and the suction
draws either blood or fluid, facilitating coagulation. Can be used to apply bone wax atraumatically.
Also used as either a wick to draw fluid away or as a protection barrier over vital structures. Many
other uses exist. Has a radiopaque strip down the middle.
Varieties: Square and rectangular shapes. Multiple sizes.
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346. 331
Cotton Sponge
Alternative Names: Ray-tec, sponge, 4×4
Category: General
Purposes: Cotton sheets serving a multitude of purposes, e.g., cleaning, hemostasis, wicking,
holding tissue, placement under skin flaps, etc. Filament in sponge allows X-ray detection.
Varieties: Various sizes.
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348. 333
Cutting Suture Needle
Alternative Name: Rarely referred to by their name based on their size
Category: General
Purposes: Triangular-shaped needle tip that cuts through tissue as it is placed through tissue.
Varieties: Straight or curved. Various sizes and diameters of the needle. Various types of suture
attached.
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350. 335
Foerster Sponge Stick
Alternative Names: Sponge stick, ringed forceps, Fletcher sponge stick
Category: General
Purposes: Large forceps good for grasping and holding tissues. Most commonly used with a 4×4
mounted and used for surgical prepping, blunt dissection, and improving visualization by soaking
up blood in large wounds.
Varieties: Straight or curved. Variable lengths of arms. Smooth or serrated jaws.
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352. 337
Frazier Suction
Alternative Name: Poppen suction
Category: General
Purposes: Used for suction of fluids in confined spaces. Thumb hole allows on-and-off style of suc-
tion. Also used as a retractor, protection device, and blunt dissection tool when removing tumor or
brain parenchyma.
Varieties: Straight or angled. Various diameters of tips.
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354. 339
Irrigator
Alternative Names: Asepto, Asepto syringe, bulb syringe, water, big irrigation, flush
Category: General
Purposes: Refillable bulb syringes used for directed irrigation of the surgical site.
Varieties: Multiple sizes and shapes of syringes.
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Monopolar
Alternative Names: Bovie, electric knife, cutter, pen knife, cauterizer
Category: General
Purposes: 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 pres-
ent, one for cutting and the other for cauterization.
Varieties: Universal design. Multiple types of tips, e.g., ring, pinpoint, insulated, etc.
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358. 343
Kittner
Alternative Name: Peanut
Category: General
Purposes: Small rolled-up gauze usually held by a Kelly, Crile, or mosquito clamp and used to dis-
sect tissue bluntly or to clear area for improved visualization. Often used to clean tissue off bone,
e.g., prevertebral tissue in ACDFs, lamina for screw placement, etc.
Varieties: Single or multi-packs.
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360. 345
10 Blade
Alternative Name: Skin knife
Category: General
Purposes: Large knife blade often used to make skin incisions.
Varieties: None. Various handle types.
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362. 347
Yankauer Suction
Alternative Name: Tonsil suction tip
Category: General
Purposes: Large-bore suction useful in large surgical exposures. Tip designed to minimize sur-
rounding tissue damage when suctioning.
Varieties: Straight or angled. Protected or non-protected tip. Metal or plastic. Reusable or disposable.
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364. 349
MIS Tubular Retractor Dilators
Alternative Name: None
Category: Dilators
Purposes: Progressive dilators used in minimally invasive spine cases that allow the use of a tubular
retraction system. Each dilator is placed over the other and is radiopaque to allow visualization
with fluoroscopy.
Varieties: Variable diameter of dilators.
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366. 351
Brewster Retractor
Alternative Names: Tissue retractor, large tissue retractor
Category: Retractors
Purposes: Retraction of surface tissue to allow for improved visualization of the surrounding areas
in large wound incisions.
Varieties: None.
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368. 353
Caspar Retractor
Alternative Names: Distraction pin retractor, pin retractor
Category: Retractors
Purposes: Adjustable and self-retaining retraction system for Caspar pins when performing ante-
rior cervical discectomies.
Varieties: Left- or right-handedness.
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370. 355
Cloward Hand-Held Retractor
Alternative Names: Hand-held retractor, Cloward retractor
Category: Retractors
Purposes: Used for retraction of surface tissue to allow for improved visualization of the surround-
ing areas. Often used in anterior cervical spine cases.
Varieties: With and without a lip on the end of the blade.
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372. 357
Collis-Taylor Retractor
Alternative Names: Taylor retractor, laminectomy nerve retractor, tissue retractor, large tissue
retractor
Category: Retractors
Purposes: Retraction of skin and surface tissue allowing for improved visualization of the surround-
ing areas. Hook at bottom allows stabilization of retraction against a hard surface, e.g., bone.
Varieties: Lengths of instruments. Small or large blades.
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374. 359
D’Errico Nerve Retractor
Alternative Names: D’Errico, Taylor retractor, laminectomy retractor, tissue retractor, large tissue
retractor, nerve root retractor, straight Love retractor, straight Scoville retractor
Category: Retractors
Purposes: Smooth-surfaced, lipped, and crescent-shaped end used for retraction of vital tissue,
normally dura or nerve roots during spinal surgery.
Varieties: Straight or angled shaft. Variable blade widths.
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Gelpi Retractor
Alternative Names: Angled Gelpi, short Gelpi
Category: Retractors
Purposes: Used for retraction of surface tissue to allow for improved visualization of the surround-
ing area. Sharp ends provide point retraction of wound. Used throughout neurosurgical procedures
for superficial and deep tissue retraction.
Varieties: Curved and angled ends. Various lengths. Locking and not.
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Gelpi Long Retractor
Alternative Names: Angled Gelpi, short Gelpi
Category: Retractors
Purposes: Used for retraction of surface tissue to allow for improved visualization of the surround-
ing area. Sharp ends provide point retraction of wound. Used throughout neurosurgical procedures
for superficial and deep tissue retraction.
Varieties: Curved and angled ends. Various lengths. Locking and not.
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380. 365
Henly Retractor
Alternative Names: Mayo-Adams retractor, cervical retractor
Category: Retractors
Purposes: Used for retraction of skin and soft tissues to allow for improved visualization. Used
most commonly in cervical spine exposures, but can be used in any small exposure.
Varieties: Sharp or blunt blades. Various lengths, widths, and number of teeth on the blades.
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Army-Navy Retractor
Alternative Names: US, Army, US Army, or Navy retractor
Category: Retractors
Purposes: Maintaining retraction in small wounds. Alternatively, these retractors can be used to
push tissue out of the way as well. Good for anterior fat harvest, initial parts of MIS (posterior and
lateral) cases, and functional implant cases.
Varieties: None.
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384. 369
Love Nerve Root Retractor
Alternative Names: Love retractor, angled Scoville retractor, D’Errico (incorrect), Taylor retractor,
laminectomy nerve retractor, nerve root retractor
Category: Retractors
Purposes: Smooth-surfaced, lipped, and crescent-shaped end used for retraction of vital tissue,
normally dura or nerve roots during spinal surgery.
Varieties: Straight or angled shaft. Variable blade widths. Plastic, metal, or wood handles.
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MIS Tubular Retractors
Alternative Name: MIS retractor
Category: Retractors
Purposes: Most commonly used for minimally invasive spine procedures; however, there are some
uses in the brain for retractors with smaller diameters. The tube is connected to a stabilizing arm.
Some systems have light systems that can be attached. Also, some systems have tubes that can
open up further, increasing the exposure.
Varieties: Multiple diameters and lengths. Adjustable and non-adjustable ends. Lighted and non-
lighted.
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Weitlaner Retractor
Alternative Names: D’Errico-Adson, Mollison, cerebellar, curved cerebellar
Category: Retractors
Purposes: Self-retaining retraction of skin and soft tissue. One of the most common retractors
used in neurosurgery.
Varieties: Sharp or blunt teeth. Single or multi-toothed jaws.
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390. 375
Williams Discectomy Retractor
Alternative Names: Meyerding retractor (incorrect), hemilam retractor, laminectomy retractor
Category: Retractors
Purposes: Deep self-retaining retractor for use when a unilateral lamina is being removed.
Varieties: Right or left orientation (side of the blade).
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Ball Tip Dissector
Alternative Names: Ball tip probe, ball-tipped nerve hook
Category: Dissectors
Purposes: Used for non-traumatically manipulating tissues including nerves, exploring underneath
or within spaces including sub-thecal sac and disc interspaces, and releasing adherent soft tissue.
Varieties: Straight, curved, or angled end. Bayoneted and variable lengths of the shaft.
Dissectors, Elevators, Curettes | Chapter 6: Spinal Procedures

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394. 379
Ball Tip Probe
Alternative Names: Pedicle probe, ball probe, hole probe
Category: Dissectors
Purposes: Used to assess the integrity of the walls in deep bony holes, most often used after drill-
ing and/or tapping pedicle screw pathways. Can also be used to feel the annulus on the other side
after discectomy.
Varieties: Various lengths of shaft. With and without rulers.
Dissectors, Elevators, Curettes | Chapter 6: Spinal Procedures

395. 380 The Neurosurgical Instrument Guide

396. 381
Krayenbuhl Ball Tip Hook
Alternative Names: Ball tip nerve hook, nerve hook
Category: Dissectors
Purposes: Exploring, probing and dissecting fine delicate soft tissue and nerves, most often used
to inspect underneath and within structures. The rounded handle allows a rolling, twisting action
to sweep tissue away or to work the instrument between tissue planes.
Varieties: Length and angle of tip. Length of shaft.
Dissectors, Elevators, Curettes | Chapter 6: Spinal Procedures

