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Taking Things in One’s Stride: Cognitive Features of Two Resilient Performances
Published in Erik Hollnagel, David D. Woods, Nancy Leveson, Resilience Engineering, 2017
Richard I. Cook, Christopher Nemeth
The decision was made to perform a craniotomy, which is surgery that involves opening the skull, and the team transported the patient to the operating room. The neurosurgeon received and answered a cellular telephone call about another patient as he pulled the gurney. While waiting for an elevator, the patient’s parents came to the gurney, accompanied by a social worker. One of the transporting physicians spoke with them about the known injuries and the expected surgical procedure. The parents touched the patient, and looked under the blankets at her legs and feet.
Predicted microscopic cortical brain images for optimal craniotomy positioning and visualisation
Published in Computer Methods in Biomechanics and Biomedical Engineering: Imaging & Visualization, 2021
Nazim Haouchine, Parikshit Juvekar, Alexandra Golby, Sarah Frisken
A craniotomy is the surgical removal of part of the bone from the skull to expose the brain, for example to provide access for tumour resection. Surgeons often use well-established image-guidance systems where a patient’s head is registered with a pre-operative MRI scan (Fraser et al. (2009), Bucholz and McDurmont (2009)) to plan the location and size of the craniotomy before beginning surgery. Those systems help surgeons navigate to prepare the patient and locate the tumour. Using the registered pre-operative MRI scans, the surgeons draw a target on the patient’s skin (see Figure 1d), then opens the skin and cuts the bone to open the skull. The target size and location is chosen to provide optimal access to the tumour while avoiding vessels and other critical structures. However, several factors, including opening the skull, head position, changes in osmotic pressure and loss of cerebral spinal fluid, can cause the brain to shift upon opening. Thus, the planned craniotomy may not provide optimal or adequate exposure, increasing patient risk and surgical complexity.Figure 2Table 1
Insights into the effect of a craniotomy on the impact resistance of the skull
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
A. Siegel, F. Sauter-Starace, S. Laporte
Craniotomy is a well-known procedure in neurosurgery, during which a bone flap is removed, and is mainly used to save patients with severe head trauma (Chaikoolvatana and Sripech 2007). They can also sometimes be performed for inserting implants, like a cochlear implant or the RNS system (NeuroPace, Inc) (Heck et al. 2014). The international standard EN 45502-2-3:2010 for cochlear implants requires a 2.5 J hammer test. It is intended to assess the implant’s mechanical resistance against everyday impact scenarios as falls or hits on the head. Human head resistance against impact is reported in the literature between 16 and 28 J in average (Yoganandan et al. 1995, Verschueren et al. 2007; Delye et al. 2007). However, to the authors’ knowledge, the influence of a craniotomy on the skull’s mechanical resistance to impact has never been addressed. Still, studies dealing with the design of cranial implants for skull reconstruction report a higher risk of skull fracture at the interface between the skull and the implant (Tsouknidas et al. 2011; Garcia-Gonzalez et al. 2017). This raises questions about the influence of a craniotomy on the mechanical resistance of the skull against impact loadings.