Journal of Postgraduate Medicine Medknow Publications and Staff Society of Seth GS Medical College and KEM Hospital, Mumbai, India ISSN: 0022-3859 EISSN: 0972-2823 Vol. 47, Num. 1, 2001

Journal of Postgraduate Medicine, Vol. 47, Issue 1, 2001 pp.

Multiposition Brain Holder: A Versatile Appliance for Microneurosurgical Laboratory

Bhatjiwale MG, Goel A, Muzumdar DP

Department of Neurosurgery, Seth G. S. Medical College and King Edward Memorial (K.E.M.) Hospital, Parel, Mumbai, India.

Code Number: jp01026

Cadaver dissection under microscope forms an essential part of training of residents and neurosurgeons.1 A practical and compact appliance for supporting and safe multi-directional manoeuvering of the fixed brain specimen suitable for microneurosurgical dissections is described. The apparatus and its advantages over the previous described head-holder2 are discussed.

Instrument

The device consists of a heavy circular stainless-steel base plate weighing 1050 grams (Fig. 1 & 2). The main stem of the brain holder consists of two ball and socket joints in continuity. Each ball and socket joint transcribes a wide cone of circumferential movement. Two joints in continuity allow a wide range of movement of the base. A screw handle fixes the joint in any selected position. The distal ball and socket joint is connected to a metal block, which has a groove for the primary blade, and mechanisms to screw fix it. The primary blade has a metal slot, which serves to anchor three sets of secondary blades as shown in the figure 1. A tertiary blade is applied to the free ends of the secondary blades to complete the supporting assembly. All blades are malleable and are made of SS316 stainless steel. The angulation achievable with the help of stabilization of brain with the malleable blades in addition to the inclination obtained by the ball and socket joints provides a wide and effective range of movements. The blades help to retain compactness and natural alignment of brainstem, cerebellum and the cerebral hemisphere. A window drape as shown in the figure 2 can be used in conjunction with the brain holder to obtain the ‘craniotomy’ effect.

Discussion

Head clamps and holders are used during an actual neurosurgical operation to stabilize the head in a particular desired position so that the surgery on the brain can be performed with minimum discomfort to the surgeon and in optimum brain position.3,4 The same principle is necessary when one is analyzing, learning or practicing a particular surgery or an anatomical territory on a fixed cadaveric brain specimen, particularly under microscope. Due to the fragility of the fixed brain it is difficult to stabilize it in a particular position for a period of time. Apart from a head-holder described by us previously,2 there is no other device described in the literature for use in the cadaveric microneurosurgical laboratory. The apparatus described by us earlier had two moulds of the skull made in the form of soup bowls for placement of the brain. One mould was made to accommodate the base of the brain including the cerebral hemispheres, brainstem and the cerebellum and the other was to hold the brain convexity. A base that held both bowls was similar to that in the present report. Due to the malleability of the blades and the possibility of firmly and circumferentially holding the specimen adds versatility in the present holder. There is a possibility of turning the specimen in a wide range of directions and even turning it upside down. The extensive angular mobility of the primary and secondary joints with the freedom lent by ‘moving blade system’ incorporated in this holder ensure that the brain can be placed and supported in any desired anatomical or operative position. The modular design and the ease of disassembly ensure easy cleaning of the apparatus. Due to the incorporation of commonly used and available stainless steel material, the apparatus is not expensive.

References

1. Quinlan DK, de Villers KQ. The organisation of a microsurgical unit. S Afr Med J 1982; 62:281-284.
2. Goel A, Panchwagh J. Brain holder for microsurgical dissections. Neurol India 2000; 48:193-194.
3. Lee S, Diez-Pardo, Olszewski W, Rowinski W, Hirner A, Brekke I, et al. An improved microsurgical course for a mixed group of surgeons. World J Surg 1981; 5:285-294.
4. Weir B, McDonald R. Intracranial aneurysm and subarachnoid haemorrhage: An overview. In: Wilkins RH, Rengachary SS, editors. Neurosurgery. 2nd edition. New York: McGraw Hill; 1996, pp 2191-2213.

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