A localization method for emergency neurosurgery using a square ruler and dividers

Abstract

Objective To introduce a localization method for intracranial lesions using a square ruler and dividers. The experience of using this method for emergency neurosurgery is presented. Methods A total of 33 cases of emergency neurosurgery from October 2018 to October 2019 were retrospectively analyzed. The baseline at each scan as well as the upper, lower and middle level of the lesion is marked by a square ruler, and the chord length is measured by dividers to point outthe anterior and posterior border. Then the lesions are projected to the cranial surface treating by puncture or open surgery. Thetime spenton location,the accuracy compared with the actual location during operation, and the error compared with the calibration CT or MRI were recorded. Results The lesion of 33 patients was localized successfully by this method, and the average time spended was (3.70±1.17)min. Among them, the bone window was designed according to the surface projection of the lesion in 20 cases of open surgery (including 14 cases with acute epidural hematoma, 5 cases with cerebral lobe hemorrhage and one case with brain metastasis), and all lesions (20/20) were found in the center of the bone window intraoperatively. Besides, 13 cases of hematoma puncture surgery (including 2 cases with subacute frontotemporal subdural hematoma and 11 cases with spontaneous basal ganglia and thalamus hemorrhage) were corrected by CT scan after the target was located and marked by surface markers. The average error between the marker and the preset target was (3.71±1.62)mm. Conclusions This localization method only needs a square ruler and dividers, which is simple, rapid, accurate and reliable. The method is practical and the error is acceptable for location and surgical treatment in emergency cases. DOI：10.3969/j.issn.1672⁃6731.2020.08.008

Keywords

• emergencies
• neurosurgical procedures
• stereotaxic techniques