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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Fixation of subdural strip electrodes during brain tumour surgery – comparison between different fixation options: Technical note

Meeting Abstract

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  • Johannes Knipps - Universitätsklinikum Düsseldorf, Neurochirurgische Klinik, Düsseldorf, Deutschland
  • Marcel A. Kamp - Universitätsklinikum Düsseldorf, Neurochirurgische Klinik, Düsseldorf, Deutschland
  • Lisa M. Neumann - Universitätsklinikum Düsseldorf, Neurochirurgische Klinik, Düsseldorf, Deutschland
  • Marion Rapp - Universitätsklinikum Düsseldorf, Neurochirurgische Klinik, Düsseldorf, Deutschland
  • Maria Smuga - Universitätsklinikum Düsseldorf, Neurochirurgische Klinik, Düsseldorf, Deutschland
  • Hans-Jakob Steiger - Universitätsklinikum Düsseldorf, Neurochirurgische Klinik, Düsseldorf, Deutschland
  • Michael Sabel - Universitätsklinikum Düsseldorf, Neurochirurgische Klinik, Düsseldorf, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 116

doi: 10.3205/17dgnc679, urn:nbn:de:0183-17dgnc6798

Published: June 9, 2017

© 2017 Knipps et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Intraoperative neurophysiological mapping and monitoring (IOM) is now a standard procedure during brain tumour surgery. Strip electrodes are used to identify and monitor primary motor cortex (M1) function. However, strip electrodes frequently become displaced during surgery, which can impact the safety of the procedure. This technical note compares temporary electrode strip fixation options in the context of improvement of intraoperative monitoring.

Methods: A sheep brain model was used to analyse temporary fixation options of subdural strip electrodes on the brain surface. Strip electrodes were placed on sheep brain cortices and connected to a spring balance. The mechanical resistance of nine different fixation techniques (1: TachoSil®, 2: TissuFleece E®, 3: Tisseel®, 4: TissuFleece E® + Tisseel®, 5: TissuFleece®, sequential + Tisseel®, 6: Hemopatch®, 7: Hemopatch® + citrate blood, 8: Oxidised cellulose, 9: DuraGen®) were tested and compared with a strip electrode without additional cortical fixation. Using a surgical microscope, brains were investigated for surface damage after fixation removal. The different fixation options were evaluated according to the following three criteria: (A) adhesion strength, (B) brain surface damage and (C) cost.

Results: Significant differences were observed between the different fixation techniques. Fixation results ranged from no additional benefit to high resistance compared with no additional fixation (mechanical resistance: 3 → >60 g). However, some fixation techniques resulted in microscopic damage to the cerebral surface. The best adhesion properties were observed using TachoSil® and Hemopatch®. However, removal of Hemopatchâ resulted in microscopically visible surface damage in the sheep brain models. Individual product cost ranged from a few cents to a hundred euros.

Conclusion: The use of temporary fixation options for subdural strip electrodes prevents loss of time during neurosurgery and reduces patient risk. The adhesion properties and cost of different fixation techniques varied. Furthermore, in some cases, microscopically visible cerebral surface damage was observed. The simple and safe handling and low cost of some fixation methods may help in ensuring an efficient operative course; however, the possibility of tissue damage must be taken into consideration.