Admonishment # 1538. On the proper neurosurgical use of rigid rod lens endoscopes in the topographically exact localizing of lesions during keyhole craniotomies.
If I may for a few moments address the neurosurgeons who might not be aware of recent advances that could boost or even save their practices: Removing the guesswork from brain microsurgery has assumed paramount importance in this age of skyrocketing malpractice insurance premiums and catastrophic jury awards. If you are still performing traditional keyhole craniotomies, hampered by inadequate illumination at operating depth and by severely restricted angle of view through the cranial aperture, you might as well be extracting BBs with a boat paddle. Now indicated is the advance in endoscope-facilitated microsurgery that optimizes diagnostic imaging of objects and minimizes patient traumatization. The exclusive use of the optically superior rigid lens scopes also affords optimal maneuverability. From the headholder a mechanical arm secures the endoscope in its desired position. The shaft of the endoscope is manipulated through the surgical microscope to provide extensive and detailed lesion-imaging complimentary to that simultaneously derived through the microscope. The two images may be viewed separately or superimposed using a variety of transmission/projection options, permitting an unprecedented specificity and comprehensiveness in diagnostic and surgical performance. Case law and professional code generally hold the physician to a standard of care that requires embracing readily-implemented technological and procedural improvements. Therefore the proper intraoperative endoscope-microscope technique might well keep the legal-process servers at bay, or at least deflect them onto your colleagues in the lesser surgical disciplines.
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