Complications of cerebral fixation devices have been reported in the literature, including skull fractures, needle infections, venous air embolism, and subdural and epidural hematoma (6-7). Despite owning these potential risks, cerebral fixation devices provide the unique advantages of fixation and stability in cerebral operations, especially for high-precision surgery, that the head frame installation must be strictly fixed. At the same time, cerebral fixation devices fixation can be used to prevent concomitant pressure ulcers and eye complications (8-9). As our investigation showed, most neurosurgeon use cerebral fixation devices to fix the skull when performing neurosurgical operations. Based on the survey of multiple senior doctors in different hospital, we investigate the stability of the cerebral fixation devices installation, and the possible potential risks are summarized.
From these results, we found that patients in the lateral prone position were more prone to induce cerebral fixation devices instability, indicating that there were large instability factors in the prone/lateral prone abdominal position, which may be due to the weigh of bodies was more distributed on the cerebral fixation devices than the supine position. It required that we should pay more special attention to the stability of the cerebral fixation devices installation when patients were performed in the prone/ lateral prone abdominal position. Among the ten patients, 40% of them are emergency surgery and 60% are routine surgery. The proportion of routine surgery seems to be higher than emergency surgery, however, the overall number of routine surgery is much higher than that of emergency surgery. From this point, we can obtain that the probability of cerebral fixation devices instability in emergency surgery is much higher than the proportion of routine surgery. These results showed that the preparation for emergency surgery might not be as full as in routine surgery, and errors were more likely to occur.
In addition, 40% patients had involuntary movements before removing the cerebral fixation devices. And in one patient who recently had unstable cerebral fixation devices, we paid special attention to the installation position and the amount of pressure applied after installing after installing the headgear, and checked with the superior doctors and traveling nurse. At the end of the operation, we found that the patient’s head appeared involuntary activities. We communicated with the anesthesiologist in time to enhance the control of anesthetic drugs. In the end, we found that the pressure of the cerebral fixation devices was changed from 70 pounds to 50 pounds. Two of the three patients who recently found the cerebral fixation devices unstable were accompanied by involuntary shaking of head during the operation. These results suggested that the depth of patient’s anesthesia also plays an important role in the stability of cerebral fixation devices. The shaking of the patient’s head during the operation may affect the stability of the cerebral fixation devices.
Among all patients, the pressure of cerebral fixation devices is strictly contolled for women 60 pounds and men for 70 pounds. Among them, there were four cases of unstable cerebral fixation devices in patients with thicker tissues, accounting for 40%, and six cases of normal and thin tissues patients accounted for 60%. These results indicated that in patients with thicker scalp, the pressure should be appropriately increased to prevent the head pins to shift or even slip. The length of the operation time is also closely related to the stability of the tissues. With the extension of the operation time, the higher proportion of cerebral fixation devices slipping or displacement happens.
In the cases investigated, there were no serious complications. Four cases showed cerebral fixation devices displacement, and the distance was less than 1 cm. Another six patients showed pressure reduction to 40-50 pounds, and no obvious head displacement occurred. Although there were no serious complications, the cause of its occurrence needs to be further summarized and analyzed, so as to minimize the serious consequences and ensure the safety of patient’s surgical procedure.
Among the doctors surveyed, about 71% doctors experienced unstable incidences of cerebral fixation devices, and 80% occurred in the first three years of their work career, rarely in the subsequent work period. This showed that the stability of the cerebral fixation devices in the beginning of the work was closely related to the doctor’s experience. This was also related to the communication between the anesthesiologist and the traveling nurse through the operation.
Based on our recent unstable cranial fixation incidents and the experience of investigating and analyzing senior doctors from different neurosurgery centers, we conducted experience analysis and summary to minimize the risk of unstable cranial fixation pins. We tried a variety of options, including a safe anatomical location for cranial fixation, teamwork and communication with anesthesiologists and itinerant nurses to ensure the stability of the patient’s cerebral fixation devices. Although the statistical value of these 10 cases is limited, just based on empirical analysis and retrospective studies, more clinical studies can be conducted to assess related risks and make recommendations for the safe installation of the cerebral fixation devices.