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Microvascular Decompression: Salient Surgical Principles and Technical Nuances
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Cottonoid Retention After Craniotomy: Causes and Ways to Avoid It.

Anton V Kalinovskiy1, Jamil A Rzaev2

  • 1Federal Neurosurgical Center of the Ministry of Health of Russia, Novosibirsk, Russia. akalinovsky1980@gmail.com.

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|August 7, 2023
PubMed
Summary

Retained surgical sponges, known as cottonoids, can lead to infections after brain surgery. Implementing strict surgical team communication and material counting protocols can prevent this dangerous complication.

Keywords:
ComplicationCottonoidsCraniotomyNeurosurgeryPreventive measuresRetained cottonoidRetained foreign bodyRisk factors

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Area of Science:

  • Neurosurgery
  • Surgical Complications
  • Patient Safety

Background:

  • Nonabsorbable surgical materials retained in wounds pose risks, including infections and granulomas.
  • Cottonoid sponges are frequently used in neurosurgery for hemostasis and brain protection.
  • Retained surgical items represent a significant, preventable patient safety concern.

Purpose of the Study:

  • To analyze the incidence and risk factors of retained cottonoid sponges after intracranial tumor resection.
  • To present cases of cottonoid retention and their management.
  • To emphasize preventative strategies for avoiding retained surgical materials in neurosurgery.

Main Methods:

  • Retrospective analysis of four cases of retained cottonoid sponges over a 5-year period (2013-2017).
  • Calculation of the incidence of retained cottonoids after craniotomy.
  • Review of contributing factors, including surgical complexity and material management.

Main Results:

  • The incidence of retained cottonoid sponges was 0.07% following craniotomy.
  • Risk factors identified include deep-seated lesions, brain edema, bleeding, prolonged surgery, unmarked cottonoids, and inadequate material counts.
  • Retained cottonoids were detected on postoperative computed tomography due to radiopaque identifiers.

Conclusions:

  • Prompt reoperation within 24 hours for foreign body removal led to uneventful postoperative courses.
  • Effective prevention relies on meticulous surgical team coordination, especially during the final material count.
  • Clear communication between surgeons and nurses is crucial for preventing retained surgical materials.