A novel temporary cranial fixation device for awake cranial surgery: Technical report of 14 cases

Abstract

Background: Awake craniotomy has become the gold standard in various cranial procedures. As part of the awake technique, three-point pin fixation of the patient's head is important. One of the issues we encountered is the problem of matching the scalp infiltration site with the final pin position. To overcome this problem, we developed a flat plunger type fixator that adapts to the Mayfield holder.

Methods: Our fixator has a 2.5 cm metallic shaft that articulates in a ball and socket joint to allow its concave surfaces to adapt to the patient's scalp. After placing the patient in the desired position, the head is fixed with the three plungers, circles are drawn around each plunger, and they are then removed for the circles to be infiltrated with bupivacaine. Standard fixation pins are then placed in the Mayfield holder and aimed at the center of the circles.

Results: So far, we have operated on 14 patients with this technique. No patient experienced pain during temporary fixation, and the drawn circles ensured that there were no mismatches between the local anesthetic and pin locations. The technique was particularly useful on hairy scalps, where infiltration sites were hidden. We also used only 22.5 mg bupivacaine at the pin sites, freeing a dose for the field block around the scalp incision.

Conclusion: The temporary plunger type fixator provided a simple method to economize on local anesthetic use, check the patient's head position before final fixation, and ensure that the Mayfield pins matched with the anesthetized area.

Keywords: Craniotomy; Infiltration; Local anesthesia; Technique; Tumor.

Figure 1:

The ARTFIX system. The flat plunger type fixators articulate with the main metallic shaft in a ball and socket-type joint.

Figure 2:

(a) Artistic rendering of the technique used with the ARTFIX system patient being secured using the ARTFIX system, (b) drawing a circle around a plunger, (c) infiltration with local anesthetic at the center of the circles, (d) final head position.

Figure 3:

Representative images of intraoperative positioning for awake craniotomy using ARTFIX Images for Cases 4 (a-c) and 5 (d and e) are shown. (a) Initial fixation of the patient’s head with ARTFIX, (b) a circle is marked on the frontal scalp, (c) final pin placement inside the marked circle, (d) a marked circle on the occipital scalp, (e) final position before craniotomy.