The Effect of Pain Reduction during Headframe Fixation for Stereotactic Radiosurgery by the Preceded Local Anesthesia under the Needle Cap Guidance

Abstract

BackgroundGamma knife radiosurgery (GKRS) has become a major alternative in the neurosurgical field. However, many patients complained of considerable discomfort during the fixation of rigid headframe. This study investigated whether our modified procedure could reduce fixation-related pain.MethodsSixty-six patients who underwent GKRS were enrolled in this study. Thirty-one patients (Group A) underwent the conventional subcutaneous infiltration technique, and 35 patients (Group B) did the modified procedure. In group A, the headframe was held in position by an assistant, and local anesthetics were injected subcutaneously using a 23-gauge spinal needle at pinning sites. Subsequently, pins were applied according to measurements based on spinal needle depth. In group B, with the frame held in position by an assistant, pin sites were marked with a surgical pen under the guidance of needle cap placed on the pin holes. The head frame was then removed, and local anesthetics were injected subcutaneously and periosteally at each marked pin site using a 26-gauge needle. The headframe was then repositioned 5 minutes after local infiltration, and pins were applied according to measurements based on spinal needle depth. To evaluate pain severity during procedures, visual analogue scale (VAS) scores were recorded during local infiltration and frame placement with pins. The pain scores of the two groups were analyzed statistically.ResultsGroup B had a significantly lower VAS score during frame placement than group A (7.26 vs. 3.61; p<0.001), and mean VAS score at local infiltration was also significantly lower in group B (4.74 vs. 3.74; p=0.008).ConclusionPatients in group B experienced significantly less pain than those in group A during pin placement. Pre-fixation time advanced local anesthesia might reduce pain during stereotactic procedures, and the use of a 26-gauge needle appeared in less pain during local infiltration.

More Than Just the Level of Consciousness: Comparing Asleep and Awake Deep Brain Stimulation

“…Nonetheless, >95% of awake patients in both this and in another patient‐reported outcome study were satisfied with the therapy, would choose to undergo (awake) DBS again, and would recommend DBS to others 18,19 . Severe pain during frame placement is largely preventable by giving local anesthetics time to take effect 20 . Discomfort related to prolonged OFF time has lessened, now that most awake surgeries are completed within 3 hours and conscious sedation can be used up to the moment of MER/test stimulation.…”

“…18,19 Severe pain during frame placement is largely preventable by giving local anesthetics time to take effect. 20 Discomfort related to prolonged OFF time has lessened, now that most awake surgeries are completed within 3 hours and conscious sedation can be used up to the moment of MER/test stimulation. In addition, the routine discontinuation of stopping dopaminergics 12 hours before surgery is a practice that needs to be reviewed.…”

Optimal mask fixation method for frameless radiosurgery with Leksell Gamma Knife IconTM

“… 1 In GKRS, a head frame is rigidly attached to the skull of a patient to establish a coordination system and enable precise positioning. 2 Fixation of the frame on the skull is crucial in the LGK Perfexion TM . However, most patients experience considerable discomfort during this process.…”

“…However, most patients experience considerable discomfort during this process. 2 Common reasons for the denial of frame fixation by patients include anxiety, intolerance against local anesthetics, or lack of stability of the skull. 3 With the advent of frameless radiosurgery options in the LGK Icon TM , a thermoplastic mask has been adopted for immobilization as it does not require an invasive frame.…”

“…The Leksell Gamma Knife (LGK) Icon TM was introduced in 2016 as an updated version of the existing the LGK Perfexion TM model 1 . In GKRS, a head frame is rigidly attached to the skull of a patient to establish a coordination system and enable precise positioning 2 . Fixation of the frame on the skull is crucial in the LGK Perfexion TM .…”