A Standard Operating Procedure Of Clean And Fast Craniotomy Without Application Of Raney Clips

Clean and fast craniotomy and closure (CAC) is a fundamental part of modern microneurosurgery, and is an essential technique that young neurosurgeons shall master. The hemostatic instruments of CAC have evolved from forceps to raney clips. Thanks to the wide application of bipolar coagulation, local infiltration anesthesia combined with cauterization is become an effective method of hemostasis. The authors worked out a standard operating procedure (SOP) of CAC assisted by fishhooks without the application of raney clips. According to the authors' experience, the average time spent on CAC decreased from more than 1 hour to <40 minutes. Owning to little bleeding, the operative field is clean throughout the procedure. Patients also experience less pain and enjoy an earlier discharge. With few complications, the authors believe that this cost-effective SOP may become a cornerstone of early recovery after surgery.