397. 382 The Neurosurgical Instrument Guide

398. 383
Large Nerve Hook
Alternative Names: Dandy nerve hook, nerve hook
Category: Dissectors
Purposes: Exploring, probing and dissecting fine, delicate soft tissue and nerves, most often used
to inspect underneath and within structures. The rounded handle allows a rolling, twisting action
to sweep tissue away or to work the instrument between tissue planes.
Varieties: Sharp or blunt tip. Length and angle of tip. Length of shaft.
Dissectors, Elevators, Curettes | Chapter 6: Spinal Procedures

399. 384 The Neurosurgical Instrument Guide

400. 385
Boles Elevator
Alternative Names: Periosteal, Langenbeck elevator (incorrect), Cobb elevator (incorrect)
Category: Elevators
Purposes: Scraping tissue off fascia and bone, e.g., periosteum. Can also be used to retract or pro-
tect soft tissue when drilling through bone (dural tack-up sutures during craniotomy).
Varieties: Sharp/blunt or narrow/wide ends. Curved or straight. Variable length of shaft.
Dissectors, Elevators, Curettes | Chapter 6: Spinal Procedures

401. 386 The Neurosurgical Instrument Guide

402. 387
Cobb Elevator
Alternative Names: Periosteal, Langenbeck elevator (incorrect)
Category: Elevators
Purposes: Used in scraping muscle, soft tissue, and periosteum off bone. Can also be used to
retract in deep spaces or protect soft tissue when drilling through or on bone. Most often used in
posterior spine cases when dissecting muscle and soft tissue around the spinous processes and
lamina.
Varieties: Lengths of shaft and size of handle. Variable size of curved end. Wood, plastic, or metal
handles.
Dissectors, Elevators, Curettes | Chapter 6: Spinal Procedures

403. 388 The Neurosurgical Instrument Guide

404. 389
Spinal Fusion Curette
Alternative Names: Brun, bone, oval, round, straight/curved curette
Category: Curettes
Purposes: Multipurpose instrument used for scraping tissue off bone (lateral recess and ligament),
sculpting/breaking small areas of bone (optic strut), debriding tissue, or harvesting bone.
Varieties: Straight or angled varieties. The angles can be right, left, upgoing, downgoing, etc. Mul-
tiple sizes for cutting end. Can be open or cupped. Various lengths of shaft.
Dissectors, Elevators, Curettes | Chapter 6: Spinal Procedures

405. 390 The Neurosurgical Instrument Guide

406. 391
Straight Spinal Fusion Curette
Alternative Names: Brun, bone, oval, round, straight/curved curette
Category: Curettes
Purposes: Multipurpose instrument used for scraping tissue off bone (lateral recess and ligament),
sculpting/breaking small areas of bone (optic strut), debriding tissue, or harvesting bone.
Varieties: Straight or angled varieties. The angles can be right, left, upgoing, downgoing, etc. Mul-
tiple sizes for cutting end. Can be open or cupped. Various lengths of shaft.
Dissectors, Elevators, Curettes | Chapter 6: Spinal Procedures

407. 392 The Neurosurgical Instrument Guide

408. 393
Bone Impactor
Alternative Names: Tamp, impactor
Category: Impactors
Purposes: Impaction of bone graft or other structure, e.g., cage, into place. Used with a mallet.
Varieties: Various diameters of ends. Various lengths. Smooth or sharp end. Metal, plastic or wood
handles.
Impactors, Rongeurs, Drill Bits, Drill Guides | Chapter 6: Spinal Procedures

409. 394 The Neurosurgical Instrument Guide

410. 395
Chisel
Alternative Names: Hibbs chisel, Hoke chisel, osteotome
Category: Impactors
Purposes: Used for any modification or sculpting of bone. Selected cranial or spinal cuts, bone
graft harvest, and/or molding. Should be used with a mallet.
Varieties: The cutting end can be straight or curved. The length of the shaft and width of the
cutting blade come in many combinations. The more common are 15 to 25 cm in length and
4 to 25 mm in width.
Impactors, Rongeurs, Drill Bits, Drill Guides | Chapter 6: Spinal Procedures

411. 396 The Neurosurgical Instrument Guide

412. 397
Adson Rongeur
Alternative Names: Bone rongeur, Juers-Lempert or Lempert rongeur (although incorrect), aneu-
rysm rongeur or bone cutter
Category: Rongeurs
Purposes: Removal of bone and soft tissue, often used for removing temporal squamous bone,
sphenoid wing, and occipital bone.
Varieties: None.
Impactors, Rongeurs, Drill Bits, Drill Guides | Chapter 6: Spinal Procedures

413. 398 The Neurosurgical Instrument Guide

414. 399
Cushing Rongeur
Alternative Names: Bone rongeur, Adson rongeur, Juers-Lempert or Lempert rongeur (incorrect),
aneurysm rongeur (incorrect), small bone cutter
Category: Rongeurs
Purposes: Single-action rongeur good for removing bone and soft tissue. Often used for removing
temporal squamous bone, sphenoid wing, and occipital bone. Can also be used in shallow spine
cases to remove soft tissue from spinous processes or lamina.
Varieties: None.
Impactors, Rongeurs, Drill Bits, Drill Guides | Chapter 6: Spinal Procedures

415. 400 The Neurosurgical Instrument Guide

416. 401
Kerrison Rongeur
Alternative Names: Ruggles, punch, spine rongeur, up or down biting rongeur
Category: Rongeurs
Purposes: Allows precise bone removal by guillotine cutting of small pieces of bone and soft tis-
sue, e.g., ligaments. Foot plate allows stabilization or non-traumatic placement of instrument over
vital tissue.
Varieties: Up or down biting. 40°, 45°, or 90° angled tip. Various widths of biting jaw. Coated or
non-coated.
Impactors, Rongeurs, Drill Bits, Drill Guides | Chapter 6: Spinal Procedures

417. 402 The Neurosurgical Instrument Guide

418. 403
Leksell Stille Rongeur
Alternative Names: Leksell, double-action, large rongeur, Beyer rongeur (incorrect), Luer-Echlin
rongeur (incorrect), Sklar-Ruskin rongeur (incorrect), Adson rongeur (incorrect)
Category: Rongeurs
Purposes: Double-action bone rongeur used for removal of bone and soft tissue. Often used for
removing temporal squamous bone, sphenoid wing, spinous processes, lamina, osteophytes, and
shaping bone flaps. Double action allows more force to be applied to bone.
Varieties: Straight or curved jaws. Variable width of jaws.
Impactors, Rongeurs, Drill Bits, Drill Guides | Chapter 6: Spinal Procedures

419. 404 The Neurosurgical Instrument Guide

420. 405
Lempert Rongeur
Alternative Names: Small bone rongeur, Adson rongeur (incorrect), Luer-Friedman, Juers-Lempert,
aneurysm rongeur, small bone cutter
Category: Rongeurs
Purposes: Single-action rongeur good for removing small amounts of soft tissue and bone. Often
used in confined spaces, e.g., along sphenoid ridge during pterional craniotomies, small amounts
of C1 lamina in posterior fossa cases, etc.
Varieties: None.
Impactors, Rongeurs, Drill Bits, Drill Guides | Chapter 6: Spinal Procedures

421. 406 The Neurosurgical Instrument Guide

422. 407
Ruskin-Liston Bone Cutter
Alternative Names: Liston bone cutters, Ruskin cutter, rib shears
Category: Rongeurs
Purposes: Double-action bone cutter used for cutting large pieces of bone, most commonly in
spine procedures. Double action allows more force to be applied to bone.
Varieties: Straight or angled blades.
Impactors, Rongeurs, Drill Bits, Drill Guides | Chapter 6: Spinal Procedures

423. 408 The Neurosurgical Instrument Guide

424. 409
Stille Rongeur
Alternative Names: Duckbill, Sklar-Stille rongeur, Leksell (incorrect), double-action, Beyer rongeur
(incorrect), Sklar-Ruskin rongeur (incorrect), Adson rongeur (incorrect)
Category: Rongeurs
Purposes: Double-action bone rongeur used for removal of bone and soft tissue. Often used for
removing temporal squamous bone, sphenoid wing, spinous processes, lamina, and osteophytes,
and for shaping bone flaps. Double action allows more force to be applied to bone. More narrow
jaws allow bone biting in more confined spaces.
Varieties: None.
Impactors, Rongeurs, Drill Bits, Drill Guides | Chapter 6: Spinal Procedures

425. 410 The Neurosurgical Instrument Guide

426. 411
Stille-Horsley Bone Cutter
Alternative Names: Angled Liston (incorrect), angled Ruskin (incorrect), spinous process cutter,
big bone cutter
Category: Rongeurs
Purposes: Double-action bone cutter used for cutting large pieces of bone, most commonly in
spine procedures. Double action allows more force to be applied to bone. Angled jaws provide
good instrument for cuts through the base of the spinous processes.
Varieties: None.
Impactors, Rongeurs, Drill Bits, Drill Guides | Chapter 6: Spinal Procedures

