July 21, 2016
There are important nuance of technique for optimizing the image coming through the OR microscope and the oculars. Remembering these nuance of technique would allow the image to be sharply in focus, clearly visible, and therefore allowing microsurgery to continue on interrupted and in a safe fashion. The first important principle is that the image should be centered. This is a left-sided microvascular decompression procedure. You can see the operative field is on the corner of our view. Some of the normal anatomy can be overlooked and injured inadvertently. Adequate zoom is specially important. You can see that this is, again, a left-sided MVD procedure. If the image is not adequately magnified or zoomed in, some of the important, fine details of server vascular structures can be overlooked leading to their injury. However, on the right side, the surgical target, the offending vessel is well illuminated, and the focus of the attention is on the surgical target. Utilizing the mouthswitch is specially important. Let's go ahead and review this right-sided MCA aneurysm clipping. As you can see here, is dam two is exposed. The operative field is not well illuminated. Some of the details of perforators or smaller arterials can be overlooked and injured during sharp dissection. However, using the mouth switch, I continued to survey the operative field and protect the important vessels, and the M2 branches while using the higher magnification technology of the microscope, to be able to find the M2 branches and protect them. Again, as you are in a higher magnification, the importance of remaining in focus is specially important, and the utility of the mouth switch is even more prominent. Obviously, the use of the mouse switch here precludes the use of the handles of the microscope, and therefore microsurgery can continue efficiently and uninterrupted while maintaining the image centered and sharply in focus. Sufficient light is obviously critically important. If you can't see the pathology, you can't handle it. On the left side, again, this is a right-sided posterior communicating artery aneurysm clipping through the terminal approach. The hand of the surgeon and the angle of the instrument interferes with the line of light of the microscope. Therefore the light does not reach the surgical target. The tips of the scissors are not clearly visible, leading to small amount of bleeding. I cannot emphasize the importance of this principle adequately. What is the optimal example of a video recording? Here is a right side of terminal craniotomy for a clip of a large, anterior artery aneurysm. You can see the vessels are adequately magnified. The small perforator remains in focus at all times. The mouthswitch is used to keep the image in focus since the view is so magnified, remaining in focus becomes so important. Thank you.
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