Instrumentation for the operating room 2016

90-4 Enlarged tip: Fogarty stealth     
applicator forceps.

90-5 Left to right, top to bottom: 1
Bard-Parker knife handle, #4; Bard-
Parker knife handle, #7; 2 Adson
forceps, 1 × 2 teeth, 4¾ inch; 2 fixation
forceps, 7 × 8 teeth, 6 inch; 1 Baker tis-
sue forceps, 1 × 2 teeth, serrated, 7½
inch; 1 DeBakey-Diethrich coronary
artery forceps, 1.0-mm tip, 9½ inch;
1 DeBakey tissue forceps, 2-mm tip,
9½ inch; 1 Russian forceps, 10 inch; 1
DeBakey vascular forceps, angled, 9½
inch; 1 Backhaus towel forceps, small;
1 Backhaus towel forceps, large; 1
Lorna towel forceps, nonperforating,
5¼ inch.
90-6 Left to right: 1 Bandage scissor;
1 Pemco suction tip; 1 Yankauer suc-
tion tip; 1 Codman wire cutter; 2 Greene
retractors, 8½ inch; 2 eyed obturators
(stylet) for Rumel tourniquets, 11½ inch;
1 Penfield dissector, #4; 1 myocardial
dilator, 5¾ inch; and 1 Finochietto rib
spreader, pediatric.

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 90-7 Enlarged tip: Eyed obturator
(stylet) for Rumel tourniquet.

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CHAPTER 91

Open Heart Microinstruments

Open heart microinstrumentation is used for coronary artery bypass grafting. These deli- Additional images are available at:
cate instruments allow the surgeon to handle very fine needles and work in very small areas evolve.elsevier.com/Tighe/instrumentation
of the heart.

91-1 Top, left to right: 1 Frazier 
suction, 7 Fr, 7½ inch; 1 Frazier suction
stylet; 2 Parsonnet epicardial retractors,
2 inch, 1½ inch, 1¼ inch. Bottom, left to
right: 1 Beaver knife handle, round,
6 inch; 1 Prince-Metzenbaum scissors;
1 Strully scissors, 8 inch; 1 microvas-
cular scissors, angled, 120 degrees,
7 inch; 1 microvascular scissors,
angled, 25 degrees, 7 inch; 1 Weary
nerve hook, fine; 3 coronary artery
probes, 1.0 mm, 1.5 mm, 2.0 mm; 1 micro
forceps, titanium 0.5 mm tip, 8½ inch;
1 micro forceps, titanium-toothed,
0.5-mm tip, 8¼ inch; 1 Castroviejo
micro needle holder, titanium, 8¼ inch;
1 Castroviejo micro needle holder,
titanium, 7¼ inch; 1 Jacobson needle
holder, titanium, fine, 8½ inch.

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 91-2 Enlarged tips: A, Microvascular A BC
scissors, angled, 120 degrees, 7 inch; E
B, microvascular scissors, angled,
25 degrees, 7 inch; C, 3 coronary artery
probes (Garrett dilators), 1.0 mm,
1.5 mm, 2.0 mm; D, Parsonnet epicardial
retractor, 3 × 3 sharp prongs, 1½ inch;
E, Strully scissors.

D

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CHAPTER 92

Sternal Saws and Sternum Knife

The sternal knife and sternal saws are used to expose the pericardium and the heart. The Additional images are available at:
incision is made through the skin, subcutaneous tissue, and muscle to expose the sternum. evolve.elsevier.com/Tighe/instrumentation
A sternotomy is then performed.

92-1 Left to right: 1 Stryker hand 
piece with battery separate; 1 blade;
1 Stryker sternal saw attachment with
safety guard.

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92-2 Left to right: Power cord; Hall   
sternal saw. Right, top to bottom:
1 Saw blade; 1 saw guide; 1 wrench.
92-3 Surgeons’ preference instead
of sternal saw. Top to bottom: Lebsche
sternum knife and mallet.

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CHAPTER 93

Open Heart Extras

Open heart extras include internal defibrillator paddles, sternal plating systems, and beating Additional images are available at:
heart retractors and stabilizers. Internal defibrillator paddles are used to reverse fibrillation evolve.elsevier.com/Tighe/instrumentation
and initiate cardiac contractions. Sternal plating systems are used to reapproximate and fix-
ate the sternum after a sternotomy. Beating heart retractors attach to the sternal retractor
proximally, and the stabilizers attach to the heart to immobilize the coronary artery to be
grafted. The stabilizer will compress or use suction on the tissue around the arteriotomy to
immobilize the anastomosis site.