427. 412 The Neurosurgical Instrument Guide

428. 413
Cutting Drill Bits
Alternative Names: Fluted ball, acorn, round cutter
Category: Drill bits
Purposes: Allow removal of large amounts of bone in a short amount of time through coarse
drilling. Can also be used to thin out bone in preparing for punch removal. Caution should be used
around delicate structures as these drill bits have no protective features when they come into
contact with tissue.
Varieties: Various sizes and shapes of drill bits.
Impactors, Rongeurs, Drill Bits, Drill Guides | Chapter 6: Spinal Procedures

429. 414 The Neurosurgical Instrument Guide

430. 415
Caspar Drill Guide
Alternative Names: Drill guide, distraction pin drill guide, distraction pin guide
Category: Drill guides
Purposes: Drill guide for placement of distraction pins, often used in anterior cervical spine ap-
proaches. Toothed guide allows stable placement on vertebral body. Allows for connection to
Caspar pin holder for more precise placement of second Caspar pin.
Varieties: Left- or right-handedness. Wood or plastic handle.
Impactors, Rongeurs, Drill Bits, Drill Guides | Chapter 6: Spinal Procedures

431. 416 The Neurosurgical Instrument Guide

432. 417
Disc Space Rasper
Alternative Names: Rasp, disc rasp, space filer
Category: Spine fusion instrumentation
Purposes: Preparation of disc space for placement of graft by clearing residual disc material from
endplates.
Varieties: Variable heights, widths, and angulation of rasper.
Spine Fusion Instrumentation | Chapter 6: Spinal Procedures

433. 418 The Neurosurgical Instrument Guide

434. 419
Hand-Held Drill
Alternative Name: None
Category: Spine fusion instrumentation
Purposes: Multipurpose drill, used most often in spine procedures for tapping screw holes or pre-
paring bone grafts.
Varieties: Various drill bit holder attachments.
Spine Fusion Instrumentation | Chapter 6: Spinal Procedures

435. 420 The Neurosurgical Instrument Guide

436. 421
K-wire
Alternative Name: None
Category: Spine fusion instrumentation
Purposes: Long metal wire used for localizing and maintaining position of desired screw trajecto-
ries during MIS procedures.
Varieties: Sharp or blunt tip.
Spine Fusion Instrumentation | Chapter 6: Spinal Procedures

437. 422 The Neurosurgical Instrument Guide

438. 423
Laminar Hooks
Alternative Name: Hook
Category: Spine fusion instrumentation
Purposes: Used most often for vertebral levels with pedicles too small for screw placement or for a
mechanistic bolster.
Varieties: Various orientations and sizes of hooks.
Spine Fusion Instrumentation | Chapter 6: Spinal Procedures

439. 424 The Neurosurgical Instrument Guide

440. 425
Pedicle Depth Probe
Alternative Names: Pedicle probe, ball probe, hole probe
Category: Spine fusion instrumentation
Purposes: Used to assess the integrity of the surrounding bony walls and measure the depth in
deep bony holes. Most often used after drilling and/or tapping pedicle screw pathways. Aids with
assessing desired screw length.
Varieties: Various lengths of shaft. With and without rulers.
Spine Fusion Instrumentation | Chapter 6: Spinal Procedures

441. 426 The Neurosurgical Instrument Guide

442. 427
Pedicle Finding Awl
Alternative Names: Gearshift, pedicle awl
Category: Spine fusion instrumentation
Purposes: Used for establishing initial bony pathway through pedicle and vertebral body for screw
placement. Tapered end travels through trabecular bone. Curved end can assess for cortical bony
walls as it traverses the trabecular bone. Ends often have ruler to allow depth assessment.
Varieties: Rubber, metal, or plastic handles. Various lengths of awl.
Spine Fusion Instrumentation | Chapter 6: Spinal Procedures

443. 428 The Neurosurgical Instrument Guide

444. 429
Pedicle Tap
Alternative Name: Tap
Category: Spine fusion instrumentation
Purposes: Used to place the initial bony threads to lay the foundation for screw trajectories.
Varieties: Many variables depending on manufacturer.
Spine Fusion Instrumentation | Chapter 6: Spinal Procedures

445. 430 The Neurosurgical Instrument Guide

446. 431
Rod Bender
Alternative Name: Bender
Category: Spine fusion instrumentation
Purposes: Allows customized bending of rods.
Varieties: Various sizes of instrument to accommodate different sizes of rods.
Spine Fusion Instrumentation | Chapter 6: Spinal Procedures

447. 432 The Neurosurgical Instrument Guide

448. 433
Rod Distractor
Alternative Name: Distractor
Category: Spine fusion instrumentation
Purposes: Allows distraction of vertebral segments by seating the instrument between the screw
heads. The instrument then pushes them outward.
Varieties: Various lengths.
Spine Fusion Instrumentation | Chapter 6: Spinal Procedures

449. 434 The Neurosurgical Instrument Guide

450. 435
Spine Block Filler
Alternative Name: Trial
Category: Spine fusion instrumentation
Purposes: Allows assessment of desired disc interspace graft size.
Varieties: Multiple heights, widths, and angles of trial.
Spine Fusion Instrumentation | Chapter 6: Spinal Procedures

451. 436 The Neurosurgical Instrument Guide

452. 437
Spine Graft Impactor
Alternative Names: Graft impactor, impactor, graft tamp, tamp
Category: Spine fusion instrumentation
Purposes: Impaction of bone graft or other structure, e.g., cage, into place. Used with a mallet.
Varieties: Various lengths. Smooth or sharp end. Metal, plastic, or wood handles.
Spine Fusion Instrumentation | Chapter 6: Spinal Procedures

453. 438 The Neurosurgical Instrument Guide

454. 439
Spine Graft Implant Trial
Alternative Name: Trial
Category: Spine fusion instrumentation
Purposes: Allows assessment of desired disc interspace graft size.
Varieties: Multiple heights, widths, and angles of trial.
Spine Fusion Instrumentation | Chapter 6: Spinal Procedures

455. 440 The Neurosurgical Instrument Guide

456. 441
Spine Instrumentation
Alternative Names: Screws called by measurement, rods by length, and other items by name
Category: Spine fusion instrumentation
Purposes: Instrumentation designed to provide stability of the spine during fusion procedure.
Countless variations allow for infinite fusion solutions. Most common construction consists of rods
connecting consecutively instrumented segments.
Varieties: Many variables depending on manufacturer.
Spine Fusion Instrumentation | Chapter 6: Spinal Procedures

457. 442 The Neurosurgical Instrument Guide

458. 443
Wire Cutters
Alternative Name: None
Category: Spine fusion instrumentation
Purposes: Trimming or cutting wire, often used in spinal stabilization procedures.
Varieties: Various lengths.
Spine Fusion Instrumentation | Chapter 6: Spinal Procedures

460. 445Retractors | Chapter 7: Transsphenoidal/Endonasal
Chapter 7: Transsphenoidal/Endonasal
Retractors.................................................................................446
F
orceps, Rongeurs, Needle Holders
...........................................450
S
cissors, Knives
.........................................................................462
Dis
sectors, Elevators, Miscellaneous
.........................................474
Endosc
opic Instruments
............................................................488

461. 446 The Neurosurgical Instrument Guide

462. 447
Cottle Speculum
Alternative Names: Nasal speculum, Killian speculum, nasal spreader, nare speculum
Category: Retractors
Purposes: Used for retraction of the nares to improve visualization during transsphenoidal/endo-
nasal procedures. This retractor is self-retaining.
Varieties: Variable blade lengths and widths.
Retractors | Chapter 7: Transsphenoidal/Endonasal

463. 448 The Neurosurgical Instrument Guide

464. 449
Killian Speculum
Alternative Names: Nasal speculum, Cottle speculum, nasal spreader, nare speculum
Category: Retractors
Purposes: Used for retraction of the nares to improve visualization during transsphenoidal/endo-
nasal procedures. This retractor is self-retaining.
Varieties: Variable blade lengths and widths.
Retractors | Chapter 7: Transsphenoidal/Endonasal

465. 450 The Neurosurgical Instrument Guide

466. 451
Blakesley Wilde Rhinoforce Forceps
Alternative Name: Blakesley forceps
Category: Forceps
Purposes: Endonasal/endoscopical manipulation of delicate tissues.
Varieties: Straight or angled jaws or blades.
Forceps, Rongeurs, Needle Holders | Chapter 7: Transsphenoidal/Endonasal

467. 452 The Neurosurgical Instrument Guide

468. 453
Takahashi Forceps
Alternative Names: Pituitary, tissue forceps
Category: Forceps
Purposes: Grasping and manipulating tissue during transsphenoidal/endonasal cases. Can be used
for tissue grasping and biopsy samples in cranial and spinal cases.
Varieties: Straight or angled jaws. Various jaw sizes. Variable length of instrument.
Forceps, Rongeurs, Needle Holders | Chapter 7: Transsphenoidal/Endonasal

469. 454 The Neurosurgical Instrument Guide

470. 455
Decker Micro Rongeur
Alternative Names: Decker forceps, endoscopic Takahashi, endoscopic forceps, biopsy forceps
Category: Rongeurs
Purposes: Manipulation of delicate tissues in deep, small spaces, especially in transsphenoidal/
endonasal, spinal, and deep cranial cases. The jaws allow biopsy material, cyst wall, or other soft
tissue to be securely taken.
Varieties: Length and diameter of shaft. Straight, directional, or angled jaws. Variable width of
jaws.
Forceps, Rongeurs, Needle Holders | Chapter 7: Transsphenoidal/Endonasal

