Cranio-Spinal Surgery with the Ronjair®: Addendum to Air Instrument Surgery PDF
Preview Cranio-Spinal Surgery with the Ronjair®: Addendum to Air Instrument Surgery
CRANIO-SPINAL SURGERY WITH THE RONJAIR®* * an Air-Powered Rongeur ADDENDUMTO AIR INSTRUMENT SURGERY VOLUME I Springer-Verlag Berlin Heidelberg GmbH 1973 Additional information concerning these instruments and techniques is available from Hall Inter national Inc., P. O. Box 4307, Santa Barbara, California 93103/USA, Telephone (805) 969-4777, Cable: HINTL. Outside of the United States contact the 3M Company in your country. Ronjair®, patented, United States trademark Reg. No. 957382. This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically those of translation, rcprinting, re-use of illustrations, broadcasting, rc production by photocopying machine or similar means, and storage in da ta banks. Under § 54 of the German Copyright Law wherc copies are made for other than private use, a fee is payable to the publisher, the amount of the fee to be determined by agreement with the publisher. © by Springer-Verlag Berlin Heidelberg 1973. Originally published by Springer-Verlag Berlin Heidelberg New York in 1973. Library of Congress Catalog Card Number 70-132149. Offsetdruck: Julius Bcltz, Hcmsbach ISBN 978-3-662-05630-1 ISBN 978-3-662-05628-8 (eBook) DOI 10.1007/978-3-662-05628-8 Seetion VII ADDENDUM: CRANIO-SPINAL SURGERY WITH THE RONJAIR® Acknowledgernent I wish to acknowledge here, despite commercial implications, that the transformation of my concept of an air-powered bone-biter to the working model of the Ronjair® was made possible only by the open-minded reception and backing of Dr. Robert M. Hall. His people at Hall International have been courteous, helpful and receptive. Mr. lohn Bent, a pneumatic engineer, designed the Ronjair and its modi fications and attachments. I find the willingness of all the "Hall" people not only to accept suggestions for improvements, but also to seek them actively, refreshing and stimulating. Mr. Bloodhart, the medical illustrator here, needs no accolades so I will only thank hirn. N. Edalatpour, M.D., F.A.C.S. Newport Beach, California 3 Seetion VII ADDENDUM: CRANIO-SPINAL SURGERY WITH THE RONJAIR® Foreword This chapter deals with so me surgical uses of an air-powered bone-biter, Ronjair®. The to01 has been developed in response to the need to prevent hand cramping, blisters, fatigue, and consequent cIumsiness after extensive bone removal. The Instru ment, which has been in operative use since April 1971, has also proved to be more precisely controllable by the surgeon than comparable hand-powered instruments. The instrument is a new Air Instrument conceived with considerable attention, to full contral of the biting tips, to versatility and ease of use. Still, a little directed learning is essential for comfortable bone-cutting. Some hints are included in "How to use the Ronjair®, Air-Powered Rongeur" and "Technique suggestions", but it is ad visable to practice outside the operating room to get the feel of it. In aseries of presentations to so me 3,000 neurosurgeons and orthopedists in the past two years at large national meetings, it was cIear that nearly all could become adept in the use of the instrument after some 5 -10 minutes. The Ronjair® Air-Powered Rongeur was developed by Hall International Inc. with the suggestions and effort of N. Edalatpour, M.D. N. Edalatpour, M.D., F.A.C.S. Newport Beach, California 4 Seetion VII ADDENDUM: CRANIO-SPINAL SURGERY WITH THE RONJAIR® Introduction Because of the clinical and surgical significance of the air-powered bone rongeur, this text has been compiled as a guide in its use. This important surgical advance requires special placement in the Air Instrument Surgery atlases, and is arranged as an addendum to Volume I. It is our ho pe that this work will be of special interest and help to the orthopedic surgeon and neurosurgeon, for whom the instrument was designed. Santa Barbara California/USA Robert M. Hall 5 Section VII ADDENDUM: CRANIO-SPINAL SURGERY WITH THE RONJAIR® Contents How to Use the Ronjair®, Air-Powered Rongeur 8 Laminectomy A. Lumbar Laminectomy Including Foraminotomy and Facetectomy 13 B. Cervical Laminectomy 20 C. Dorsal Laminectomy 22 Craniotomy A. Posterior Fossa Craniectomy 23 B. Bilateral Parasagittal Craniotomy 27 Subnasal Transsphenoidal Approach to the Hypophysis - a Possible Use 29 Technique Suggestions 31 Equipment Guide 33 Index 37 7 Seetion VII ADDENDUM: CRANIO-SPINAL SURGERY WITH THE RONJAIR® How to Use the Ronjair®, Air-Powered Rongeur For safest use, this instrument requires the use ofboth hands. The exception, i. e. one handed use, may be where the bone to be removed is away from any neural or other vital structures, such as a spinous process. Small bites are best, filling one half to two thirds of the cups. The use of the instrument, once mastered, becomes smooth and flowing in one sweeping step. For the purposes of emphasis and learning, however, the biting action is broken down into four steps. 1. Application 01 the Stationary Blade Each biting tip has a stationary and a moving blade. It is probably best to apply the stationary blade to the bone first as this improves contro!. Insert the stationary blade of the Leksell tip into the burr hole. PuB the stationary blade against the edge of the burr hole with the left index finger. 8 How to Use the Ronjair®, Air-Powered Rongeur 2. Counter-Press ure Counter-pressure should be applied in two directions to keep the instrument tip in pi ace against the bone. The moving blade needs to bite against so me resistance, and that is wh at the counter-pressure supplies. at the tationary blad on th dgc of the bone and exert light traction. Blade oves ·orward Under Trigger Pre ure to Engage Bone onlinue Traction Trigger Finger Continue traction. Apply right lateral pressure with the left index finger. Press the trigger slowly to move the cutting blade forward and engage the bone. 9 Section VII ADDENDUM: CRANIO-SPINAL SURGERY WITH THE RONJAIR® 2. Counter-Pressure (continued) For thc down ward bit , eat the tationar blade on thc edg of the b ne and appl light traction. U c the left hand to tabiliz and direct the bladc tip. \ The leEr hand is al 0 u d to tabilizc and dircct the tip in the right lateral bite. 10
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