 93-1 Left to right: 1 Ankeney sternal
retractor; 1 Himmelstein sternal
retractor.

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93-2 Morse sternal retractor.
  
AB
93-3 Left to right: A, Horizon clip appliers, 2 small, 2 medium; B, enlarged tips of Horizon clip appliers,
small, medium.

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93-4 Internal defibrillator paddles  
and handles with cable.
93-5 Octopus retractor with dispos-
able tissue stabilizers.

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  93-6 Top, left to right: 1 Sternal
crimper; 1 tensioning handle. Bottom,
left to right: 1 Crimp passer; 3 sternal
cables with needles attached and
3 crimpers in the middle; cable cutter.

93-7 Top, left to right: 2 SternaLock
power driver units (cords not included);
1 bone reduction forceps; plate and
wire cutter. Bottom, left to right:
1 Tray containing plates, screws, and
blades; 1 Beuse plate-holding forceps;
1 SternaLock screw sizer; 1 plate-
holding wand, 2.4 mm; 1 ratcheting
screwdriver with SternaLock blade
attached; 1 ratcheting screwdriver;
1 SternaLock blade; 1 double-action
rongeur, small.

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 93-8 Pericardial window. Top, left to
right: 1 Bandage scissors; 1 double-
action ronguer, small; 1 Richardson
retractor, narrow; 1 Army Navy retrac-
tor. Bottom, left to right: 1 Bard-Parker
knife handle, #3; 1 Bard-Parker knife
handle, #7; 2 Adson forceps, 1 × 2 teeth;
1 fixation forceps, 7 × 8, 6 inch; 1 Baker
tissue forceps, 1 × 2, serrated 7½ inch;
1 Russian forceps, 10 inch; 1 atraugrip
forceps, 9½ inch. On stringer:
4 Halsted mosquito clamps, curved,
5 inch; 4 Crile hemostatic forceps,
curved, 6½ inch (1 hidden); 2 Boettcher
tonsil clamps, curved, 7½ inch; 2 Allis
clamps; 2 Ochsner-Kocher, 8 inch
(1 hidden); 1 sponge forceps; 1 Mayo-
Péan hemostatic forceps; 2 Mayo-
Hegar needle holders, 7¼ inch; 1 Mayo
dissecting scissors, straight, 6¾ inch;
1 Vital Metzenbaum scissors; 1 Nelson
scissors, curved, 9 inch; 1 4-prong
rake, sharp, 8½ inch.

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CHAPTER 94

Cardiovascular Instruments

Additional images are available at: Cardiovascular instruments are used on the vessels because, when clamped on them, the
evolve.elsevier.com/Tighe/instrumentation instrument tips do not damage the vessels.

These instruments needed for the procedure are often found within open heart sets.

94-1 Left to right: A, Cooley clamp, 
angled jaw, straight shank, 5¼ inch,
front view and tip; B, DeBakey bulldog
clamp, ring handle, 45-degree angle,
4¾ inch, front view and tip; C, DeBakey
peripheral vascular clamp, angular,
7 inch, front view and tip.

AB C

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94-2 Left to right: A, Fogarty clamp-   
applying forceps, angled, front view
and tip; B, Fogarty clamp-applying
forceps, straight, front view, and tip;
C, renal artery clamp, 7¼ inch, front
view and tip.
AB C
94-3 Left to right: A, Potts-Smith
tissue forceps, Carb-Bite tip, front
view and tip; B, Lee bronchus clamp,
9¼ inch, front view and tip; C, Cooley
coarctation clamp, straight handle,
8¾ inch, front view and tip.
AB C

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94-4 Left to right: 1 DeBakey aortic     
exclusion clamp, acute S-shape,
medium, 7¼ inch; 1 DeBakey aortic
exclusion clamp, acute S-shape, long;
1 DeBakey multipurpose vascular
clamp, obtuse angle, 60 degrees,
8¼ inch; 1 Semb ligature-carrying
forceps, 9 inch.
94-5 Top: 1 Andrews-Pynchon suc-
tion tube. Bottom, left to right: 1 Metal
ruler, 6 inch; 1 Freer double-ended
elevator; 1 Penfield dissector, single-
ended, #4; 1 Hoen nerve hook; 1 Adson
hemostatic forceps, angled, fine tip;
2 Ryder needle holders, 7 inch, fine tip.

94-6 Left to right: Tips: A, DeBakey A B
aortic exclusion clamp, S-shape;
B, Hoen nerve hook, straight.