471. 456The Neurosurgical Instrument Guide

472. 457
Jansen-Middleton Rongeur
Alternative Names: Angled rongeur, angled septal rongeur
Category: Rongeurs
Purposes: Angled rongeurs for transsphenoidal/endonasal cases for the removal of bony material,
mainly the septum. Can be used as forceps as well.
Varieties: None.
Forceps, Rongeurs, Needle Holders | Chapter 7: Transsphenoidal/Endonasal

473. 458 The Neurosurgical Instrument Guide

474. 459
Oldberg Rongeur
Alternative Names: Bateman pituitary forceps, pituitary, tissue graspers, biopsy forceps
Category: Rongeurs
Purposes: Used for grasping and manipulating tissue during transsphenoidal/endonasal cases.
Often used for tissue biopsy.
Varieties: Various cup sizes. Variable length of instrument.
Forceps, Rongeurs, Needle Holders | Chapter 7: Transsphenoidal/Endonasal

475. 460 The Neurosurgical Instrument Guide

476. 461
Webster Needle Holder
Alternative Names: Baumgartner needle holder, Derf needle holder, Par needle holder, pediatric
needle holder, small needle holder, needle driver
Category: Needle holders
Purposes: Small needle holder with jaws that allow movement of the needle without releasing the
jaws. Also used with smaller needles.
Varieties: Smooth or serrated jaws. Various lengths. Various materials.
Forceps, Rongeurs, Needle Holders | Chapter 7: Transsphenoidal/Endonasal

477. 462 The Neurosurgical Instrument Guide

478. 463
Becker Septum Scissors
Alternative Names: Septum scissors, double-action septum scissors
Category: Scissors
Purposes: Used for cutting septal tissue in transsphenoidal/endonasal procedures.
Varieties: None.
Scissors, Knives | Chapter 7: Transsphenoidal/Endonasal

479. 464 The Neurosurgical Instrument Guide

480. 465
Blakesley Wilde Rhinoforce Scissors
Alternative Name: Blakesley scissors
Category: Scissors
Purposes: Endonasal/endoscopic manipulation of or cutting of delicate tissues.
Varieties: Straight or angled jaws or blades.
Scissors, Knives | Chapter 7: Transsphenoidal/Endonasal

481. 466 The Neurosurgical Instrument Guide

482. 467
Knight Nasal Scissors
Alternative Names: Meisterhand Knight scissors, Fomon, Heymann, Cottle scissors, nasal scissors
Category: Scissors
Purposes: Used for cutting nasal mucosa and soft tissue. Most often used in transsphenoidal/
endonasal cases.
Varieties: Straight or curved blades. Various lengths of blades and arms.
Scissors, Knives | Chapter 7: Transsphenoidal/Endonasal

483. 468 The Neurosurgical Instrument Guide

484. 469
Ballenger Swivel Knife
Alternative Names: Swivel or Ballenger knife
Category: Knives
Purposes: Resection of tissue in small spaces, especially turbinae in transsphenoidal/endonasal
procedures.
Varieties: Straight or bayonet.
Scissors, Knives | Chapter 7: Transsphenoidal/Endonasal

485. 470 The Neurosurgical Instrument Guide

486. 471
Freer Knife
Alternative Names: Pierce septal knife, septal knife
Category: Knives
Purposes: Used for cutting and dissecting tissue off and from the septum during transsphenoidal/
endonasal cases. Can be used in other cases for fine dissection of delicate tissue, e.g., large cranial
or spinal tumors.
Varieties: None.
Scissors, Knives | Chapter 7: Transsphenoidal/Endonasal

487. 472 The Neurosurgical Instrument Guide

488. 473
Sickle Knife
Alternative Names: House sickle, House knife, Sexton ear knife, curved knife
Category: Knives
Purposes: Cutting and dissecting tool often used in transsphenoidal/endonasal cases for creation
of septal flaps. Can be used in any procedure requiring a long-handled knife for non-delicate tissue
cutting and dissection.
Varieties: Reusable or disposable.
Scissors, Knives | Chapter 7: Transsphenoidal/Endonasal

489. 474 The Neurosurgical Instrument Guide

490. 475
Hardy Curette
Alternative Names: Sklar curette, Rogozinski curette, cone ring curette, ring curette
Category: Dissectors
Purposes: Used to dissect and mobilize soft tissue in a confined space, e.g., transsphenoidal/endo-
nasal or large craniospinal tumors. The edges of the ring allow a continued orthogonal force to be
applied and the subsequent removal of tissue without obstruction from the previously removed
tissue.
Varieties: Straight, curved, or angled shafts. Bayonet or straight handles. Various lengths of shaft.
Dissectors, Elevators, Miscellaneous | Chapter 7: Transsphenoidal/Endonasal

491. 476 The Neurosurgical Instrument Guide

492. 477
Maxillary Ostium Seeker
Alternative Names: Ostium probe, ostium seeker
Category: Dissectors
Purposes: Double-ended ball tip probe used to find the ostium in transsphenoidal/endonasal
cases.
Varieties: Single- or double-ended.
Dissectors, Elevators, Miscellaneous | Chapter 7: Transsphenoidal/Endonasal

493. 478 The Neurosurgical Instrument Guide

494. 479
Cottle Elevator
Alternative Names: Septal elevator, mucosa elevator
Category: Elevators
Purposes: Double-ended instrument with a sharp, flat end and the other with a teardrop shape, al-
lowing the dissection of delicate soft tissue off, most commonly, the septum. However, this eleva-
tor can be used to separate the dura, ligament, or other soft tissue from bone.
Varieties: None.
Dissectors, Elevators, Miscellaneous | Chapter 7: Transsphenoidal/Endonasal

495. 480 The Neurosurgical Instrument Guide

496. 481
Freer Elevator
Alternative Names: Cottle elevator, Pierce elevator, submucosal elevator
Category: Elevators
Purposes: Multipurpose tool used to separate soft tissue from bone, e.g., nasal septum, skull base,
dura, etc. to dissect vascular plaque in endarterectomies; and even as a protection device when
drilling or placing bone wax for hemostasis in narrow spaces.
Varieties: Single- or double-ended. Sharp or blunt blades.
Dissectors, Elevators, Miscellaneous | Chapter 7: Transsphenoidal/Endonasal

497. 482 The Neurosurgical Instrument Guide

498. 483
Halle Elevator
Alternative Names: Elevator, tissue elevator, septal elevator (incorrect), Penfield 4 (incorrect)
Category: Elevators
Purposes: Multipurpose tool used in separating soft tissue from bone, e.g., nasal septum, skull
base, dura, etc., and even as a protection device when drilling or placing bone wax for hemostasis
in narrow spaces.
Varieties: None.
Dissectors, Elevators, Miscellaneous | Chapter 7: Transsphenoidal/Endonasal

499. 484 The Neurosurgical Instrument Guide

500. 485
Chisel
Alternative Names: Hibbs chisel, Hoke chisel, osteotome
Category: Miscellaneous
Purposes: Used for any modification or sculpting of bone. Selected cranial or spinal cuts, bone
graft harvest, and/or molding. Should be used with a mallet.
Varieties: The cutting end can be straight or curved. The length of the shaft and width of the
cutting blade come in many combinations. The more common are 15 to 25 cm in length and
4 to 25 mm in width.
Dissectors, Elevators, Miscellaneous | Chapter 7: Transsphenoidal/Endonasal

501. 486 The Neurosurgical Instrument Guide

502. 487
Cottle Mallet
Alternative Names: Mallet, hammer
Category: Miscellaneous
Purposes: Used for application of force, usually on another instrument, e.g., osteotome, bone
graft impactor, chisel, etc.
Varieties: Variable weights. Variable material for mallet head and handle.
Dissectors, Elevators, Miscellaneous | Chapter 7: Transsphenoidal/Endonasal

503. 488 The Neurosurgical Instrument Guide

504. 489
Endodscopic Grasping Forceps
Alternative Names: Endo forceps, Takahashis
Category: Forceps
Purposes: Grasping and holding forceps designed for endoscopic use.
Varieties: Straight or angled jaws. Variable width of jaws. Sharp or smooth jaws.
Endoscopic Instruments | Chapter 7: Transsphenoidal/Endonasal

505. 490 The Neurosurgical Instrument Guide

506. 491
Endoscopic Biopsy Forceps
Alternative Names: Endoscopic Takahashi, endoscopic forceps, biopsy forceps
Category: Forceps
Purposes: Used for endoscopically manipulating delicate tissues. The cups allow biopsy material or
cyst wall material to be securely taken, especially in endoscopic ventricular or pediatric cases.
Varieties: Length and diameter of shaft. Straight or angled jaws.
Endoscopic Instruments | Chapter 7: Transsphenoidal/Endonasal

507. 492 The Neurosurgical Instrument Guide

508. 493
Endoscopic Long Nerve Hook
Alternative Names: Nerve hook, long Dandy hook
Category: Dissectors
Purposes: Exploring, probing, and dissecting fine delicate soft tissue and nerves, often used to
inspect underneath and within structures. The rounded handle allows a rolling, twisting action to
sweep tissue away or to work the instrument between tissue planes.
Varieties: Length and angle of tip. Length of shaft.
Endoscopic Instruments | Chapter 7: Transsphenoidal/Endonasal

