Prototype screwdriver stopper to avoid intracranial penetration injury

Abstract

Screwdriver slipping from the tapping screw head (screwdriver slip) represents a very dangerous situation that leads to the risk of entry into the intracranial operation field. We have developed a screwdriver stopper device to attach to the top of the screwdriver in order to prevent intracranial penetration injuries. We performed 48 craniotomies in our institute. The instrument is made from clear acrylic with a central hole (diameter, 3 mm). We checked the number of screwdriver slip events, as a precursor to intracranial penetration injury, in screwdrivers from five different companies, and compared the results. We used 496 tapping screws in 512 tightening procedures. Although screwdriver slip occurred at an overall rate of 17/512(3.3%), we completely avoided serious intracranial penetration injuries. No significant differences in rates of screwdriver slip were seen between the five companies (χ² test, p = 0.997). Screwdriver slip is a precursor to intracranial penetration injury, but cannot be avoided with cross-type screwdrivers. Many neurosurgeons may be operating without knowledge of the potential risk of intracranial penetration injury. The screwdriver stopper described herein may prove extremely useful for preventing intracranial penetration injuries during neurological surgery.