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CHAPTER 95

Open Heart Valve Extras

Instrumentation needed for a heart valve repair or replacement includes a basic open heart Additional images are available at:
set and a valve instrument set. evolve.elsevier.com/Tighe/instrumentation

95-1 Left to right: 6 Backhaus towel   
forceps, small; 1 Providence Hospital
hemostatic forceps; 2 Ayers needle
holders, 11 inch; 2 Heaney needle
holders; 2 tonsil hemostatic forceps;
2 tonsil hemostatic forceps, long;
2 Allis tissue forceps, long; 1 Allis
tissue forceps, long, curved. Right, top
to bottom: 1 Pituitary rongeur, straight
bite, 7 inch; 1 pituitary rongeur, upbite,
7 inch; 1 pituitary rongeur, downbite,
7 inch.

95-2 Left to right: 3 Pituitary rongeur
tips: straight bite, downbite, upbite.

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  95-3 Left to right: 1 Bard-Parker knife
handle #3, long; 1 Cushing-Brown
tissue forceps with teeth (9 × 9);
1 Cushing tissue forceps with teeth
(1 × 2); 2 Teflon Bardic plugs; 3 leaflet
retractors, 2 side view and 1 front
view; 1 grafting suction tube.

95-4 Enlarged tips: A, Leaflet retractor; A B
B, Cushing-Brown tissue forceps with D
teeth (9 × 9); C, Heaney needle holder;
D, Allis tissue forceps, curved.

C

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CHAPTER 96

Return Open Heart Set

A return open heart set is used when an unexpected complication (e.g., hemorrhage) occurs Additional images are available at:
following an open heart procedure. Possible equipment needed for the procedure includes evolve.elsevier.com/Tighe/instrumentation
open heart instrumentation including retractors and a re-open sternal saw or sternal plating
removal instrumentation.

96-1 Top left: 3 Bard-Parker knife  
handles: #7, #4, and #3. Bottom, left to
right: 2 Hayes Martin tissue forceps
with multiteeth, front view and side
view; 1 Ferris Smith tissue forceps;
1 Cushing tissue forceps with teeth
(1 × 2), 7 inch; 2 Reul dressing forceps,
front view and side view; 2 DeBakey
vascular atraugrip tissue forceps, long,
front view and side view; 2 Russian
tissue forceps, long, front view and
side view.

96-2 Left to right: 8 Paper drape clips;
6 Crile hemostatic forceps, 6½ inch; 12
Ochsner hemostatic forceps, medium
jaw; 2 Ochsner hemostatic forceps,
long jaw; 2 Westphal hemostatic
forceps, short; 4 tonsil hemostatic
forceps; 2 Mayo-Péan hemostatic
forceps, long, curved; 1 Adson hemo-
static forceps, long; 1 Foerster sponge
forceps; 1 Crile-Wood needle holder,
7 inch; 2 Jarit sternal needle holders,
7 inch; 2 Crile-Wood needle holders,
8 inch; 1 Ayers needle holder, 8 inch;
2 Yankauer suction tubes with tips.

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96-3 Left to right: 2 Volkmann retrac-   
tors, 4 prong, dull, front view and side
view; 1 Richardson retractor, small;
1 Ochsner malleable retractor, medium;
2 Army Navy retractors, front view and
side view; 1 wire cutter, heavy.
96-4 Top, left to right: 1 Wire cutter,
small; 1 hemoclip cartridge base.
Bottom, left to right: 2 Mayo dissecting
scissors, straight; 1 Mayo dissecting
scissors, curved; 1 Metzenbaum scis-
sors, 7 inch; 2 Weck EZ Load hemoclip
appliers (the new version is the Weck
Horizon hemoclip).

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 96-5 Left to right: 1 Lambert-Kay aor-
tic clamp; 1 DeBakey multipurpose
vascular clamp, obtuse angle,
60 degrees; 1 Beck aorta clamp; 1 Jarit
microsurgical needle holder with lock,
7 inch; 2 eyed obturators (stylets) for
Rumel tourniquet.

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CHAPTER 97

Vein Retrieval Instruments

Additional images are available at: Vein retrieval instruments are used when veins are taken from one part of the body (usually
evolve.elsevier.com/Tighe/instrumentation the legs or arms) and used for a bypass procedure on the heart. Leg procedures for harvest-
ing the greater saphenous vein can be performed as an open procedure or as a minimally
invasive procedure. A vein harvest kit can be used for the minimally invasive procedure.

