Neurosurgical Surgery Phases: Reduce Risks with Preventive Measures

Introduction 

Neurosurgery is a complex and delicate medical procedure that carries certain risks and complications. However, advancements in medical technology and surgical techniques have made brain surgery safer than ever before. To further reduce the risks and complications associated with neurosurgery, several preventive measures can be taken. These measures can be controlled in three phases: 

• Preoperative phase: Preoperative planning, patient selection and Infection control
• Intraoperative Phase: Proper positioning and monitoring during surgery
• Postoperative Phase: Thorough postoperative care and monitoring

In this article, let’s explore with UpSurgeOn the preventive measures to reduce neurosurgical risks and complications.

To discover more about the Risks and complications of brain surgery, please read our article HERE

I. Preoperative Phase of neurosurgical surgery

1. Preoperative planning and patient selection

To guarantee a successful surgery, there are several crucial steps that must be taken: 

• Adherence to strict policies and procedures: To avoid any mishaps during surgery, it is crucial to strictly follow established policies and procedures. By doing so, the risk of errors can be minimized, ensuring accurate patient identification and consent [1].
• Use neurosurgical checklists: Checklists are invaluable tools that not only enhance patient safety but also boost the confidence of neurosurgeons. They provide an efficient, reliable, cost-effective, and time-saving approach to ensure a secure environment in the neurosurgical intraoperative MRI suite. By incorporating checklists into the surgical briefing, preventable medical errors, such as wrong-site surgery, complications from incorrect patient positioning, and equipment failure, can be significantly reduced [2].
• Develop a safety culture in your neurosurgical department: Each neurosurgical department should develop its own checklist or adapt an existing one to suit its unique characteristics and requirements. The promotion of safety checklists and their benefits can be facilitated by international, continental, regional, and national neurosurgical societies, fostering a culture of safety within the field. [2]
• Thorough preoperative evaluation: A comprehensive assessment of a patient’s overall health, including pre-surgical testing, medication management, and hospital admission planning, is essential. This thorough evaluation helps identify and address any potential risk factors before the surgery, ensuring a smoother and safer procedure [3].
• Patient education and preparation: Providing patients with detailed information about the procedure, potential complications, and the recovery process is crucial [3]. This empowers patients to make informed decisions and actively participate in their own recovery, leading to better outcomes.
• Optimizing general health: Prior to surgery, it is important to address any underlying medical conditions that a patient may have, such as diabetes or high blood pressure. By optimizing their general health, the risk of complications can be minimized, ensuring a successful surgical outcome.

By following these crucial steps, the chances of a successful surgery can be greatly increased. Adhering to policies and procedures, using neurosurgical checklists, developing a safety culture, conducting thorough preoperative evaluations, educating patients and optimizing patient’s general health are all essential components of guaranteeing a successful surgical outcome.

2. Infection Control

In the realm of neurosurgery, infection control plays a pivotal role in ensuring successful outcomes. By implementing preventive measures, the risk of surgical site infections can be significantly reduced. These measures encompass a range of practices:

• Unwavering adherence to sterile techniques: Maintaining proper hand hygiene, meticulous surgical site preparation, and utilizing sterile instruments and equipment are paramount in minimizing the risk of surgical site infections. When dealing with contaminated patient devices, it is crucial to follow the guidelines set forth by the Centers for Disease Control and Prevention (CDC) for hand hygiene and employ appropriate personal protective equipment (PPE) [4].

• Mitigating contamination: Employing a multitude of strategies to minimize microbial contamination of the sterile field is essential. This includes upholding a clean and organized operating room, employing mechanical, chemical, and biological monitoring to ensure the effectiveness of the sterilization process, and diligently maintaining sterilization records [5].

• Thorough disinfection and sterilization: The disinfection and sterilization of medical and surgical instruments are vital in preventing the transmission of infectious agents to patients. Healthcare policies should dictate whether cleaning, disinfecting, or sterilizing is necessary based on the intended use of the item. The CDC serves as an invaluable resource for healthcare personnel, offering comprehensive guidelines for disinfection and sterilization in healthcare facilities [6].

By diligently implementing these measures, the field of neurosurgery can ensure the highest standards of infection control, safeguard the well-being of patients, and promote successful surgical outcomes.

II. Intraoperative Phase of neurosurgical surgery

During the crucial intraoperative phase of neurosurgical surgery, it is of utmost importance to prioritize patient safety by implementing these preventive measures: 

• Prevent incorrect site surgery: Implement a pre-procedure checklist that includes a step to verify the correct site prior to the procedure. Ensure that the surgical procedure is performed on the correct body part, level, side, and patient. This can be achieved through proper patient identification, site marking, and clear communication between members of the surgical team [2].

