The Sitting Position in Neurosurgery: Uncut video. (Part 1) скачать в хорошем качестве

The Sitting Position in Neurosurgery: Uncut video. (Part 1)

This uncut, continuous video clip shows how one can safely achieve a sitting neurosurgical position. See part 2 on how to fix the skull clamp:    • Sitting position for neurosurgery: Fixing ...   Part 3 shows the final position:    • Sitting position for neurosurgery: Final p...   Part 4 describes the elbow rest for the surgeon:    • Sitting position for neurosurgery: Elbow r...   A sitting neurosurgical position has several advantages during the operations of the posterior fossa. This position is typically used when one wants to remove an acoustic neuroma (vestibular schwannoma). The venous bleeding is much reduced due to the effect of gravity and there is no need for constant suctioning to remove the blood. The position permits the surgeon to use bimanual dissection to attempt preservation of the seventh cranial nerve. The surgery proceeds much faster because of the reduction in bleeding. However, there are big risks too, like air embolism and should only be attempted by an experienced team. Transesophageal echocardiography is required throughout the procedure to detect air bubbles that enter the right atrium. If and when air embolism happens, the neurosurgeon must flood the field with saline and wax the bone. A small amount of air almost always enters the atrium during such operations but does not cause harm. But if very large amounts of air enter unabated, hemodynamic instability will occur. Because of the risks, many centers have abandoned the sitting position and some surgeons report equally good outcome with a supine oblique or the lateral position. The sitting position can also be rather fatiguing for the surgeon. So, the elbow needs to be supported well and the hands should be rested while dissecting. This video clip runs uncut and unedited until the body position is achieved. We believe that an uncut video aids a team to learn the nuances better. When we first started, we could not find a good video. I hope this helps. The second part shows how the skull clamp is applied. Prasanna Bidkar is the neuro-anesthetist. I am the cameraman and the operating surgeon. The video was shot on a D70 Canon Digital SLR.