97-1 Top, left to right: 2 DeBakey 
tissue forceps, 6 inch; 2 Adson forceps,
1 × 2, 4¾ inch; 1 weitlaner retractor,
3 × 4 inch, sharp, 6½ inch; 1 Bard-Parker
knife handle, #3. Bottom, left to right,
on stringer: 2 Metzenbaum scissors,
curved, 5½ inch; 1 Vital Metzenbaum
scissors; 1 Mayo dissecting scissors,
straight, 6¾ inch; 1 tenotomy scissors,
6 inch (hidden); 2 Mayo-Hegar needle
holders, 7¼ inch; 2 tubing clamps (for
tubing with OD, 5⁄8 inch); 1 Boettcher
tonsil clamp, curved, 7½ inch; 1 Lahey
gall duct forceps, 7½ inch; 6 Halsted
mosquito clamps, curved, 5 inch; 10
mosquito clamps, fine, (1 hidden);
1 Backhaus towel forceps, 3½ inch;
1 Senn retractor, sharp, 6¾ inch; 1 Army
Navy retractor; 1 Richardson retractor,
1 × ¾ inch; 1 Castroviejo delicate touch
micro needle holder, straight, locking,
75⁄8 inch; 1 hemoclip applier, small;
1 hemoclip applier, medium.

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97-2 Top to bottom: 1 Bipolar cord;   
1 VasoView harvesting cannula;
1 BiSector bipolar ligating forceps
(connects to bipolar cord); 1 Olympus
5-mm 0-degree lens; 1 short port, blunt
tip; 1 sealing balloon; 1 20-cc syringe;
1 dissection tip (connects on harvest-
ing cannula).
97-3 Top to bottom: Olympus 1 chip
camera and light cord.

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­ ­ CHAPTER 98

Radial Artery Harvest Set

Additional images are available at: Radial artery harvest instrumentation is used when the radial artery is harvested from the
evolve.elsevier.com/Tighe/instrumentation arm and used for a coronary artery bypass graft procedure.
98-1 Left to right: 1 Andrews-

Pynchon suction tube; 1 Bard-Parker
knife handle #3; 2 DeBakey vascular
atraugrip tissue forceps, medium.
Top: 2 Brawley scleral wound retrac-
tors. Bottom: 1 Weitlaner retractor;
1 cerebellar retractor, small. On instru-
ment stringer: 4 Halsted microline
artery forceps; 2 Adson hemostatic
forceps, fine, right-angle; 2 Horizon
clip appliers, small; 2 Metzenbaum
dissecting scissors, 7 inch, 5 inch;
1 Crile-Wood needle holder, 5 inch
(hidden).

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UNIT TEN: NEUROSURGERY CHAPTER 99

Craniotomy

Craniotomy is an incision made in the head through the skull that allows the performance Additional images are available at:
of surgery on the brain for tumor resection, vascular defect repair, or traumatic injury. evolve.elsevier.com/Tighe/instrumentation

Possible equipment needed for the procedure includes:
1. Midas Rex drill with craniotome blades, used to open the skull.
2. A Cavitron ultrasonic surgical aspirator (CUSA), used for tumor removal.
3. An operating microscope, used for visualization.
4. An electrosurgical unit, used for hemostasis.
5. A neuroplating set of screws and plates, used to repair fractures and to replace the

bone flap.
6. Burr-hole covers, used to cover the burr holes.

A brief description of the procedure follows:
1. Local injection at incision.
2. Incision of skin and galea with skin blade and hemostasis with cautery.
3. Remove scalp from the periosteum with either cautery or a periosteal elevator.
4. Burr holes are created using a high-speed drill with a perforator attachment.
5. Hemostasis of the burr holes use bone wax, followed by separation of the dura using a

Penfield dissector.
6. To create a bone flap, the burr holes are connected with a craniotome attachment to

the high-speed drill. The bone flap is removed using a Penfield dissector.
7. The dura is preserved by cutting with dura or Metzenbaum scissors and tacking up

the dura with sutures to the skull.
8. Hemostasis of brain tissue is achieved using bipolar forceps or irrigating bipolar for-

ceps. Hemostatic agents such as Thrombin and Gelfoam may be used.
9. Exposure to deep brain tissue is achieved by using a Leyla or Greenberg retractor.

Superficial work on the surface or skull may be limited to weitlaner retractors or skin
hooks attached to the drape.
10. Tumor resection or dissection of brain tissue may involve microsurgical instruments
such as micro Penfield dissectors, scissors, and Rhoton dissectors. An ultrasonic irri-
gator/aspirator may be used in larger tumors. All of these instruments will be utilized
under a microscope.
11. Craniotomies for aneurysms or arteriovenous malformations utilize specialized clips
with appliers to prevent the aneurysm from rupturing.
12. Following hemostasis, the dura is closed and the skull flap replaced using titanium
screws and plates to secure the bone flap in place. If swelling of brain tissue is too
great to replace the bone flap, the patient’s bone flap is cryopreserved until brain
swelling subsides. If the skull flap is not intact, methyl methacrylate can be used in
conjunction with titanium mesh for a skull flap substitute, or an artificial skull flap
using a poly-ether ether ketone (PEEK) plastic can be constructed and applied in a
separate cranioplasty procedure.