509. 494 The Neurosurgical Instrument Guide

510. 495
Endoscopic Scissors
Alternative Names: Micro scissors, endoscopic scissors
Category: Scissors
Purposes: Endoscopic scissors used for cutting and dissecting delicate soft tissue.
Varieties: Straight, curved, or angled blades. Various lengths of arms.
Endoscopic Instruments | Chapter 7: Transsphenoidal/Endonasal

512. 497
Adeor (adeor.com)
Aesculap (aesculapinc.com)
Anspach (anspach.com)
ASSI (accuratesurgical.com)
Biomet (biomet.com)
Codman and Shurtleff (depuy.com)
DePuy (depuy.com)
Electro Surgical Instrument Company
(electrosurgicalinstrument.com)
Fehling Surgical Instruments Inc
(fehlingsurgical.com)
GerMedUSA Inc (germedusa.com)
Globus Medical (globusmedical.com)
HNM Medical (hnmmedical.com)
Integra Life Sciences (integralife.com)
Jarit (integralife.com/jarit)
Karl Storz (karlstorz.de)
Leica Microsystems (leica-microsystems.com)
Life Instruments (lifeinstruments.com)
Lorenz Surgical (lorenzsurgical.com)
Medicon Instrumente (medicon.de)
Medtronic (medtronic.com)
Millenium Surgical Corp (milleniumsurgical.com)
Miltex (medicalresources.com)
Appendix
Neurosurgical Instrument Distributors, Suppliers, and Manufacturers

513. 498 The Neurosurgical Instrument Guide
Mizuho (mizuho.com)
NuVasive (nuvasive.com)
Roboz (roboz.com)
Ruggles Instrument Inc (integralife.com)
Scanlan International (scanlaninternational.com)
Sklar Instruments (sklarcorp.com)
Stealth Surgical (stealthsurgical.com)
Stryker (stryker.com)
Surgical Tools Inc (surgicaltools.com)
Synthes (synthes.com)
Ulrich Medical USA (ulrichmedicalusa.com)
Whittemore Enterprises (wemed1.com)
World Federation for Neurosurgical Societies
(wfns.org)
Zeiss (zeiss.com)

514. 499
A
Acorn. See Cutting drill bits
Adson Brown forceps, 78f, 79
Adson clamp. See Classic clamp; Crile clamp
Adson forceps, 76f, 77, 318f, 319
Adson hook. See Fisch sharp nerve hook; Frazier
dural retractor
Adson rongeur, 174f, 175, 396f, 397. See also
Cushing rongeur; Leksell Stille rongeur;
Lempert rongeur; Luer Friedmann rongeur;
Stille rongeur
Adson with teeth. See Adson forceps
Adson-Woodson. See Woodson dural separator
Allis clamp, 96f, 97, 320f, 321
Aneurysm clip applier. See Yasargil bayonet
aneurysm clip applier
Aneurysm clips, 300f, 301
Aneurysm rongeur. See Adson rongeur; Cushing
rongeur; Lempert rongeur; Luer Friedmann
rongeur
Aneurysm scissors. See Yasargil bayonet scissors
Angled clamp. See Cooley clamp
Angled Gelpi. See Gelpi long retractor; Gelpi
retractor; Long Gelpi retractor
Angled Liston. See Stille-Horsley bone cutter
Angled rongeur. See Jansen-Middleton rongeur
Angled Ruskin. See Stille-Horsley bone cutter
Angled scissors. See Potts-DeMartel scissors
Angled Scoville retractor. See Love nerve root
retractor
Angled septal rongeur. See Jansen-Middleton
rongeur
Index
Note: Page numbers followed by f and t indicate fi gures and tables, respectively.

515. 500 Index
Arachnoid knife, 214f, 215
Army. See Leyla-Yasargil arm retractor
Army-Navy retractor, 114f, 115
Asepto. See Irrigator
Asepto syringe. See Irrigator
B
Backhaus clamp. See Towel clamps
Ballenger knife. See Ballenger swivel knife
Ballenger swivel knife, 468f, 469
Ball probe. See Ball tip probe; Pedicle depth
probe
Ball tip dissector, 376f, 377
Ball tip nerve hook. See Krayenbuhl ball tip hook
Ball-tipped nerve hook. See Ball tip dissector
Ball tip probe, 378f, 379. See also Ball tip
dissector
Barraquer needle holder. See Micro needle
holder
Bateman pituitary forceps. See Oldberg rongeur
Baumgartner needle holder. See Webster needle
holder
Bayonet. See Bayonet tissue forceps; General
bayonet bipolar forceps; Yasargil bayonet
bipolar forceps; Yasargil bayonet tissue
forceps
Bayonet Cushing. See Bayonet tissue forceps;
Yasargil bayonet tissue forceps
Bayonet Cushing tissue forceps. See Bayonet
tissue forceps; Yasargil bayonet tissue forceps
Bayonet Doppler. See Micro Doppler probe
Bayonet micro needle holder. See Yasargil
bayonet needle holder
Bayonet micro scissors, 198f, 199. See also
Yasargil bayonet micro scissors
Bayonet needle holder. See Yasargil bayonet
needle holder
Bayonet scissors. See Yasargil bayonet scissors
Bayonet tissue forceps, 80f, 81
Beaver blade. See Arachnoid knife
Becker septum scissors, 462f, 463
Bender. See Rod bender
Beyer rongeur, 176f, 177. See also Leksell Stille
rongeur; Stille rongeur

516. 501Index
Big bone cutter. See Stille-Horsley bone cutter
Big irrigation. See Irrigator
Biopsy forceps. See Decker micro rongeur;
Endoscopic biopsy forceps; Oldberg rongeur
Bipolar forceps. See General bayonet bipolar
forceps; Yasargil bayonet bipolar forceps
Bipolars. See General bayonet bipolar forceps;
Yasargil bayonet bipolar forceps
Blakesley forceps. See Blakesley Wilde
rhinoforce forceps
Blakesley scissors. See Blakesley Wilde
rhinoforce scissors
Blakesley Wilde rhinoforce forceps, 450f, 451
Blakesley Wilde rhinoforce scissors, 464f, 465
Blunt Cottle double hook. See Joseph skin hooks
2-prong
Blunt Joseph hook. See Joseph skin hooks
2-prong
Boles elevator, 150f, 151, 384 f, 385
Bone clamp. See Kocher clamp
Bone curette. See Spinal fusion curette; Straight
spinal fusion curette; Volkmann bone curette
Bone cutter. See Adson rongeur
Bone impactor, 392f, 393
Bone rongeur. See Adson rongeur; Beyer
rongeur; Cushing rongeur
Bonn. See Ins scissors; Knapp iris scissors
Bovie. See Monopolar
Brain needle, 26f, 27
Brain retractor. See Malleable brain retractor
Brain ribbon. See Malleable brain retractor
Brewster retractor, 350f, 351
Brown-Adson forceps. See Adson Brown forceps
Brown-Adson pickups. See Adson Brown forceps
Brown forceps. See Adson Brown forceps
Brown pickups. See Adson Brown forceps
Brun. See Spinal fusion curette; Straight spinal
fusion curette; Volkmann bone curette
Budde Halo retraction system, 13–14
Bulb syringe. See Irrigator
Bulldog clamp. See Cooley clamp
Bunny forceps. See Adson forceps
Burr hole bit. See Perforator drill bit
Burr hole covers. See Cranial plates

517. 502 Index
C
Carotid clamp. See Cooley clamp
Caspar drill guide, 414f, 415
Caspar retractor, 352f, 353
Caspar screwdriver, 322f, 323
Castroviejo needle holder, 218f, 219
Catheter holders. See Suture boots
Cauterizer. See Monopolar
Cerebellar. See Weitlaner retractor
Cervical retractor. See Henly retractor
Chandler elevator. See Langenbeck elevator
Chisel, 302f, 303, 394f, 395, 484f, 485
Clamp. See Classic clamp; Crile clamp; Halstead
mosquito clamp; Kelly clamp; Straight
Halstead mosquito clamp
Clamp boots. See Suture boots
Clamp with teeth. See Allis clamp; Kocher clamp
Classic clamp, 98f, 99, 324f, 325
Cloward hand-held retractor, 354f, 355
Cloward retractor. See Cloward hand-held
retractor
Coarse diamond bit. See Diamond burr
Cobb elevator, 386f, 387. See also Boles
elevator; Cottle crani elevator; Langenbeck
elevator
Collis-Taylor retractor, 356f, 357
Cone ring curette. See Hardy curette
Converse osteotome, 304f, 305
Cooley clamp, 234f, 235. See also Glover
bulldog clamp
Cooley needle holder. See Mayo-Hegar needle
holder; Ryder needle holder
Cottle crani elevator, 152f, 153. See also
Langenbeck elevator
Cottle double hook. See Joseph skin hooks
2-prong sharp
Cottle elevator, 154f, 155, 478f, 479. See also
Freer elevator
Cottle mallet, 194f, 195, 326f, 327, 486f, 487
Cottle scissors. See Knight nasal scissors
Cottle skin hook. See Joseph skin hooks
Cottle speculum, 446f, 447. See also Killian
speculum
Cotton patty, 28f, 29, 328 f, 329

