CSF hydrothorax following V/P shunt surgery is a very rare complication that may cause serious respiratory distress. It is important to keep in mind that peritoneal catheter migration into the chest may or may not occur. Even ascites may not accompany CSF hydrothorax in a patient without peritoneal catheter migration.

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AIm:The objective of this study was to introduce a surgical navigation method which provides a safe, quick and effective access to cortical and subcortical tumors, along with a review of other methods in use for this purpose. mAteRIAl and methods: 53 patients have been operated using this technique. The area overlying the tumor is shaved and one half of a smoothly cut hazelnut is taped on the skin. The precise localization of the hazelnut is confirmed with MRI and then stained. After general anesthesia, the stained impression is projected firstly to the bone, dura and then cortex respectively by the Midas Rex cutting tip. Cortical landmarks surrounding the tumor's cortical projection are further confirmed with ultrasonography.Results: After removal, cortical and subcortical tumors were separately graded for efficiency. Grade 1 and 2 were accepted as precise access. Our method accordingly yielded 95.2% and 90.6% success rates for cortical and subcortical tumors respectively. ConClusIon:Considering the method's success rate along with its inexpensiveness and modest technical requirements, it is believed that this method can be of widespread use.KeywoRds: Cortical landmarks, Subcortical tumor, Cortical tumor, Tumor localization, Surgical navigation ÖZ AmAÇ: Bu çalışmanın amacı, kullanımda olan diğer metodları da gözden geçirerek, topikal işaretler yardımıyla kortikal ve subkortikal yerleşimli tümörlerde etkili, güvenli ve hızlı bir cerrahi yöntemi sunmaktır. yÖntem ve GeReÇleR: 53 hasta bu teknik kullanılarak opere edildi. Tümörün izdüşümündeki saçlı deri traş edildikten sonra düzgün şekilde yarısı kesilmiş fındık cilt üzerine yapıştırıldı. Fındığın tümör izdüşümündeki lokalizasyonu doğrulandıktan sonra alan işaretlendi. Genel anestezi altında işaretlenmiş alanın izdüşümü alınarak sırasıyla kemik ve dura, kortekse kadar Midas rex kesici uç yardımıyla işaretlendi. Tümör ve onu çevreleyen kortikal yapılar ultrasonografi yardımıyla görüldü ve doğrulandı.BulGulAR: Tümör çıkartıldıktan sonra etkinlik açısından derecelendirme yapıldı. Buna göre grade 1 ve grade 2 lokalizasyon açısından kesin doğru giriş noktası olarak kabul edildi. Bizim metodumuzun subkortikal tümörlerde %90,6 ve kortikal tümörlerde %95,2 oranında giriş noktası açısından etkin olduğu saptandı. sonuÇ: Bu yöntem ucuzluğu, basit ve kolay şekilde uygulanabilirliği nedeniyle geniş bir kullanım alanı olabilecek bir teknik gibi gözükmektedir.

Keywords:Hand tremor Microsurgery Neurosurgery Hand holding device Brain surgery Surgical equipment ARTICLE INFO ABSTRACTThe hand holding devices are generally used during the course of micro-surgical operations in neurosurgery to prevent hand tremor. Recently we designed a new instrument for holding two arms. This instrument used for stabilization of two arms especially during microsurgical operations. We used this instrument in different type of operations such as aneurysm surgery, brain tumor surgery, hypophysis surgery, pontocerebellar tumor surgery and posterior fossa surgery. The ability of the instrument in the preventing of arm tremor, and comfort of the arm during surgery was graded as bad, good and excellent in terms of the description of surgeon during microsurgical operations. This instrument was used during 20 neurosurgical operations. The capability of the instrument during microsurgical operation was found as excellent in 65% of the operations. The capability was found as good in 35% of the operation. In conclusion; this instrument holds two arms in the same time and provide unrelated moving from each others. The capability of this instrument is high in the preventing of hand tremor. This instrument may be used during microsurgical operations in neurosurgery.J. Exp. Clin. Med., 2011; 28:111-116 © 2011 OMU All rights reserved IntroductionIn the development of new surgical instruments and their practical using, brain surgery has a very special place in the history of medicine. Many surgical instruments had been developed for using in neurosurgical operations. The majority of these instruments is used the main part of surgical intervention and the others take actions to support the surgery. Design of these instruments is usually made by the neurosurgeons. An idea was developed for a better and more easily doing a part of the operation. Developed these ideas are translated into a design. Then, the design was turned into a drawing in accordance with a plan, and drawing was given to the masters and prototypes were produced. These produced prototypes are used during surgery and a much more improved during intervention, and after general production is started. This is no way that could not be reached in the brain.Yasargil (Yaşargil, 1977;Yaşargil, 1978;Yaşargil et al, 1988; Yaşargil, 1997;Yaşargil , 1999;Yaşargil, 2005;Yaşargil, 2010), Sugita (Sugita et al., 1978;Sugita et al., 1979;Sugita et al., 1980), andGilsbach (Gilsbach et al ., 1984;Gilsbach et al., 1994) such peoples are among those leading the design tool. An idea creating a new design is the searching of an answer for this question "how can I do better this operation?" Another question is "how the previously developed device is

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