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99-1 Top to bottom, left to right:   
2 Bard-Parker knife handles #7; 2 Bard-
Parker knife handles #3; 1 Cushing
bipolar cautery forceps, microtip, insu-
lated bayonet shaft; 1 Adson hypophy-
seal forceps, bayonet shaft, round-cup
tip; 1 Gerald dressing forceps, bayonet
shaft, narrow tips, serrated; 1 Adson
dressing forceps, bayonet shaft.
Bottom, left to right: 2 Adson tissue
forceps with teeth (1 × 2), front view
and side view; 2 Gillies tissue forceps
with teeth (1 × 2), front view and side
view; 2 DeBakey vascular atraugrip
tissue forceps, medium, front view
and side view; 2 Gerald tissue forceps
with teeth (1 × 2), front view and side
view; 2 Cushing tissue forceps with
teeth (1 × 2), front view and side view;
2 Cushing tissue forceps with teeth
(1 × 2), Gutsch handle, front view and
side view.

99-2 Left to right: Enlarged tips: A B C
A, Gillies tissue forceps with teeth E F
(1 × 2); B, Gerald tissue forceps with
teeth (1 × 2); C, Adson dressing forceps,
bayonet shaft; D, Gerald dressing
forceps, bayonet shaft, narrow tips,
serrated; E, Adson hypophyseal
forceps, bayonet shaft, round-cup tip;
F, Cushing bipolar cautery forceps,
microtip, insulated bayonet shaft.

D

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99-3 Top to bottom, left to right:     
1 Mayo dissecting scissors, straight;
1 Metzenbaum dissecting scissors,
7 inch; 1 Metzenbaum dissecting scis-
sors, 5 inch; 1 Strully scissors, 8 inch;
1 Adson ganglion scissors, straight,
6¼ inch. Bottom, left to right: 2 Raney
scalp clip appliers; 3 paper drape
clips; 2 Ligaclip appliers, small/short;
4 Backhaus towel forceps; 6 Back-
haus towel forceps, small; 6 Cairns
hemostatic forceps; 6 Crile hemostatic
forceps, curved; 2 Allis tissue forceps;
2 Ochsner tissue forceps; 2 Ligaclip
appliers, medium/medium; 1 Westphal
hemostatic forceps; 1 Adson hemo-
static forceps, fine tip; 2 DeBakey
needle holders, 7 inch; 2 Webster
needle holders, 6 inch; 2 Crile-Wood
needle holders, 7 inch.

A B CD 99-4 Left to right: Tips: A, Strully
scissors; B, Adson ganglion scissors,
straight; C, Samii scissors (tip); D, dura
scissor (tip).

99-5 Top to bottom, left to right:
1 Dura scissors, 1 Samii scissors,
3 micro suctions.

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99-6 Top, left to right: 6 Frazier suc-   
tion tubes, sizes 6 to 12. Bottom, left
to right: 5 Silicone spatula retractors,
6, 9, 13, 16, and 22 mm; 1 metal ruler;
5 Davis brain spatulas, various widths.
99-7 Top to bottom, left to right:
5 Ventricular needles with stylets,
3½ inch, 12, 14, 16, 18, and 20 gauge;
1 10-cc glass syringe (2 parts). Bottom,
left to right: 2 Jarit crossing-action
retractors, 4 inch, blunt prongs; 2 Raney
scalp clip appliers, side view; 2 vein
retractors, side view and front view.

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99-8 Left to right: 1 Acra scalp clip   
applier, unloaded; 1 scalp clip car-
tridge; 1 scalp clip; 1 Acra scalp clip
applier, loaded.
99-9 Left to right: 1 Dura hook;
1 Woodson dura separator and packer,
7 inch; 1 Brun oval-cup curette, an-
gled, 3-0; 3 Penfield dissectors, #1, #2,
and #3, 7¼ inch; 1 Penfield dissector,
#4, 8 inch; 1 Adson dura hook, sharp;
1 nerve hook, dull, flat; 1 Freer elevator;
1 Kistner probe; 1 Adson periosteal
elevator (joker), curved, blunt, 6¾ inch;
1 Hoen periosteal elevator, narrow;
1 Hoen periosteal elevator, wide.

