Head positioning for anterior circulation aneurysms
                    microsurgery

Chaddad-Neto, Feres; Doria-Netto, Hugo Leonardo; Campos-Filho, José Maria de; Ribas, Eduardo Santamaria Carvalhal; Ribas, Guilherme Carvalhal; Oliveira, Evandro de

doi:10.1590/0004-282X20140156

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Arquivos de Neuro-Psiquiatria

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Sumário

Articles • Arq. Neuro-Psiquiatr. 72 (11) • Nov 2014 • https://doi.org/10.1590/0004-282X20140156 copy

Head positioning for anterior circulation aneurysms microsurgery

Posicionamento da cabeça para microcirurgias de aneurismas da circulação anterior

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective

To study the ideal patient's head positioning for the anterior circulation aneurysms microsurgery.

Method

We divided the study in two parts. Firstly, 10 fresh cadaveric heads were positioned and dissected in order to ideally expose the anterior circulation aneurysm sites. Afterwards, 110 patients were submitted to anterior circulation aneurysms microsurgery. During the surgery, the patient's head was positioned accordingly to the aneurysm location and the results from the cadaveric study. The effectiveness of the position was noted.

Results

We could determine mainly two patterns for head positioning for the anterior circulation aneurysms.

Conclusion

The best surgical exposure is related to specific head positions. The proper angle of microscopic view may minimize neurovascular injury and brain retraction.

cerebral aneurysm; head positioning; anatomical landmarks; anterior circulation arteries; microsurgery

	ICA, OFT segment		ICA, PCo segment		ICA, ACo segment		ICA bifurcation		ACA, ACoA segment		MCA
Specimen	Rotation / Extension		Rotation / Extension		Rotation / Extension		Rotation / Extension		Rotation / Extension		Rotation / Extension
1	16	2	13	4	20	3	10	15	3	16	10	13
2	17	3	12	6	17	4	11	14	4	17	8	13
3	13	2	15	5	12	4	7	14	4	20	7	12
4	12	2	16	5	11	5	6	12	5	19	9	17
5	10	1	14	7	11	6	7	17	4	19	9	17
6	18	1	12	3	10	1	9	20	6	12	8	14
7	15	0	16	3	15	1	9	19	6	12	4	14
8	16	1	18	4	14	2	10	19	9	13	5	13
9	14	3	17	4	9	2	6	9	10	13	5	15
10	14	0	10	2	12	1	7	11	11	12	7	15
11	15	2	12	3	13	2	7	10	8	16	7	15
12	16	1	14	3	13	3	8	13	10	15	4	16
13	17	1	13	3	12	1	9	14	11	14	6	12
14	15	3	15	4	19	1	10	16	7	14	6	10
15	15	2	15	4	18	2	6	16	7	15	9	12
16	18	1	16	6	10	2	6	17	8	13	7	15
17	13	2	12	6	10	3	7	18	8	12	7	14
18	14	0	13	3	11	2	7	18	6	15	8	14
19	16	2	12	3	12	3	8	15	5	17	8	15
20	16	1	18	2	12	2	10	13	9	16	6	14
Mean	15.00	1.50	14.15	4.00	13.05	2.50	8.00	15.00	7.05	15.00	7.00	14.00
Std Deviation	2.00	0.95	2.23	1.41	3.17	1.40	1.62	3.09	2.46	2.49	1.69	1.75
Lower CI on mean (95%)	14.06	1.06	13.11	3.34	11.57	1.85	7.24	13.55	5.90	13.83	6.21	13.18
Upper CI on mean (95%)	15.94	1.94	15.19	4.66	14.53	3.15	8.76	16.45	8.20	16.17	7.79	14.82

Segments	Patients (male:female)
ICA, OFT segment	20 (9:11)
ICA,Acha segment	10 (4:6)
ICA, PCo segment	20 (9:11)
ICA bifurcation	20 (7:13)
ACA, ACoA segment	20 (9:11)
MCA	20 (7: 13)
TOTAL	110 (45:65)
Mean Age	53.2 (55:52)

Segments	Appropriate rotation and extension	Appropriate rotation and inappropriate extension	Inappropriate rotation and appropriate extension	Inappropriate rotation and extension
ICA, Oph segment (20 pts)	14 pts (70%)	3 pts (15%)	3 pts (15%)	0 pts (0%)
ICA, PCo segment (20 pts)	17 pts (85%)	1 pt (5%)	1 pt (5%)	1 pt (5%)
ICA, ACha segment (10 pts)	8 pts (80%)	1 pt (10%)	0 pts (0%)	1 pt (10%)
ICA bifurcation (20 pts)	15 pts (75%)	1 pt (5%)	4 pts (20%)	0 pts (0%)
ACA, ACoA segment (20 pts)	13 pts (65%)	3 pts (15%)	4 pts (20%)	0 pts (0%)
MCA (20 pts)	18 pts (90%)	1 pt (5%)	1 pt (5%)	0 pts (0%)
TOTAL (110 pts)	85 pts (77.2%)	10 pts (9.1%)	13 pts (11.8%)	2 pts (1.8%)

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[1] Correspondence: Hugo Leonardo Dória-Netto; Praça Amadeu Amaral, 27 - 5° andar; 01327-010 São Paulo SP, Brasil; E-mail: hldoria@hotmail.com

	Oo Ophtalmic Segment of ICA (20pts)	p Post. Comm. Segment of ICA (20 pts)	Choroidal Segment of ICA (10pts)	Ant. Comm. Artery (20pts)	ICA Bifurcation (20 pts)	Middle Cerebral Artery (20 pts)
App. R/E	14 pts (70%)	17 pts (85%)	8 pts (80%)	13 pts (65%)	15 pts (75%)	18 pts (90%)
App. R / Inapp. E	3 pts (15%)	1 pt (5%)	1 pt (10%)	3 pts (15%)	1 pt (5%)	1 pt (5%)
Inapp. R / App. E	3 pts (15%)	1 pt (5%)	0 pt (0%)	4 pts (20%)	4 pts (20%)	1 pt (5%)
Inapp. R/E	0 pt (0%)	1 pt (5%)	1 pt(10%)	0 pt (0%)	0 pt (0%)	0 pt (0%)