Safety Control in Neurosurgery- The Perspective of Neurosurgical Checklists

Neurosurgical procedure at large represents a chain of consecutive actions as surgery itself, being only the top of the iceberg. It includes: the introduction of the patient in the operating theater and verification of its identity and pathology; loading the actual images of the patient; intubation and anesthesiological preparation; positioning of the patient with fixation of the headrest; checking the upper and lower extremities, the genitals and the breasts as well as the eyes and neck for abnormal position or compression and ensuring their antidecubital setting; checking the side and/or the level of surgery; shaving the operating field; outlining the skin incision; switching on and checking the reliability of the high speed drill, the operating microscope and the other devices necessary for the specific procedure; scrubbing; dressing of the operative field; surgery itself; undressing of the operative field; extubation; prescription of postoperative therapy and laboratory studies. Hence, the overall success of every neurosurgical procedure could not be achieved if there is even one incorrect step. In the circumstances of emergency, time limits, stress and overwork, which are indivisible parts of the professional life of most of the neurosurgeons in the world, the risk of such mistakes and oversights is significant. Up to date, to the best of our knowledge the neurosurgeons worldwide are not protected from these mostly preventable omissions by any reliable measures. The senior author developed universal neurosurgical checklist examiner (UNCLE) as a model of clinical preoperative safety control. UNCLE was routinely applied in our clinic since its introduction almost two years ago. Its advantages and disadvantages were studied. UNCLE proved itself as a simple, reliable, cost effective and time-saving instrument for pre-surgical safety control.