1182. Postoperative countermeasure against the operative 10-0 needle which has been lost during the STA-MCA bypass surgery

Authors: Katsuhiko Maruichi, MD; Souichiro Takamiya; Shunsuke Terasaka; Sadao Kaneko (Sapporo, Japan)

 [Purpose] The intraoperative needle loss is an accident that we surgeon must certainly avoid. We can recognize the 4-0 needles easily and there is not so that we leave them in the surgical field. However we may sometimes have difficulty in confirming 10-0 needles under the microscope. We experienced two cases that we lost 10-0 needle in operation, and identified and removed it based on postoperative CT/MRI image. We report about future prevention policies.

 [Object] From April, 2012 to June, 2018, we perform 1435 craniotomy surgery and perform 51 bypass operations above all. Of these, in two cases that the loss of the needle in the operative field was doubted during operation, we could point out the needles with postoperative CT/MRI image. Subsequently removal surgeries were done for both patients, and there was not the new complication associated with the residual needles.

[Consideration, Conclusions] On the bypass surgery, we keep the following things in mind every time. Make the operative field clear basically. Spread out the gel form on the surface around the bypass field for preventing to damage the brain and to lose needles. Every loss of the needle occurs after reopening the bypass flow.  Therefore we think that it is related to the situation that blood appears in the operative field, being upset mentally, the left thread with needle is short. It is occasionally impossible to find needles although we make an effort looking for a needle during an operation. However, when we cannot completely deny existence in the skull in operation, we strongly doubt the existence and it is necessary to react as promptly as possible so that secondary complication does not occur.