518. 503Index
Cotton sponge, 30f, 31, 330 f, 331
Cotton strip. See Cotton patty
Cranial instrument set
basic, 18–19
Cranial plates, 190f, 191
Craniotome bit, 166f, 167
Crile clamp, 100f, 101. See also Classic clamp;
Kelly clamp
Crile-Wood needle holder. See Mayo-Hegar
needle holder; Ryder needle holder
Curved cerebellar. See Miskimon retractor;
Weitlaner retractor
Curved curette. See Spinal fusion curette;
Volkmann bone curette
Curved Cushing retractor. See Cushing retractor
Curved knife. See Sickle knife
Curved Metz. See Curved Metzenbaum scissors;
Long curved Metzenbaum scissors
Curved Metzenbaum scissors, 60f, 61
Curved tissue retractor. See Cushing retractor
Curved tissue scissors. See Curved Metzenbaum
scissors; Long curved Metzenbaum scissors
Curved Weitlaner. See Miskimon retractor
Cushing bipolars. See General bayonet bipolar
forceps; Yasargil bayonet bipolar forceps
Cushing forceps. See General tissue forceps;
Gerald forceps without teeth
Cushing nerve retractor. See Cushing retractor
Cushing retractor, 116f, 117. See also Cushing
vein retractor
Cushing rongeur, 398f, 399
Cushing vein retractor, 238f, 239
Cushing with teeth. See Gerald with teeth
Cutter. See Monopolar
Cutting drill bits, 168f, 169, 412f, 413
Cutting suture needle, 68f, 69, 332f, 333
D
Dagger. See Malleable micro dissector
Dandy hook. See Dandy nerve hook
Dandy nerve hook, 248f, 249. See also Large
nerve hook; Malis nerve hook
DeBakey clamp. See Cooley clamp
DeBakey forceps, 82f, 83

519. 504 Index
DeBakey needle holder. See Mayo-Hegar needle
holder; Ryder needle holder
DeBakey pickups. See DeBakey forceps
DeBakeys. See DeBakey forceps
Decker forceps. See Decker micro rongeur
Decker micro rongeur, 454f, 455
Dental instrument. See Woodson dural
separator
de Quervain. See Quervain elevator
Derf needle holder. See Webster needle holder
D’Errico. See D’Errico nerve retractor; Love
nerve root retractor
D’Errico-Adson. See Miskimon retractor;
Weitlaner retractor
D’Errico nerve retractor, 358f, 359
Diamond. See Diamond burr
Diamond burr, 170f, 171, 292f, 293
Diamond knife, 216f, 217
Disc rasp. See Disc space rasper
Disc space rasper, 416f, 417
Dissector. See Malleable micro dissector
Distraction pin drill guide. See Caspar drill guide
Distraction pin guide. See Caspar drill guide
Distraction pin retractor. See Caspar retractor
Distractor. See Rod distractor
Dog bone. See Cranial plates
Double-action. See Leksell Stille rongeur; Stille
rongeur
Double-action septum scissors. See Becker
septum scissors
Drill guide. See Caspar drill guide
Drill handle, 158f, 159
Drill handle attachments, 160f, 161
Duckbill. See Stille rongeur
Dural elevator. See Frazier dural retractor;
Woodson dural separator
Dural fish hooks. See Fish hooks with Songer
cables
Dural hook. See Frazier dural retractor
E
Edna clamp. See Towel clamps
Electric knife. See Monopolar
Elevator. See Halle elevator

520. 505Index
11 blade, 50f, 51
Endo forceps. See Endoscopic grasping
forceps
Endoscopic biopsy forceps, 490f, 491
Endoscopic forceps. See Decker micro rongeur;
Endoscopic biopsy forceps
Endoscopic grasping forceps, 488f, 489
Endoscopic long nerve hook, 492f, 493
Endoscopic scissors, 494f, 495
Endoscopic Takahashi. See Decker micro
rongeur; Endoscopic biopsy forceps
F
15 blade, 52f, 53
Fine Metz. See Fine Metzenbaum scissors
Fine Metzenbaum scissors, 62, 63f
Fine tissue scissors. See Fine Metzenbaum
scissors
Fisch hook. See Frazier dural retractor
Fisch sharp nerve hook, 250f, 251
Fish hooks. See Fish hooks with Songer cables
Fish hooks with Songer cables, 118f, 119
Fixation base. See Leyla-Yasargil retractor arm;
Yasargil box connector
Fixation plates. See Cranial plates
Flap hooks. See Fish hooks with Songer cables
Fletcher sponge stick. See Foerster sponge stick
Flush. See Irrigator
Fluted ball. See Cutting drill bits
Foerster sponge stick, 102f, 103, 334f, 335
Fomon. See Knight nasal scissors
Footed bit. See Craniotome bit
Forceps without teeth. See General tissue
forceps
Forceps with teeth. See Large tissue forceps
4×4. See Cotton sponge
Four dissector. See Penfield #4
Frazier dural retractor, 240f, 241
Frazier hook. See Fisch sharp nerve hook
Frazier suction, 32f, 33, 336f, 337
Freer elevator, 284f, 285, 480 f, 481
Freer knife, 470f, 471
Freer skin hook. See Joseph skin hooks
Fukishima. See Japanese suction

521. 506 Index
G
Gearshift. See Pedicle finding awl
Gelpi long retractor, 362f, 363
Gelpi retractor, 120f, 121, 360f, 361
General bayonet bipolar forceps, 84f, 85
General tissue forceps, 86f, 87
Gerald forceps without teeth, 224f, 225
Gerald with. See Gerald with teeth
Gerald without. See Gerald forceps without teeth
Gerald with teeth, 88f, 89
Gilles skin hook. See Joseph skin hooks
Glover bulldog clamp, 306f, 307
Graft impactor. See Spine graft impactor
Graft tamp. See Spine graft impactor
Greenberg retraction system, 14
Groove director. See Woodson dural separator
Guthrie hook. See Joseph skin hooks 2-prong sharp
H
Halle elevator, 286f, 287, 482 f, 483
Halstead. See Halstead mosquito clamp;
Straight Halstead mosquito clamp
Halstead clamp. See Classic clamp; Crile clamp
Halstead mosquito clamp, 104f, 105
Hammer. See Cottle mallet
Hand-held drill, 418f, 419
Hand-held retractor. See Cloward hand-held
retractor
Hardy curette, 474f, 475
Hartman. See Halstead mosquito clamp;
Straight Halstead mosquito clamp
Head holder(s)
horseshoe, 11, 13f
Mayfield-Keys, 11, 13f
Heiss retractor. See Small toothed retractor
Hemilam retractor. See Williams discectomy
retractor
Hemoclip applier, 34f, 35
Hemostat. See Classic clamp; Crile clamp;
Halstead mosquito clamp; Kelly clamp;
Straight Halstead mosquito clamp
Henly retractor, 242f, 243, 364f, 365
Heparin needles, 308f, 309
Heymann. See Knight nasal scissors

522. 507Index
Hibbs chisel. See Chisel
Hoke chisel. See Chisel
Hole probe. See Ball tip probe; Pedicle depth
probe
Hook(s). See Laminar hooks
House knife. See Sickle knife
House sickle. See Sickle knife
Hoyes micro scissors. See Vannas micro scissors
I
Impactor. See Bone impactor; Spine graft
impactor
Ins scissors, 200f, 201
Instrument distributors, 497–498
Instrument manufacturers, 497–498
Instrument set(s)
basic, 17–23
cranial, 18–19
spinal, 20–21
transsphenoidal, 22–23
trauma, 18–19
Instrument suppliers, 497–498
Instrument tray(s)
basic, 17–23
Iris scissors. See Ins scissors; Knapp iris scissors
Irrigator, 36f, 37, 338f, 339
J
Jameson-Potts. See Jameson tenotomy scissors
Jameson tenotomy scissors, 202f, 203
Jamison-Metz. See Jameson tenotomy scissors
Jamison-Reynolds. See Jameson tenotomy
scissors
Janetta dissector. See Rhoton #1; Rhoton #2;
Rhoton #3
Janetta elevator. See Rhoton #4; Rhoton #5;
Rhoton #6; Rhoton #7; Rhoton #8
Jansen-mastoid. See Mastoid retractor
Jansen-Middleton rongeur, 456f, 457
Jansen tissue forceps. See Bayonet tissue
forceps; Yasargil bayonet tissue forceps
Japanese suction, 196f, 197
Jeweler’s. See Micro suture forceps
Jones clamp. See Towel clamps

