Touch Surgery Simulation - Acute Trauma Craniotomy скачать в хорошем качестве

Touch Surgery Simulation - Acute Trauma Craniotomy

This Touch Surgery procedure demonstrates how to remove the bone flap and open the dura during an acute trauma craniotomy. The trauma craniotomy (TC) is an essential tool in the neurosurgeon’s armamentarium. Used in a variety of settings, an emergent decompression is used to evacuate a mass lesion or treat globally increased intracranial pressure secondary to cerebral edema. TC is used in life-threatening situations to prevent downward herniation of the brainstem through the foramen magnum. The three most common indications for TC include: 1) severe TBI, 2) malignant edema following acute large vessel infarct, and 3) aneurysmal SAH.2 In the setting of acute TBI, when an extra-axial mass lesion is present, emergent surgical removal of the cranium is recommended. These include epidural hematomas (EDH) and subdural hematomas (SDH), where significant midline shift occurs in an acutely decompensating patient. A standard unilateral question mark incision is made, the bone is removed with a pneumatic drill, and when present, the extra-axial compressive lesion is evacuated. Bone replacement is left to the surgeon’s discretion, and is often done if minimal subsequent parenchymal swelling is expected. In the setting of a high energy trauma, with traumatic subarachnoid hemorrhage and other small contusions, the bone is often left off in anticipation of future malignant edema, and replaced months later with a cranioplasty. The use of TC for intraparenchymal hematomas (IPH) and cerebral contusions is more controversial. The STICH3 trial demonstrated a small benefit for removal of superficial, lobar hemorrhages, which led to STICH II.6 These studies were conducted with stable patients with large hemorrhages. However, in the setting of a life-threatening IPH causing impending herniation, TC and hematoma removal is recommended. Despite the controversial data, TC is a technical skill that should be mastered by all neurosurgeons and has powerful implications in life-saving situations and is a procedure that will always have a place in modern medicine. Knowing the procedural skills to quickly and confidently manage malignant intracranial hypertension is mastered only through practice and repetition. This simulation includes the pre-procedural and intraoperative skillset to safely and efficiently perform an emergent trauma craniotomy. Authors: -Robert Singer MD is the Director of Neurovascular Therapeutics and Assistant Professor of Surgery & Radiology at the Geisel School of Medicine at Dartmouth. -Peter Morone MD is a third year neurosurgery resident at Vanderbilt University Medical Center. -Scott Zuckerman MD is a third year neurosurgery resident at Vanderbilt University Medical Center. -Michael Dewan MD is a third year neurosurgery resident at Vanderbilt University Medical Center. For more information about Touch Surgery, visit us on: Web: https://www.touchsurgery.com/simulati... Facebook:   / touchsurgery   Twitter:   / touchsurgery   Instagram:   / touchsurgery   Google+: https://plus.google.com/+TouchSurgery/ LinkedIn:   / touch-surgery   Music: Nightrider - DJ Booma