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AB CD
EF

GHI J

KL M

 99-10 Left to right: Enlarged tips: A, Frazier dura hook, 5 inch; B and C, Woodson dura separator and
packer, double-ended, 7 inch; B, packer end; C, separator end; D, Brun oval-cup curette, angled, 3-0;
E and F, Penfield dissectors, #1, #2, and #3; E, side view, dissector end; F, front view, spoon and wax-packer
end; G and H, Penfield dissector #4, 8 inch; G, side view; H, front view; I, Adson dura hook, sharp, 8 inch;
J and K, Freer double-ended elevator, 7¾ inch; J, side view; K, front view; L and M, Adson periosteal
elevator (joker), curved, blunt, 6¾ inch; L, side view; M, front view.

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 99-11 Top to bottom: 1 Gigli blade
with attached saw handles; 1 passer.

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  CHAPTER 100

Neurologic Bone Pan Instruments

Additional images are available at: Bone instrumentation consists of instrumentation to be used on bone and tougher tissues.
evolve.elsevier.com/Tighe/instrumentation It may also consist of handheld and self-retaining retractors.

100-1 Top, left to right: 1 Adson
rongeur; 1 cup rongeur, 6 mm. Bottom,
left to right: 1 Ruskin double-action
rongeur, small, straight; 1 Ruskin
double-action rongeur, small, curved;
1 Leksell rongeur, side-curved;
1 Leksell rongeur, curved; 1 Smith-
Petersen laminectomy rongeur.

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A 100-2 A, Top: 1 Kerrison rongeur,   
45-degree, 1 mm. Bottom, left to right:
4 Kerrison rongeurs, 45-degree:
2, 3, 4, and 5 mm. B, Left to right: Tips:
5 Kerrison rongeurs, 45-degree, 1, 2, 3, 4,
and 5 mm.

B
100-3 Left to right: 2 Senn retrac-
tors, side view and front view; 2 Army
Navy retractors, side view and front
view; 2 Green goiter retractors, side
view and front view; 1 metal mallet.
Top to bottom, left to right: 2 weitlaner
retractors, baby, angled; 2 weitlaner
retractors, small, angled.

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­­ 100-4 Left to right: 2 Weitlaner
retractors, small; 2 weitlaner
retractors, medium; 2 Adson
retractors, sharp, medium, angled.

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CHAPTER 101

Neurologic Retractors

Neurologic retractors generally are flexible and have numerous attachments in various sizes Additional images are available at:
allowing the retractor to be positioned to gain the best exposure.
evolve.elsevier.com/Tighe/instrumentation

101-1 Left to right: 1 Leyla holding 
arm, angled; 1 Leyla ball and socket
joint clamp; 1 Leyla holding arm,
straight. (Flexible Lone Star retractor
hooks in Figure 31-8 may be attached
to Leyla retractor for retraction.)

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101-2 Tapered malleable brain   
retractors that are often used with the
Leyla retractor.
101-3 Top to bottom, left to right:
Greenberg Universal retractor: hand
rest with flexible bar to clamp; 2 pri-
mary bars; 1 long retractor arm. Right
side: 4 Secondary bars.

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 101-4 Greenberg Universal retractor,
continued: 2 flexible retractor bars,
long. Middle, top to bottom: 8 Metal
brain spatulas, various widths;
10 plastic-coated blades, various widths.
Right: 2 Flexible retractor bars, short.

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 CHAPTER 102

Medtronic Midas Rex Electric Drill

Additional images are available at: The Midas Rex drill has numerous attachments to cut and drill bone as needed.
evolve.elsevier.com/Tighe/instrumentation

102-1 Top: Midas Rex cord and hand
piece. Bottom, left to right: Midas Rex
hand piece attachments: 1 perforator;
8 B small bone attachment; 9 M large
bone attachment; AM-14 large bone
attachment; F1 B5 footed attachment;
TT 12 telescoping attachment; AT 10
telescoping attachment.

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102-2 3 Midas tips.   
102-3 1 Midas perforator tip.

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CHAPTER 103

Rhoton Neurologic Microinstrument Set

Additional images are available at: Rhoton microinstruments are dissection instruments used in aneurysms, tumors, and
evolve.elsevier.com/Tighe/instrumentation acoustic neuroma resections. Each instrument is made of light-weight titanium for balance
and durability. These instruments are often referred to by number.