• Prevent complications due to incorrect positioning of patients: Be aware of the physical and physiological consequences of improper patient positioning. Surgical comfort must be balanced against the risks associated with patient positioning to achieve ideal patient positioning. Complications can include perioperative nerve injury and postoperative vision loss.
• Prevent complications due to failure of devices required for the procedure: Regularly check the functionality of all required systems and equipment in the operating room. Malfunctioning equipment can result in the failure or incomplete performance of surgery. This potential problem must be given the attention and safety precautions it deserves, as it could have devastating consequences. [2]
• Address risk factors for preventable medical errors in neurosurgery: Risk factors for wrong-site surgery include incorrect patient positioning or preparation of the surgical site, incorrect information provided by the patient or family, lack of or improper patient consent, failure to use site markers, neurosurgeon fatigue, multiple neurosurgeons involved in a case, and overall poor communication by the surgical team [2]. Be aware of these risk factors and take appropriate measures to mitigate them.
• Protect the vital structures: To avoid complications such as cerebrospinal fluid (CSF) leakage, cranial nerves and vascular structures should be preserved during skull base tumor removal. Microsurgical instruments, such as a surgical microscope, may be used to help the surgeon better visualize brain structures and distinguish between abnormal and healthy tissue. In addition, tissue samples may be sent to the laboratory for testing. [7]
• Apply multidisciplinary approach: Neurosurgery often requires a multidisciplinary team that includes neurosurgery, anesthesia, nursing, and other health care providers. Work closely with the team to ensure the best possible outcome for your patients. [7].

By implementing these preventive measures and addressing potential risks, the intraoperative phase of neurosurgical surgery can be conducted with enhanced patient safety and reduced chances of complications.

III. Postoperative Phase of neurosurgical surgery

Postoperative care and monitoring are crucial aspects of any surgical procedure. After surgery, patients are typically observed in a recovery room or intensive care unit (ICU) to ensure their stability and recovery from anesthesia and surgery. It is essential to develop a comprehensive postoperative care plan that includes vigilant monitoring for complications such as elevated intracranial pressure, infection, and bleeding. In the event of any complications, prompt intervention and appropriate treatment should be provided.

To prevent complications like deep vein thrombosis (DVT) and pneumonia, it is important to promote early mobilization and rehabilitation of patients. Encouraging patients to start moving and engaging in rehabilitation exercises at the earliest possible time can significantly reduce the risk of these complications.

In addition to immediate postoperative care, it is crucial to emphasize the importance of long-term follow-up for patients. Encourage your patients to schedule regular check-ups and undergo imaging tests to detect and treat any potential complications or recurrences at an early stage. By staying proactive and vigilant, we can ensure the best possible outcomes for our patients.

Conclusion

By implementing these preventive measures, neurosurgeons can further enhance the safety and success of neurosurgical procedures, reducing the risks and complications associated with these complex surgeries. Thanks to the advances in medical technology, neurosurgeons can enhance skills to reduce the risks and complications related to neurosurgery and improve patient outcomes.  UpSurgeOn is your trusted partner on this transformative journey. Our surgical simulation technologies were created with the mission of empowering surgeons to do their mission with confidence, precision and skill. Let’s embark on the journey to explore the transformative power of surgical simulation with UpSurgeOn and stay ahead in the ever-evolving field of surgery!

References: 

1. Muzumdar, D. (2007). Safety in the operating room: Neurosurgical perspective. International Journal of Surgery, 5(4), 286–288. https://doi.org/10.1016/j.ijsu.2006.03.013
2. Enchev, Y. (2015). Checklists in Neurosurgery to Decrease Preventable Medical Errors: a review. Balkan Medical Journal, 32(4), 337–346. https://doi.org/10.5152/balkanmedj.2015.15481
3. Preparing for brain surgery. (n.d.). Johns Hopkins Comprehensive Brain Tumor Center. https://www.hopkinsmedicine.org/brain-tumor/prepare-procedure
4. Spagnolo, A. (2013, September 1). Operating theatre quality and prevention of surgical site infections. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4718372/
5. Andersen, B. M. (2019b). Prevention of postoperative wound infections. In Springer eBooks (pp. 377–437). https://doi.org/10.1007/978-3-319-99921-0_33
6. Rutala, William A. (William Anthony), 1948- and Weber, David J. (David Jay), 1951- (2008). Guideline for disinfection and sterilization in healthcare facilities, 2008.
7. Craniotomy. (2022c, April 26). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/craniotomy