Positioning for supratentorial surgery

1. POSITIONING FOR SUPRATENTORIAL SURGERY ADETUNMBI. B Neurosurgery unit LUTH

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

3. INTRODUCTION Positioning can be defined as the arrangement of bodily parts or to place into an advantageous location Neurosurgery procedures are usually lengthy First obligatory step in proper planning Depends on indication for surgery, approach, patients body habitus and surgeons preference

4. Diagram Showing the Skull

5. AIMS Prevent post operative complications due to positioning Best access to the pathological site Comfort to the surgeon Provision of space to other team members and efficient ergonomics

6. PRINCIPLES OF NEUROSURGICAL POSITIONING Final choice of position should made known as early as possible to the operating team Position chosen should ensure patients safety, surgeons comfort, good airway access and adequate mobility It should be done typically after induction It is sometimes necessary to disconnect ventilator

7. contd Body positioned before head Positioning done to minimise brain retraction, highest point to pathology site shortest distance, craniotomy side parallel to ground Eye protection , lubrication and tapping. Adequate padding and relief of pressure points must be ensured Ultimately risk/benefit ratio should considered

8. ACCESSORIES FOR POSITIONING Mayfield head clamp

9. Principle of use Must be an indication Avoided in aneurysm and ICH procedures, air sinus, sutures, temporalis muscle Single pin usually in front while double pin opposite. Usually fixed in axial plane below the equator of the head.

10. Complications Heamorrhage : extracranial and intracranial Skin and eye avulsion Skull fracture Brain parenchymal injury Pin site infection

11. contd Horse shoe head rest

12. contd Doughnut head ring

13. Contd Others include bean bags , handrest , gel pads, pillows

14. American Society of Anesthesiologists Task Force on the Prevention of Perioperative Peripheral Neuropathies

15. TYPES OF POSITIONING Supine Lateral Park bench Three quarter prone

16. SUPINE

17. LATERAL

18. LATERAL

19. PARK BENCH

20. THREE QUARTER PRONE

21. Complications of positioning Pressure necrosis Peripheral neuropathy Venous air embolism Facial oedema Macroglossia Blindness

22. CONCLUSION Positioning in neurosurgery cannot be overemphasized Positioning is team work Ideal positioning gives good post operative outcome A well planned surgical procedure can be catastrophic if patient is not well positioned

23. REFERENCES Principles of Neurological Surgery 3 rd edition Youmans Neurological Surgery 6 th edition Images from wilkepeadia Safe positioning for neurosurgical patients : Danielle st Arnaud Management of positioning in neurosurgical patient : Lam A.M

24. THANK YOU