103-1 A, Left to right: 2 Beaver  A
blade handles with insert, knurled;
1 microscissors, straight; 1 microscis-
sors, curved; 1 microneedle holder,
straight; 1 microneedle holder, curved;
1 micrograsping forceps. B, Left to
right: Tips: Microscissors, straight;
microscissors, curved; microneedle
holder, straight; microneedle holder,
curved; micrograsping forceps.

B

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    103-2 Rhoton dissectors #1 to #19 in
numbered rack for identification.

103-3 Tips: 3 Round microdissec-
tors: 1, 2, and 3 mm; 2 general-purpose
microelevators: curved and angled;
3 spatula microdissectors: small,
medium, and large; 2 microhooks,
90-degree: semisharp and blunt.

103-4 Tips: Microhook, 45-degree,
semisharp; microneedle point,
straight; 2 microcurettes: straight
and angled; 4 ball microdissectors:
straight; 40-degree, 4 mm; 90-degree,
5 mm; 40-degree, 8 mm; 1 arachnoid
microknife.

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103-5 Left to right: Enlarged tips:       
3 Round microdissectors: 1, 2, and
3 mm; 1 general-purpose microeleva-
tor, angled.

103-6 Left to right: Enlarged tips:
4 Spatula microdissectors: large, small,
medium, and medium straight.
103-7 Left to right: Enlarged tips:
2 Microhooks, 90 degrees: Semisharp
and blunt; 1 general purpose microel-
evator, curved; 1 microneedle point,
straight.
103-8 Left to right: Enlarged tips:
2 Microcurettes: straight and angled;
1 ball microdissector, 90-degree angle
tip.

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CHAPTER 104

Ultrasonic Handpieces

Ultrasonic aspirators use ultrasound technology to dissect and aspirate targeted tissues with Additional images are available at:
minimal transmitted movement to adjacent normal neural structures and with minimal evolve.elsevier.com/Tighe/instrumentation
blood loss.

104-1 Top to bottom, left to right: 1 
Selector 24 KHz flue; 1 Selector metal
extension, angled; 1 Selector black
plastic shroud, angled; 1 Selector
hand piece with cord; 1 hand piece
support with wrench.

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CHAPTER 105

Neurologic Shunt Instruments

Additional images are available at: A shunt is a tube or device implanted in the body to redirect body fluid from one cavity or
evolve.elsevier.com/Tighe/instrumentation vessel to another. Generally, a neurological shunt redirects cerebrospinal fluid from the ven-
tricles in the brain to another cavity, often the abdomen. A valve and catheter combination
is placed. The neurosurgeon will place the valve and catheters, and a general surgeon may
assist with placement of a catheter into the abdomen laparoscopically.

105-1 Top, left to right: 1 Frazier 
suction, angled 10 Fr; 1 Green bipolar
bayonet forceps, 1.5 mm × 8.5 inch; 1
Kerrison ronguer, 2 mm, 7 inch. Bot-
tom, left to right: 1 Bard-Parker knife
handle, #3; 1 Bard-Parker knife handle,
#7; 1 DeBakey vascular tissue forceps,
7¾ inch; 1 bayonet forceps, Gutsch
handle, 7¾ inch; 1 Crile forceps,
curved, 6¼ inch; 1 Heiss skin retrac-
tor, blunt, 4 × 4 prongs; 1 weitlaner
retractor, sharp; 1 Penfield dissector,
#1; 1 curette, straight, 3-0; 1 Penfield
dissector, #4; 1 Codman cranial perfo-
rator; 1 Midas Rex perforator driver; 1
Péan clamp, curved, 10 inch.

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 105-2 Shunt passer.

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CHAPTER 106

MINOP Neuroendoscopy Set

Additional images are available at: MINOP is a neuroendoscopy system used primarily for intraventricular indications,
evolve.elsevier.com/Tighe/instrumentation although it can be used for endoscope-assisted neurosurgery. It consists of endoscopes,
trocars, instruments, and electrodes for diagnostic and therapeutic purposes.

106-1 Top to bottom: 2 Guidewires; 
1 endoscope lens, 0 degrees ×
2.7 mm; 1 endoscope lens, 30 degrees ×
2.7 mm; 1 sheath, 6 mm; 1 sheath,
4.6 mm; 1 trocar, 4.6 mm; 1 trocar, 6 mm;
1 sheath (no working channel), 3.2 mm;
1 trocar, 3.2 mm.

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106-2 Top to bottom in rack: 2 Micro-   
scissors, B/B, S/S; 1 biopsy forceps;
1 fixation and dissecting forceps;
1 surgical microforceps; 2 suction tips.
106-3 Left to right: 1 Monopolar cord;
1 hook electrode; 1 needle electrode;
3 hook electrodes; 1 blunt electrode. Top
to bottom: 1 Silastic tubing; in center of
tubing: 2 Light cord adaptors; 1 bipolar
cord. Right: 1 Bipolar fork electrode.

