Surgical treatment of trigeminal neuralgia - Home Study Program

AORN Journal,  Nov, 2003  by Cassi Brown

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OR SETUP. The perioperative nurse ensures that the OR is prepared for a craniotomy procedure and the more detailed microvascular portion of the procedure before leaving the room to interview the patient. Routine craniotomy setup includes a

* craniotomy set,

* drill for making burr holes and turning a small bone flap,

* unipolar electrosurgical unit, and

* irrigating bipolar electrosurgical unit. Special instrumentation and equipment required for MVD include

* aneurysms clips,

* microvascular instruments,

* microscope,

* self-retaining retractor that attaches to the three-point headrest,

* small endoscopes,

* special chairs for microsurgery, and

* towers containing the microscope and endoscope equipment.

Medications on the field include

* antibiotic irrigating solution,

* antibiotic ointment,

* fibrin glue,

* hemostatic sponge agents, and

* local medications containing epinephrine

INTRAOPERATIVE CARE

Preoperatively, the circulating nurse greets the patient, explains the anticipated procedure, and reviews the preoperative assessment form. The anesthesia care provider lightly sedates the patient and, cooperatively with the circulating nurse, transports the patient to the OR. After anesthetizing and intubating the patient, the anesthesia care provider inserts an arterial line, a central line, and an oral gastric tube. He or she lubricates the patient's eyes and protects them by taping cotton eye pads in place over closed eyelids. The anesthesia care provider tapes a precordial doppler in place to listen for any air that could enter the venous system through an open sinus. Meanwhile, the circulating nurse inserts a temperature-monitoring Foley catheter and places antiembolism stockings and sequential compression devices on the patient.

INTRAOPERATIVE NEUROPHYSIOLOGICAL MONITORING. Intraoperatively, neurophysiological monitoring is used to record electrical signals at different levels of the neuraxis or at different muscle groups. Using intraoperative neurophysiological monitoring helps detect changes that might presage irreversible damage (ie, pressure or stretching of the ganglion or eighth cranial nerve can cause temporary or permanent deafness). This allows the surgeon to alter surgical technique whenever possible to reduce morbidity and mortality. The underlying assumptions of intraoperative neurophysiological monitoring are that

* it can detect changes resulting from surgical manipulation of brain tissue;

* such a change will be detected quickly enough to prevent permanent injury; and

* the information can be used by the surgeon to stop or change the surgical procedure.