523. 508 Index
Joseph hook. See Joseph skin hooks 2-prong
sharp
Joseph skin hooks, 122f, 123
Joseph skin hooks 2-prong, 124f, 125
Joseph skin hooks 2-prong sharp, 126f, 127
Juers-Lempert. See Lempert rongeur
Juers-Lempert rongeur. See Adson rongeur;
Cushing rongeur; Lempert rongeur; Luer
Friedmann rongeur
K
Kelly. See Ins scissors; Knapp iris scissors
Kelly clamp, 106f, 107
Kerrison rongeur, 178f, 179, 400f, 401
Killian speculum, 448f, 449. See also Cottle
speculum
Kittner, 38f, 39, 342f, 343
Knapp iris scissors, 204f, 205
Knife holder #3, 54f, 55
Knife holder #7, 56f, 57
Knight nasal scissors, 466f, 467
Koch clamp. See Kocher clamp
Kocher clamp, 108f, 109
Krayenbuhl ball tip hook, 380f, 381
K-wire, 420f, 421
L
Lahey clamp. See Classic clamp; Crile clamp
Lambottle. See Converse osteotome
Laminar hooks, 422f, 423
Laminectomy nerve retractor. See Collis-Taylor
retractor; Love nerve root retractor
Laminectomy retractor. See D’Errico nerve
retractor; Williams discectomy retractor
Langenbeck elevator, 156f, 157. See also Boles
elevator; Cobb elevator
Large clip applier. See Yasargil bayonet
aneurysm clip applier
Large micro elevator. See Rhoton #5
Large micro spatula. See Rhoton #8
Large nerve hook, 382f, 383
Large pancake dissector. See Penfield #1;
Rhoton #3
Large rongeur. See Leksell Stille rongeur

524. 509Index
Large round dissector. See Rhoton #3
Large tissue forceps, 90f, 91
Large tissue retractor. See Brewster retractor;
Collis-Taylor retractor; D’Errico nerve retractor
Large vessel clamp. See Glover bulldog clamp
Leksell. See Leksell Stille rongeur; Stille rongeur
Leksell Stille rongeur, 180f, 181, 402f, 403
Lempert rongeur, 182f, 183, 298f, 299, 404f,
405. See also Adson rongeur; Cushing
rongeur; Luer Friedmann rongeur
Lexer-Baby. See Ins scissors; Knapp iris scissors
Leyla-Yasargil arm retractor, 366f, 367
Leyla-Yasargil retraction system, 13–14
Leyla-Yasargil retractor arm, 244f, 245
Ligaclip applier. See Hemoclip applier
Liston bone cutters. See Ruskin-Liston bone cutter
Long curved Metzenbaum scissors, 64f, 65
Long Dandy hook. See Endoscopic long nerve
hook
Long Gelpi retractor, 128f, 129
Long iris scissors. See Jameson tenotomy
scissors
Long Metz. See Long curved Metzenbaum scissors
Love nerve root retractor, 368f, 369
Love retractor. See Love nerve root retractor
Luer-Echlin rongeur. See Leksell Stille rongeur
Luer-Friedman. See Lempert rongeur
Luer Friedmann rongeur, 184f, 185
Luer-Friedman rongeur. See Lempert rongeur
M
M8. See Match head drill bit
Malis bipolars. See General bayonet bipolar
forceps; Yasargil bayonet bipolar forceps
Malis nerve hook, 252f, 253
Malleable brain retractor, 130f, 131
Malleable dissector. See Malleable micro
dissector
Malleable micro dissector, 254f, 255
Malleable retractor. See Malleable brain
retractor
Mallet. See Cottle mallet
Mastoid. See Mastoid retractor
Mastoid retractor, 132f, 133

525. 510 Index
Match head drill bit, 172f, 173, 294f, 295
Maxillary ostium seeker, 476f, 477
Mayo-Adams retractor. See Henly retractor
Mayo-Hegar needle holder, 72f, 73
Mayo scissors, 66f, 67
Medium micro spatula. See Rhoton #7
Medium pancake. See Rhoton #2
Medium round dissector. See Rhoton #2
Meisterhand Knight scissors. See Knight nasal
scissors
Metz. See Curved Metzenbaum scissors; Fine
Metzenbaum scissors
Meyerding retractor. See Williams discectomy
retractor
Micro angled hook. See Rhoton #11
Micro blunt hook. See Rhoton #10
Micro curette. See Rhoton #13; Rhoton #14
Micro dissecting scissors. See Ins scissors; Knapp
iris scissors
Micro dissector. See Rhoton #6; Rhoton #7;
Rhoton #8; Rhoton #12
Micro Doppler probe, 310f, 311
Micro elevator. See Rhoton #4; Rhoton #5
Micro forceps. See Micro suture forceps
Micro hook. See Fisch sharp nerve hook; Frazier
dural retractor
Micro large curette. See Rhoton #14
Micro locking needle holder. See Castroviejo
needle holder
Micro needle driver. See Micro needle holder
Micro needle holder, 220f, 221. See also
Castroviejo needle holder
Micro nerve dissector. See Rhoton #9; Rhoton
#10; Rhoton #11; Rhoton #12
Micro nerve hook. See Rhoton #9; Rhoton #10;
Rhoton #11
Micro scissors. See Bayonet micro scissors;
Endoscopic scissors; Vannas micro scissors;
Yasargil bayonet micro scissors
Microscope
placement, in operating room, 15
Micro small curette. See Rhoton #13
Micro spatula. See Rhoton #6; Rhoton #7;
Rhoton #8

526. 511Index
Micro suture forceps, 226f, 227
Microvascular Doppler. See Micro Doppler
probe
Miller-Senn. See Senn retractor
Mini clip applier. See Yasargil bayonet aneurysm
mini clip applier
Mini Doppler. See Micro Doppler probe
Mini snap. See Halstead mosquito clamp;
Straight Halstead mosquito clamp
Miskimon retractor, 134f, 135
MIS retractor. See MIS tubular retractors
MIS tubular retractor dilators, 348f, 349
MIS tubular retractors, 370f, 371
Mixter clamp. See Classic clamp; Crile clamp
Mixter right angle clamp, 236f, 237
Mollison. See Miskimon retractor; Weitlaner
retractor
Monopolar, 58f, 59, 340f, 341
Mosquito. See Halstead mosquito clamp;
Straight Halstead mosquito clamp
Mucosa elevator. See Cottle elevator
N
Nare speculum. See Cottle speculum; Killian
speculum
Narrow elevator. See Quervain elevator
Nasal scissors. See Knight nasal scissors
Nasal speculum. See Cottle speculum; Killian
speculum
Nasal spreader. See Cottle speculum; Killian
speculum
Navy retractor. See Leyla-Yasargil arm retractor
Needle driver. See Mayo-Hegar needle holder;
Ryder needle holder; Webster needle holder
Nerve hook. See Dandy nerve hook; Endoscopic
long nerve hook; Krayenbuhl ball tip hook;
Large nerve hook; Malis nerve hook
Nerve root retractor. See D’Errico nerve
retractor; Love nerve root retractor
Number 1. See Penfield #1; Rhoton #1
Number 2. See Rhoton #2
Number 3. See Rhoton #3
Number 4. See Rhoton #4

527. 512 Index
Number 5. See Rhoton #5
Number 6. See Rhoton #6
Number 7. See Rhoton #7
Number 8. See Rhoton #8
Number 9. See Rhoton #9
Number 10. See Rhoton #10
Number 11. See Rhoton #11
Number 12. See Rhoton #12
Number 13. See Rhoton #13
Number 14. See Rhoton #14
O
Obtuse clamp. See Classic clamp; Crile clamp
Ochsner clamp. See Kocher clamp
Oldberg rongeur, 458f, 459
Operating room, 2–4
basic arrangements, 4–5, 5t, 6f–9f
equipment, 11–15, 12f–14f
lighting system, 15
personnel, 1–2
setup, 2–4, 3f
Operating room table, 11–13, 12f
attachments, 11–14, 13f
Osteotome. See Chisel; Converse osteotome
Ostium probe. See Maxillary ostium seeker
Ostium seeker. See Maxillary ostium seeker
Oval curette. See Spinal fusion curette; Straight
spinal fusion curette; Volkmann bone curette
P
Pancake. See Rhoton #2; Rhoton #3
Par needle holder. See Webster needle holder
Patton needle holder. See Micro needle holder
Patty. See Cotton patty
Pean clamp. See Kelly clamp
Peanut. See Kittner
Pediatric needle holder. See Webster needle
holder
Pedicle awl. See Pedicle finding awl
Pedicle depth probe, 424f, 425
Pedicle finding awl, 426f, 427
Pedicle probe. See Ball tip probe; Pedicle depth
probe
Pedicle tap, 428f, 429
Peers towel clamp. See Towel clamps
Penfield #1, 142f, 143

528. 513Index
Penfield #2, 144f, 145
Penfield #3, 146f, 147
Penfield 4. See Halle elevator
Penfield #4, 148f, 149
Pen knife. See Monopolar
Perforator drill bit, 162f, 163
Periosteal. See Boles elevator; Cobb elevator;
Cottle crani elevator; Langenbeck elevator;
Quervain elevator
Pickups without teeth. See Gerald forceps
without teeth
Pickups with teeth. See Adson forceps; Gerald
with teeth
Pierce elevator. See Freer elevator
Pierce septal knife. See Freer knife
Pin retractor. See Caspar retractor
Pin screwdriver. See Caspar screwdriver
Pituitary. See Oldberg rongeur; Takahashi
forceps
Plates. See Cranial plates
Poppen suction. See Frazier suction
Potts-DeMartel scissors, 206f, 207
Potts scissors. See Potts-DeMartel scissors
Potts-Smith. See Potts-DeMartel scissors
Punch. See Kerrison rongeur
Q
Quervain elevator, 288f, 289
R
Ragnell. See Curved Metzenbaum scissors
Rake. See Senn retractor
Raney applier, 40f, 41
Raney clip appliers. See Raney applier
Rasp. See Disc space rasper
Rat tooth forceps. See Large tissue forceps
Ray-tec. See Cotton sponge
Regulated suction tip. See Japanese suction
Retraction system(s), 13–14
Rhoton #1, 256f, 257
Rhoton #2, 258f, 259
Rhoton #3, 260f, 261
Rhoton #4, 262f, 263
Rhoton #5, 264f, 265