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CHAPTER 107

Intracranial Pressure Monitoring Tray

Additional images are available at: An Intracranial Pressure (ICP) monitoring tray contains equipment used to monitor intra-
evolve.elsevier.com/Tighe/instrumentation cranial pressure. The monitoring device may be a fiber optic catheter or a bolt-shaped
sensor that connects to a machine that measures ICP. A disposable cranial access kit is
generally used to place the monitor, as this procedure is most frequently performed at the
bedside or in the emergency department.

107-1 All contents of the Codman 
cranial access kit are disposable. Top,
left to right: 1 Codman cranial hand
crank drill; 2 medicine cups; 1 drill bit
with stop, 2.7 mm; 1 Allen wrench;
1 drill bit with stop, 5.8 mm. Tray con-
tents: 2 25-gauge Needles;
1 18-gauge needle; 1 spinal needle;
1 ventricular needle; 1 culture tube
with screw cap; 1 razor; 2 syringes,
12 cc. Bottom, left to right: 1 #15 Scalpel;
1 #11 scalpel; 1 ruler; 1 skin marker;
1 suture scissors, sharp; 1 Adson
forceps with teeth; 1 Adson forceps,
smooth; 1 Heiss skin retractor, blunt,
4 × 4 prongs; 2 mosquito forceps,
curved; 1 needle holder.

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CHAPTER 108

Yasargil Aneurysm Clips with Appliers

Yasargil aneurysm clips are used on either side of an aneurysm, which is a localized dilation Additional images are available at:
of the wall of a blood vessel.
evolve.elsevier.com/Tighe/instrumentation

108-1 Aneurysm clip trays and 2 non- 
locking aneurysm clip appliers.

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CHAPTER 109

Synthes Low-Profile Cranial Plating Set

Additional images are available at: At closure, the skull flap is replaced using titanium screws and plates to secure the bone flap
evolve.elsevier.com/Tighe/instrumentation in place. If swelling of brain tissue is too great to replace the bone flap, the patient’s bone
flap is cryopreserved until brain swelling subsides. If the skull flap is not intact, methyl
methacrylate can be used in conjunction with titanium mesh for a skull flap substitute, or
an artificial skull flap using a poly-ether ether ketone (PEEK) plastic can be constructed
and applied in a separate cranioplasty procedure. Both of these are secured with titanium
screws and plates.

109-1 Synthes low-profile cranial 
plating set. Left side: 2 Screwdriver
handles and a variety of drill bits,
4 mm, 6 mm. Right side: 1.5-mm Screws.

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 109-2 Variety of Synthes low-profile
implant cranial plates. Right side:
2 Burr hole covers, 12 mm, 17 mm.

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CHAPTER 110

Laminectomy

Additional images are available at: A laminectomy is an incision in the back to remove the lamina so as to expose the spinal
evolve.elsevier.com/Tighe/instrumentation column.

  Possible instruments and equipment needed for the procedure include a neurologic soft
tissue set; an operating microscope for visualization; an electrosurgical unit; and an electric
drill, bits, and burrs.

A brief description of the procedure follows:
1. A Beckman-Adson retractor is used to expose the vertebrae.
2. A Hibbs retractor is used if deeper retraction is needed.
3. A Cobb elevator is used to remove periosteum from the laminae.
4. A Smith-Petersen rongeur is used to remove the spinous processes.
5. Cushing bayonet forceps with teeth are used to grasp the ligamentum flava.
6. A Bard-Parker scalpel handle #7 with a #15 blade is used to incise close to the mid-

line.
7. A Mellon curette is used to remove lateral gutter ligaments.
8. A Brun curette is used to define the laminae edges.
9. A Leksell rongeur is used to remove the laminae and expose the spinal cord.
10. An Adson blunt nerve hook is used to explore nerve roots and extradural space.
11. A Love retractor is used to protect nerves from injury.
12. A Cushing disk rongeur is used to remove disk material.

110-1 Top, left to right: 4 Cushing
intervertebral disk rongeurs, 2 mm:
straight, 6 inch; upbiting, 6 inch;
narrow, straight, 7 inch; straight,
7 inch. Bottom, left to right: 1 Cushing
intervertebral disk rongeur, 3 mm,
7 inch, upbiting; 1 Ferris Smith pituitary
rongeur, 6 mm, 7 inch; 1 Cushing inter-
vertebral disk rongeur, 4 mm, 7 inch.

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