Efficacy of monitoring patient's position during neurosurgical procedures: introduction of real-time display and record

Abstract

There are many reports on position-related complications in neurosurgical literature but so far, continuous quantification of the patient's position during the surgery has not been reported. This study aims to explore the utility of a new surgical table system and its software in displaying the patient's body positions during surgery on real-time basis. More than 200 neurosurgical cases were monitored for their positions intra-operatively. The position was digitally recorded and could be seen by all the members in the operating team. It also displayed the three-dimensional relationship between the head and the heart positions. No position-related complications were observed during the study. The system was able to serve as an excellent indicator for monitoring the patient's position. The recordings were analyzed and even used to reproduce or improve the position in the subsequent operations. The novel technique of monitoring the position of the head and the heart of the patients and the operating table planes are considered to be useful during delicate neurosurgical procedures thereby, preventing inadvertent procedural errors. This can be used to quantify various surgical positions in the future and define safety measures accordingly.

Fig. 1.

Drawing showing the location of all encoders. Each encoder converts the angular position and motion of the shaft/axle to digital code. Encircled number 1: encoder 1 for table up/down, encircled number 2: encoder 2 for table-sliding for rostro-caudal direction, encircled number 3: encoder 3 for right-left direction, encircled number 4: encoder 4 for the angle of table top for transverse direction, encircled number 5: encoder 5 for the angle of back section, encircled number 6: encoder 6 for the angle of table top for longitudinal directions, and encircled number 7: encoder 7 for the angle of the leg section.

Fig. 2.

A 65-year-old man in prone position for osteoplastic laminotomy before (A) and after (B) draping. Lateral (C) and oblique (D) views of his position are monitored continuously during surgery, which can be changed by pushing a function key. Yellow circles (indicated by yellow arrows) show head position, and red circles (indicated by red arrows) show heart position. Green arrow indicates reference position reproduced from the data obtained from the record of a former similar operation.

Fig. 3.

A: A 43-year-old man in sitting position for a posterior fossa tumor (case 2). B: Numerical position data are demonstrated by a computer connected to the table. Each abbreviation in B is described as follows. Table up/down: height (mm) of table top, Trend: the angle (degree) of table top for longitudinal direction, Tilt: the angle (degree) of table top for transverse direction, Back: the angle (degree) of back section, Y-axis: the length (mm) of table-sliding for rostro-caudal direction, X-axis: the length (mm) of table sliding for right-left direction, and Leg: the angle (degree) of the leg section. Monitoring of the table was performed throughout the operation, displayed as line chart (a part of early phase of this case including the position setting is displayed as line chart in C). The color of each line is matched to that of the position data respectively. D: A representative diagram showing the front and lateral views of the table. Green arrows: reference position, red arrows: heart position, yellow arrows: head position.

Fig. 4.

Monitoring during sitting position for paramedian supra-cerebellar approach to a pineal region tumor. Data registration was used in the second operation to improve the position by reducing height difference between head and heart and eliminating air emboli during the surgery. Green position: the position at the first operation, red dot: heart position, yellow dot: head position.