529. 514 Index
Rhoton #6, 266f, 267
Rhoton #7, 268f, 269
Rhoton #8, 270f, 271
Rhoton #9, 272f, 273
Rhoton #10, 274f, 275
Rhoton #11, 276f, 277
Rhoton #12, 278f, 279
Rhoton #13, 280f, 281
Rhoton #14, 282f, 283
Rhoton forceps. See General bayonet bipolar
forceps; Yasargil bayonet bipolar forceps
Rib shears. See Ruskin-Liston bone cutter
Right angle. See Mixter right angle clamp
Right angle Adson clamp. See Mixter right angle
clamp
Right angle Crile clamp. See Mixter right angle
clamp
Right angle hemostat. See Mixter right angle
clamp
Right angle snap. See Mixter right angle clamp
Ring curette. See Hardy curette
Ringed forceps. See Foerster sponge stick
Rochester clamp. See Kelly clamp
Rochester-Ochsner clamp. See Kocher clamp
Rod bender, 430f, 431
Rod distractor, 432f, 433
Rogozinski curette. See Hardy curette
Round body forceps, 228f, 229
Round curette. See Spinal fusion curette; Straight
spinal fusion curette; Volkmann bone curette
Round cutter. See Cutting drill bits
Round jeweler’s forceps. See Round body
forceps
Round micro forceps. See Round body forceps
Rubber shod. See Suture boots
Ruggles. See Kerrison rongeur
Rusin rongeur. See Beyer rongeur
Ruskin cutter. See Ruskin-Liston bone cutter
Ruskin-Liston bone cutter, 406f, 407
Ryder needle holder, 74f, 75
S
Sachs retractor. See Cushing vein retractor
Screw bit. See Twist drill bit

530. 515Index
Screwdriver. See Caspar screwdriver
Semken forceps. See General tissue forceps
Semken forceps with teeth. See Large tissue
forceps
Senn retractor, 136f, 137
Septal elevator. See Cottle elevator; Halle
elevator
Septal knife. See Freer knife
Septum scissors. See Becker septum scissors
Sexton ear knife. See Sickle knife
Sharp nerve hook. See Fisch sharp nerve hook
Short Gelpi. See Gelpi retractor
Shunt passer, 42f, 43
Sickle knife, 472f, 473
Single hook. See Joseph skin hooks
Skin forceps. See Adson forceps
Skin hook. See Joseph skin hooks; Joseph skin
hooks 2-prong; Joseph skin hooks 2-prong
sharp
Skin knife. See 10 blade
Skin pickups. See Adson forceps
Skin rake. See Senn retractor
Skin/scalp clip appliers. See Raney applier
Sklar curette. See Hardy curette
Sklar micro needle holder. See Micro needle
holder
Sklar-Ruskin rongeur. See Leksell Stille rongeur;
Stille rongeur
Sklar-Stille rongeur. See Stille rongeur
Small aneurysm clip applier. See Yasargil
bayonet aneurysm mini clip applier
Small bone cutter. See Cushing rongeur;
Lempert rongeur; Luer Friedmann rongeur
Small bone rongeur. See Lempert rongeur; Luer
Friedmann rongeur
Small burr hole bit. See Match head drill bit
Small double-action rongeur. See Beyer rongeur
Small elevator. See Rhoton #4
Small needle holder. See Webster needle holder
Small pancake. See Rhoton #1
Small round dissector. See Rhoton #1
Small skin retractor. See Small toothed retractor
Small toothed retractor, 138f, 139
Small Weitlaner. See Mastoid retractor

531. 516 Index
Smooth forceps. See General tissue forceps
Snake charmer. See Leyla-Yasargil retractor arm;
Yasargil box connector
Snake holder. See Leyla-Yasargil retractor arm;
Yasargil box connector
Snap. See Classic clamp; Crile clamp; Halstead
mosquito clamp; Straight Halstead mosquito
clamp
Songer hooks. See Fish hooks with Songer
cables
Space filer. See Disc space rasper
Spatula dissector. See Rhoton #6; Rhoton #7;
Rhoton #8
Spinal fusion curette, 388f, 389
Spinal instrument set
basic, 20–21
Spine block filler, 434f, 435
Spine curette. See Volkmann bone curette
Spine graft impactor, 436f, 437
Spine graft implant trial, 438f, 439
Spine instrumentation, 440f, 441
Spine rongeur. See Kerrison rongeur
Spinous process cutter. See Stille-Horsley bone
cutter
Sponge. See Cotton sponge
Sponge stick. See Foerster sponge stick
Stille-Horsley bone cutter, 410f, 411
Stille rongeur, 186f, 187, 408f, 409
Straight bipolar forceps. See Yasargil bipolar
forceps straight
Straight bipolars. See Yasargil bipolar forceps
straight
Straight curette. See Spinal fusion curette;
Straight spinal fusion curette; Volkmann bone
curette
Straight Cushing bipolars. See Yasargil bipolar
forceps straight
Straight Halstead mosquito clamp, 110f, 111
Straight Love retractor. See D’Errico nerve
retractor
Straight Malis bipolars. See Yasargil bipolar
forceps straight
Straight Rhoton forceps. See Yasargil bipolar
forceps straight

532. 517Index
Straight Scoville retractor. See D’Errico nerve
retractor
Straight spinal fusion curette, 390f, 391
Strip. See Cotton patty
Submucosal elevator. See Freer elevator
Suture boots, 44f, 45
Suture scissors. See Mayo scissors
Swivel knife. See Ballenger swivel knife
T
Takahashi forceps, 92f, 93, 452 f, 453
Takahashis. See Endoscopic grasping forceps
Tamp. See Bone impactor; Spine graft impactor
Tap. See Pedicle tap; Twist drill bit
Tapered bit. See Craniotome bit
Tapered side cutting. See Match head drill bit
Tapered spiral bit. See Craniotome bit
Tapered suture needle, 70f, 71
Taylor retractor. See Collis-Taylor retractor;
D’Errico nerve retractor; Love nerve root
retractor
10 blade, 48f, 49, 344f, 345
Tenotomies. See Jameson tenotomy scissors
Three dissector. See Penfield #3
Tissue clamp. See Allis clamp
Tissue elevator. See Halle elevator
Tissue forceps. See DeBakey forceps; Takahashi
forceps
Tissue graspers. See Oldberg rongeur
Tissue pickups. See DeBakey forceps
Tissue retractor. See Brewster retractor; Collis-
Taylor retractor; D’Errico nerve retractor
Tissue scissors. See Curved Metzenbaum
scissors; Fine Metzenbaum scissors; Long
curved Metzenbaum scissors
Tonsil suction tip. See Yankauer suction
Towel clamps, 112f, 113
Transsphenoidal instrument set
basic, 22–23
Trauma instrument set
basic, 18–19
Trial. See Spine block filler; Spine graft implant
trial
Twist drill. See Twist drill bit

533. 518 Index
Twist drill bit, 164f, 165, 296f, 297
Two dissector. See Penfield #2
U
Up or down biting rongeur. See Kerrison
rongeur
US. See Leyla-Yasargil arm retractor
US Army. See Leyla-Yasargil arm retractor
US Army retractor, 114f, 115
US Navy retractor, 114f, 115
V
Vannas micro scissors, 208f, 209
Variable suction. See Japanese suction
Vascular clip applier. See Hemoclip applier
Vascular Doppler. See Micro Doppler probe
Vascular forceps. See DeBakey forceps
Vascular scissors. See Potts-DeMartel scissors
Vascular tissue forceps. See DeBakey forceps
Vein retractor. See Cushing vein retractor
Vessel clip applier. See Hemoclip applier
Vessel needles. See Heparin needles
Volkmann bone curette, 188f, 189
W
Water. See Irrigator
Webster needle holder, 460f, 461
Weitlaner. See Mastoid retractor
Weitlaner-Mollison. See Mastoid retractor
Weitlaner retractor, 140f, 141, 372f, 373
Westcott scissors. See Vannas micro scissors
Williams discectomy retractor, 374f, 375
Wilson frame, 11
Wire cutters, 442f, 443
Woodson dural separator, 290f, 291
Wound spreader. See Small toothed retractor
Y
Yankauer suction, 46f, 47, 346f, 347
Yasargil bayonet aneurysm clip applier, 312f, 313
Yasargil bayonet aneurysm mini clip applier,
314f, 315
Uploaded by [StormRG]

534. 519Index
Yasargil bayonet bipolar forceps, 230f, 231
Yasargil bayonet micro scissors, 212f, 213
Yasargil bayonet needle holder, 222f, 223
Yasargil bayonet scissors, 210f, 211
Yasargil bayonet tissue forceps, 94f, 95
Yasargil bipolar forceps straight, 232f, 233
Yasargil box connector, 246f, 247
Yasargil micro scissors. See Bayonet micro scissors
uploaded by [stormrg]