SEPS = Subdural Evacuating Port System (Medtronic)
“The SEPS™ Cranial Access Kit is indicated when access to the subdural space and evacuation of a cranial subacute or chronic hematoma or hygroma is necessary. The SEPS Cranial Access Kit consists of surgical instruments and accessories used for draining subdural fluid accumulations such as hygromas and liquid-state subdural hematomas to an external suction reservoir without touching the brain. Utilizing a minimally invasive technique, the SEPS Cranial Access Kit’s components are designed to promote gradual brain re-expansion by creating a low homogeneous negative pressure throughout the subdural space as fluid is drained to an external suction reservoir.”
Instructions for Putting a SEPS drain:
- perform SEPS under local or general anesthesia
- identify area of greatest subdural fluid thickness using CT scan or MRI
- prep and drape selcected site with Chloraprep
- Mark incision site with sterile marking pen
- make a 5 mm incision through skin, subcutaneous tissue, galea and periosteum.
- apply holzheimer retractor to expose skull
- attach safety stop collar to drill bit
- secure drill bit with safety stop collar to hand drill
- place drill into chuck, hold chuck motionless while rotating handle clockwise.
- create twist drill hole through outer and inner tables of the skull
- incise dura, remove all exposed dura and subdural membranes form twist drill hole before inserting evacuating port (use #11 scalpel blade and forceps or unipolar cautery)
- Do not insert evacuating port until fluid is flowing freely from twist drill hole
- remove self-retaining scalp retractor and insert evacuating port by twisting clockwise. (4 turns will seat port securely into skull above inner table.
- evacuating port should never protrude beyond inner table
- attach silicone tubing to evacuating port and to suction reservoir bulb
- apply low homogenous negative pressure with suction reservoir bulb
- close wound around evacuating port
- fluid evacuation generally completed within 24-48h. Monitor suction reservoir blood and empty as needed with repeated reapplication of negative pressure.