Benefits in using microscope for intracranial surgery

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Benefits in using microscope for intracranial surgery

teaching microscopes

The microscope magnifies the surgeons view of the area that being operated on and allowing it to be more exact and clear in examining. An added benefit is a monitor that projects an image of the organs that the surgeon is currently working on. This allows students and interns to observe the entire procedure, gaining extra and valuable knowledge in how to operate the microscope for intracranial surgery.. These procedures and modalities include Gamma Knife Radiosurgery, stereotactic image guided surgery, microscopic surgery, lasers, and endoscopic surgery. The result has been better outcomes, less morbidity and mortality and higher patient satisfaction. Management of intracranial abnormalities has progressed rapidly over the past decade. Northwest Neurological Surgery (NWNS) is the oldest private neurosurgical group practice in Seattle. they helped to pioneer the use of modern microsurgical techniques, performing the first microdiscectomy in the Northwest and were among the first to utilize the operating microscope for intracranial surgery. Intracranial surgery encompasses all fields within surgery, as well as biomedical imaging and instrumentation, and digital technology employed as an adjunct to imaging in diagnosis, therapeutics, and surgery.

INTRACRANIAL PRESSURE-is the term applied to the pressure of CSF with in the cranium. 8 to 18 mm Hg is the normal intracranial pressure for adults and for the babies the pressure is 10-20mm less when measured through a lumbar puncture. The ICP is not a static state, however it influenced several factors. It shows 2 forms of pressure fluctuations while recording the ICP. The cardiac systole will raise due to distention of intracranial arteriolar tree which follows and a slower change in pressure with respiration, falling with each inspiration and rising with expiration. Rise in pressure is caused by straining, compression of neck veins. The conception of the cranium acting as a near rigid container of virtually incompressible substances. MONRO KELLIE doctrine-form of brain, blood and CSF. The CSF can be displaced through the foramen magnum into spinal theca. In states of increased ICP there is increase in passage of blood through venous emissaries. Intracranial pressure is a result of at least 2 factors, the volume of the brain about 1400ml in an adult being constant. CSF circulation is slow 500 to 700 ml/day.

CSF which is constantly secreted & after circulating absorbed at an equal rate. At a given time the cranium contains 75 ml of CSF. 1000 liters of intracranial circulation of blood per day delivered at a pressure of 100 mmHg and at a given time, the cranium contains 75 ml. Any obstruction to venous outflow will entail an increase in the volume of intracranial blood and ICP. As the ICP increases, the cerebral venous pressure increases in parallel so as to remain 2 to 5 mm higher or else the venous system would collapse. This relationship CPP meant art pressure venous pressure or mean ICP can be satisfactorily estimated from mean art pressure ICP. The 3 ICP waves pattern by LUNDBERG are A, B and C waves. A-plateau waves which are pathological. There is a rapid rise in ICP up to 50-100 mm Hg followed by a variable period during which the ICP remains elevated followed by a rapid fall to the baseline and when they persist for longer periods called plateau or pathological. ATYPICAL ONES OR TRUNCATED that do not exceed an elevation of 50 mm Hg, are early indicators of neurological deterioration. B and C waves are related to respiration and Traube Hering Mayer waves respectively and are of little clinical significance.

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teaching microscopes

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Saturday, May 19th, 2007 at 3:19 am

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Teaching Microscopes

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Benefits in using microscope for intracranial surgery

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