Endoscopic microvascular decompression without the use of rigid head fixation

Area of Science:

• Neurosurgery
• Surgical Techniques
• Patient Safety

Background:

• Rigid fixation with three-point skull clamps is standard in cranial surgery but carries risks like hemodynamic changes and skull fractures.
• Alternative head fixation methods are needed to improve patient safety during neurosurgical procedures.

Purpose of the Study:

• To evaluate the safety and efficacy of a pinless head fixation system during endoscopic microvascular decompression (E-MVD).

Main Methods:

• A pinless head fixation technique was employed for patients undergoing E-MVD in the lateral position.
• Head support was provided using a doughnut pillow, with specific head angulation and tape placement to ensure stability and access.
• Shoulder positioning was optimized to maximize the surgical working corridor.

Main Results:

• Fifty-two patients successfully underwent E-MVD using pinless head fixation without any reported clinical complications.
• The procedure was effective for various indications, including trigeminal neuralgia and hemifacial spasm.
• Operative times were comparable to those using traditional three-point skull clamp fixation, with no intraoperative or postoperative complications.

Conclusions:

• Pinless head fixation presents a viable and safe alternative to rigid fixation for select E-MVD patients, reducing potential complications.
• Close communication with the anesthetist is crucial to prevent intraoperative patient movement when using pinless fixation.