The Neurosurgical Instrument Guide 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 Thieme Medical Publishers, Inc. 333 Seventh Ave. New York, NY 10001 Executive Editor: Kay Conerly Senior Vice President, International Marketing and Sales: Cornelia Schulze Editorial Assistant: Daniel De Corral Vice President, Finance and Accounts: Sarah Vanderbilt Editorial Director, Clinical Reference: Michael Wachinger International Production Director: Andreas Schabert Production Editor: Kenneth L. Chumbley Compositor: Prairie Papers Inc. President: Brian D. Scanlan Printer: Everbest Printing Co. Library of Congress Cataloging-in-Publication Data: Available from the publisher upon request. Copyright ©2012 by Thieme Medical Publishers, Inc. This book, including all parts thereof, is legally protected by copyright. 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However, in view of the possibility of human error by the authors, editors, or publisher of the work herein or changes in medical knowledge, neither the authors, editors, nor publisher, nor any other party who has been involved in the preparation of this work, warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or for the results obtained from use of such information. Readers are encouraged to confirm the information contained herein with other sources. For example, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this publication is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text. Therefore, the appearance of a name without designa- tion as proprietary is not to be construed as a representation by the publisher that it is in the public domain. Printed in China 5 4 3 2 1 ISBN 978-1-60406-638-8 Contents 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 .................................................................................................................................................................................................... v vi Contents 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 ............................................................................................................................................................................................................................................................................ Foreword Neurosurgical instrumentation is a complex mix Dr. Christopher Eddleman has done all of of traditional tools shared by multiple surgical us involved in neurosurgery—surgeons, nurses, disciplines, coupled with instruments unique instrument technicians, etc.—a great favor by to neurosurgery dating back to the dawn of our collating a common spectrum of neurosurgi- specialty. This basic armamentarium is topped cal instruments into a systematically presented by a vast, confusing panorama of subspecialty text that not only visually identifi es each tool, tools whose individual structure and function re- but concisely explains its function and common main opaque to most of us not initiated into the usage, details the multiple names by which it is rites of that particular surgical cult. As confusing often (and sometimes erroneously) called, and as this hodgepodge collection is to residents and explains its usual place in the generic “sets” used fellows relatively new to neurosurgery, it is infi - by most operating suites. This innovative format nitely more diffi cult to navigate for our nursing facilitates the rapid identifi cation of any instru- staff and surgical tech partners on whom we and ment by sight, title, “nick-name,” function, or our operative procedures depend for rapid and normal association and is the essence of “user reliable instrument identifi cation and exchange. friendly.” vii viii Foreword Despite the fact that instrumentation is un- even slight design modifications, and the thought- deniably “faddish,” out on the far borders of sub- ful accessibility mentioned above, promise to specialization, the core tools of our neurosurgical make this unique, detailed guide a “must read” for trade enjoy a remarkable longevity. That durability, young neurosurgeons and the gold standard refer- added to Dr. Eddleman’s compulsive exploration of 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 Preface I vividly remember the days, both as a medical their names? Was it time and experience? Was student and a junior neurosurgical resident, when there a neurosurgical instrument instructional the chief resident or attending neurosurgeon text? Was there something I was missing in terms would ask for an instrument in the operating of instructional learning? room, I thought they were speaking another lan- For neurosurgical residents, time and experi- guage, especially when muffl ed behind their sur- ence are how one learns the tools of the trade in gical masks. I can also remember surgical techs in the neurosurgical operating room. For surgical training who had the very same look on their fac- scrub nurses and techs, there are countless text- es when the neurosurgeon’s hand opened up for books and guides that usually cover all surgical an instrument and they said, “ehofpiwefuiwdbcv- instrumentation (not just for neurosurgery) and pi.” After some time, the neurosurgeons’ voices with personalized instruction to boot. So yes, became more understandable and the names of over time, and with a little experience, it is obvi- the instruments became clearer. However, some ously possible to learn surgical instrumentation instruments were called three diff erent names and all of their accompanying, quirky names. by three diff erent people on three diff erent occa- However, for neurosurgical instrumentation spe- sions. How is one to learn these instruments and cifi cally, I thought there must be a better way ix