Microsurgery - Overview

Microsurgical techniques offer to surgeons a great improvement in working conditions to achieve the effective surgery of intracranial aneurysms and other small lesions, and an improved outcome for patients.

Microsurgery, however, requires a clear definition: it is not just the sole use of a microscope during a conventional neurosurgical exploration. It is an entirely new surgical discipline and concept requiring the use of a mobile counter-balanced operating microscope, and necessitating mastery of indirect eye-hand interaction which can only be acquired in a specially equipped laboratory.

Microneurosurgery constitutes two main components:

1. Special equipment:

• Counter-balanced mobile operating microscope equipped with a mouth-switch which allows free manual surgical manipulations during the entire procedure and T.V. camera and monitors to enhance and promote team work in the operating room between surgeon, neuroanesthesiologist, nurses, and technicians.
• Bipolar coagulators and bipolar forceps of different lengths and tip size.
• Pressure regulated suction apparatus and suction tubes in different lengths and diameters.
• Bayonet-shaped surgical instruments in different lengths and tip sizes and malleable microinstruments.
• Variety of temporary and permanent aneurysm and vessel clips and applications. There are now 180 different clips available.
• Microsutures and special needle holders.
• Self-retaining "protective" brain retractors.
• Hydraulic chair and adjustable arm rest for the surgeon.
  

2. Special surgical techniques requiring laboratory training to perfect:

• Enhanced eye-hand interaction working under conditions of indirect vision with the operating microscope.
• Delicate manipulation with microinstruments during dissection, clipping, coagulating, neurovascular repair, and grafting.
• Tactics to operating within a key-hole approach performing the procedures as mentioned above; but, under more difficult conditions, for example plastic boxes of different heights (5-12 cm) and with narrow openings cm diameter) simulate deep narrow approaches within and around the brain.
• Delicate and controlled manipulations within the confines of a small gap and using a self-retaining protective brain retractor.
• Training the use and applications of the bipolar coagulator and microsuction equipment.
• Exercises for the creation of an aneurysm and arteriovenous fistula on the carotid artery or aorta of a laboratory rat; practicing the technique of application of temporary and permanent clips and the technique of bipolar coagulation to shrink the different parts of the created vascular anomaly, to form in the case of an aneurysm, a suitable neck from the original wide base, which is more amenable to precise placement of a clip.
• Training to develop expertise and comfort using high-speed surgical drills.

Mr D'Urso utiltises the Zeiss OPMI/NC4 microscope system for his microsurgery at The Epworth Hospital. Legendary optics have always been the hallmark of surgical microscopes from Carl Zeiss. Carl Zeiss optics ensure outstanding colour fidelity, razor-sharp, crisp imagery and an unprecedented level of detail. A new zoom design delivers amazing depth of field and reduces eyestrain and the need to refocus. Integrated high-accuracy autofocus quickly produces a perfect image every time. Amazing light transmission and a unique two-way light path illumination to reduce shadows ensures the best possible vision.

For cross-table, face-to-face procedures, the NC4 can be placed conveniently behind the surgeon in the overhead position.

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