Level I—360° Retraction
Refer to Figures 15-1 through 15-8 when using the Gardner Skull Clamp. Refer to Figures 16-1 through 16-7 when using the Symmetry Surgical Skull Clamp.
NOTE: Position the mounting screws of the skull clamp towards the patientʼs shoulders, away from the area in which the surgeon is standing or sitting. The
base of the skull clamp should be parallel to the floor (see Figure 15-1 or Figure 16-1). FROM THIS POINT, THE PATIENT IS DRAPED AND THE FIELD
IS STERILE. The entire assembly process to be shown is carried out by sterile technique, with the GREENBERG Primary Bar clamps being applied on top
of the sterile drapes, covering the headrest.
Gardner
Step 1—Attaching Primary Bars
The GREENBERG Primary Bars are mounted perpendicular to the base of
the Gardner Skull Clamp and point toward the surgeon (see Figure 15-2).
Step 2—Mounting Secondary Bars
One GREENBERG Secondary Bar is placed on each GREENBERG
Primary Bar (see Figure 15-3). These secondary bars are positioned so that
they rest on top of the opposite primary bar.
A secondary bar is then mounted onto each of the secondary bars previ-
ously mounted (see Figure 15-4).
To complete a frame around the surgical field, a final secondary bar is
attached (see Figure 15-5).
Step 3—Attaching Pattie Tray
Attach pattie tray to the secondary bar using a GREENBERG Retractor
Arm. The tray is held by the mini-vise.
NOTE: Scalp retraction can be achieved by attaching small towel clips to
the flap edge. Rubber bands can be attached to the clips and mounted on
the frame. See Figure 15-6.
Step 4—Attaching Retractor Arms (Figure 15-7)
Retractor arms (four are shown) are attached to the frame to enable 360°
retraction and dissection of the brain. (Scalp retractors omitted from illustra-
tion for simplicity.)
Step 5—Attaching Microinstrument Holders (Figure 15-8)
Attach microinstrument holders to the primary and/or secondary bars. Micro -
suction and microdissection instruments can now be placed in the field.
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Symmetry Surgical
Step 1—Attaching Primary Bars
The GREENBERG Primary Bars are mounted on the vertical arms of the
Symmetry Surgical Skull Clamp so that they are parallel with the base of the
skull clamp and perpendicular to the patient (see Figure 16-2).
NOTE: The primary bar applied to the ratchet arm must be applied low and
must completely encircle that arm. When the primary bar clamp is fully tight-
ened, it must make contact with the skull clamp arm at three points.
Step 2—Mounting Secondary or Floating Secondary Bars
One secondary bar is then mounted onto each primary bar (see Figure 16-3).
To complete a frame around the surgical field, two secondary bars are
attached (see Figure 16-4). NOTE: Attaching floating secondary bars will
allow symmetry. Floating secondary bars are available separately. Using
secondary bars will result in an asymmetrical box.
Step 3—Attaching Pattie Tray
Attach pattie tray to the secondary or floating secondary bar using a
GREENBERG Retractor Arm. The tray is held by the mini-vise.
NOTE: Scalp retraction can be achieved by attaching small towel clips to
the flap edge. Rubber bands can be attached to the clips and mounted on
the frame. See Figure 16-5.
Step 4—Attaching Retractor Arms (Figure 16-6)
Retractor arms (four are shown) are attached to the frame to enable 360°
retraction and dissection of the brain. (Scalp retractors omitted from illustra-
tion for simplicity.)
Step 5—Attaching Microinstrument Holders (Figure 16-7)
Attach microinstrument holders to the primary, secondary, and/or floating
secondary bars. Microsuction and microdissection instruments can now be
placed in the field.
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