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|LETTER TO EDITOR
|Year : 2014 | Volume
| Issue : 5 | Page : 554-556
Silicone neuropatty: An innovative protective tool
Jasmit Singh, Hrushikesh Kharosekar, Vernon Velho, Deepak Palande
Department of Neurosurgery, Sir Jamshedjee Jeejeebhoy Group of Hospitals and Grant Medical College, Mumbai, Maharashtra, India
|Date of Submission||14-Mar-2014|
|Date of Decision||15-Apr-2014|
|Date of Acceptance||03-Oct-2014|
|Date of Web Publication||12-Nov-2014|
Department of Neurosurgery, Sir Jamshedjee Jeejeebhoy Group of Hospitals and Grant Medical College, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh J, Kharosekar H, Velho V, Palande D. Silicone neuropatty: An innovative protective tool. Neurol India 2014;62:554-6
Neurosurgical patty has been used since the inception of this field. Traditionally, patty used in neurosurgery is made of cotton or fine fabric and is intended for use during operative procedures to protect underlying tissues during dissection. It also absorbs fluids due its porous nature, so the patty kept under the suction tip helps in absorbing fluid and clearing the field and at the same time preventing injury to the underlying neurovascular.
The patty has been a loyal tool and has served these purposes well, still iatrogenic injuries that occur during operative procedures on the brain and spine continues to be a cause of concern. Iatrogenic injury to the brain, nerves and vessels can manifest as subarachnoid hemorrhage (SAH), brain contusions or edema. This damage usually results from heat transmission from monopolar/bipolar cautery, hand piece of CUSA and drill. Iatrogenic injury can also occur by sharp instruments or due to retraction of the edematous brain. Sometimes the patty, if left on the brain surface for long tends to dry up and stick to the brain surface, leading to injury while removing it. At times cottonoid patty can get caught up in the electric pneumatic drill causing damage to the surrounding.
In order to prevent such injuries, a patty made up of silicone was conceptualized by our neurosurgery department at Grant Medical College, Mumbai. It is obtained from a transparent sheet of silicone elastomer, which is cut to the desired shape and size on the operating table. Its main advantage is that it is transparent so that the underlying surface is under constant vision and it does not stick to the brain surface and moulds as per the surface [Table 1] [Figure 1].
A study was carried out in the department of neurosurgery, Grant Medical College and Sir J J Group of Hospitals with the purpose of defining the role of silicone pattie in neurosurgical practice in preventing iatrogenic injury to the brain and spinal cord during surgery. This was a prospective study which included a total of 486 cases of cranial and spinal elective brain surgeries from all age groups over a period of one year from June 2012 to June 2013, out of which 320 were cranial cases and 166 were spinal cases. Silicone patty was used as described in [Table 2].
During surgery, patients were screened for subarachnoid hemorrhage, brain laceration/contusion, injury to the neurovascular structures and brain under the cover of silicone pattie. After extubation, the patients were subjected to complete neurological assessment to detect any potential neurological deficit. This was followed up by a computed tomography (CT) of the brain in cranial cases at 48 hours to identify iatrogenic injury; in cases of spinal surgeries, magnetic resonance imaging (MRI) of the area of interest was done.
Out of the 320 cranial cases, SAH was observed in 3 cases while none of the patients under study had brain contusion/laceration. None of the spinal cases had any iatrogenic injury and patients recovered well after surgery. The patients who had SAH were controlled well at an early stage because of the transparent nature of the silicone pattie. The use of silicone pattie limited/prevented iatrogenic injury to neural structures.
This study demonstrates the effectiveness of this simple tool. Though it is not a randomized control trial, but the significantly lower rate of injury speaks of the magnitude of the protection that it confers. The most notable point is its transparent nature that helps to detect or halt the injury as soon as it occurs and it does not hide the structures while cutting the dura or while retracting the brain [Table 1].
The silicone neurosurgical pattie is not without its disadvantages. It tends to float if the cavity containing the patty is irrigated, causes glare through the operating microscope; and it tends to slip occasionally. Its main drawback is that it cannot absorb fluid/blood, so a small cottonoid is used under the tip of the suction tube, which is not the purpose for the silicone patty to be used. Also it has to be shaped during surgery.
Till date, there has been no study on the role of a patty in neurosurgical practice. Our experience demonstrates the efficacy of this tool; and a more widespread use of this patty can further establish its role in the neurosurgical field. A list of surgeries in which we used silicone pattie is mentioned in table [Table 2] [Figure 2].
|Figure 2: Silicone patty used for retraction of Cerebellum in CP angle surgery|
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Silicone pattie is obtained from soft sheet of silicone elastomer, which is 0.4 mm thick and is available in many readymade sizes, that is 20 × 35 mm, 40 × 50 mm and 60 × 80 mm. It can be used only once and is discarded at the end of the procedure. At the time of use, the patty is trimmed.
[Figure 1], [Figure 2]
[Table 1], [Table 2]