Neurosurgical Operations Research Articles

Intracerebral Hemorrhage-Associated Iron Release Leads to Pericyte-Dependent Cerebral Capillary Function Disruption

Intracerebral hemorrhage leads to immediate brain injury due to local mechanical damage, on which current treatment approaches are focused, but it also induces secondary brain injury. The purpose of this study is to characterize blood components, degradation products and their effects in secondary brain injury. Immunocyto- and immunohistochemistry, Fluorescence-Activated Cell Sorting, WST-1 assays and RNA sequencing were applied using human cell cultures and human ex vivo brain tissue slices. Brain tissue was immediately collected, cooled and sliced during neurosurgical operations to perform experiments on living tissue slices of the human brain. Among the blood degradation products, free iron (Fe2+ and Fe3+), but not hemoglobin, induced detrimental effects on pericyte function and survival (78.5% vs. 94.3%; p-value < 0.001). RNA sequencing revealed ferroptosis as the underlining cellular mechanism, mediated via GPX-4 (log2 fold change > 1.0, p-value < 1.08 × 10−30) in pathway analysis and eventually resulting in oxidative cell death. Pericytes located at cerebral capillary branching sites were specifically affected by ferroptosis, leading to capillary disruption and vasoconstriction, which were partially prevented by ferrostatin-1. Free iron induces the pericyte-dependent disruption of cerebral capillary function and represents a therapeutic target to attenuate secondary injury after intracerebral hemorrhage.

Retrospective Single-Center Analysis of 5575 Spinal Surgeries for Complication Associations and Potential Future Use of Generated Data.

Background: This study aims to retrospectively detect associations with postoperative complications in spinal surgeries during the hospitalization period using standardized, single-center data to validate a method for complication detection and discuss the potential future use of generated data. Methods: Data were generated in 2006-2019 from a standardized, weekly complications conference reviewing all neurosurgical operations at the University Hospital Luebeck. Paper-based data were recorded in a standardized manner during the conference and transferred with a time delay of one week into a proprietary complication register. A total of 5575 cases were grouped based on the diagnosis, surgical localization, approach, instrumentation, previous operations, surgery indication, age, ASA score, and pre-existing conditions. Retrospective analysis was performed using a logistic regression detecting complication associations. The results were compared to the literature validating the method of complication detection. Results: Mean cohort age: 58.83 years. Overall complication rate: 10.9%. Mortality rate: 0.25%. The statistically significant complication associations were age; an age of >60; the localization (cervical, thoracic); a cervical tumor or trauma diagnosis; lumbar degenerative conditions, tumor, trauma, or infection; a cervical hemi-/laminectomy and vertebral body replacement; a lumbar hemi-/laminectomy, posterior spondylodesis, and 360° fusion; lumbar instrumentation, with an ASA score of three and four; a ventral and combined/360° approach; a lumbar combined/360° revision; two, three and ≥four pre-existing conditions; hypertension; osteoporosis; arrhythmia; an oncological condition; kidney dysfunction; stroke; and thrombosis. Conclusions: Documenting risk profiles for spinal procedures is important in identifying postoperative complications. The available data provide a comprehensive overview within a single center for spinal surgeries. Standardized complication recording during an established complication conference in the clinical routine enables the detection of significant complications. It is desirable to standardize the registration of postoperative complications to facilitate comparability across different institutions. The results may contribute to national or international databases used for automated AI risk profiling.

A Clinical Learning Curve Should Be Avoided in Neurosurgery.

Achieving competence in performing complex neurosurgical operations and learning new techniques after qualification take time. The improvement in skill over time (or as more procedures are performed) can be represented graphically as a learning curve. While surgeons are operating on patients to acquire the required skills, patients might be harmed. This is often referred to colloquially but incorrectly as "a steep learning curve." Although this may be an accepted learning practice for surgeons, it is unlikely to be acceptable to patients. Surgeons need to find ways of reaching a competent level of practice before operating on patients. To this end, the need for new techniques, what skills they require, and how they can be learned in a nonclinical environment should be defined. This can help surgeons determine where they start on a learning curve and what skills they need to achieve competence.

In Defense of Desflurane: Is There a Specific Role for Desflurane in Neuroanesthesia?

AbstractIt is challenging to counter the widespread criticism of desflurane as the volatile anesthetic agent with the most significant greenhouse gas effect, one which is likely to exacerbate global warming. In 2022, the journal “Anaesthesia” published guidelines for minimizing the impact of anesthetic gases on global warming, which the anesthetic community has largely embraced. One of its recommendations was the removal of desflurane from drug formularies. However, this review underlines the likely benefits of desflurane in the context of actual and potential neurological injuries. With an estimated 13.8 million neurosurgical operations performed annually, desflurane could offer advantages to some of these patients. Therefore, it is imperative to develop an environmentally safe approach for its use rather than remove it from formularies. We discuss desflurane's environmental impact, its unique anesthetic and chemical properties, and its specific application in neuroanesthesia practice. Based on existing evidence, we argue that desflurane could hasten the wake-up of neurosurgical patients. We propose switching to desflurane toward the end of surgery for patients at risk of, or with, neurological injuries. Predictable, early, and monitorable wake-up in these cases could prevent surgical delays, avoid additional investigations, or enable early detection of new deficits. Instead of a blanket ban, desflurane's use should be investigated—systematically and carefully. With education, well-defined indications, limited use, intelligent vaporizers, scavenging, and recycling systems, the use of desflurane could be justified under specific circumstances. Moreover, the problem of environmental damage from inhaled anesthetics must be comprehensively evaluated. Minimizing the use of desflurane is a positive step to protect the environment, but anesthesiologists should enforce other measures to protect the environment with equal urgency.

Optimal Patient Positioning for Microvascular Decompression of Trigeminal Neuralgia Utilizing the "Arrowhead" Technique: A Technical Report.

Microvascular decompression (MVD) is a neurosurgical operation used to treat trigeminal neuralgia (TN). The surgery is performed through a retrosigmoid approach, where a Teflon pledget is placed in between the offending vessel (most commonly the superior cerebellar artery) and trigeminal nerve. The surgery is performed within the superior aspect of the cerebellopontine angle (CPA) through a small working corridor that is triangulated by the petrous bone and tentorium. Patient positioning is the foundation to accessing this corridor and performing a successful operation. This article provides a detailed guide on the positioning steps of the park bench position typically employed at Arrowhead Regional Medical Center (ARMC) in Colton, CA, USA. We then review pertinent surgical anatomy in a MVD for trigeminal neuralgia and describe the "Arrowhead" technique to perform this operation.

The Role of Edmonton Frailty Scale in Determining the Postoperative Complications in Elderly: A Prospective Observational Study.

To explore the effect of Edmonton Frailty Index on the determination of postoperative complication and mortality rates in patients over 65 years of age. An observational study. Place and Duration of the Study: Department of Anaesthesiology and Reanimation, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, Izmir, Turkiye, from January to July 2021. Patients aged >65 years undergoing surgery were inducted. Frailty was defined as a multisystemic condition in which physical, physiological, and cognitive abilities are reduced. Demographic data, ASA, and Edmonton Frailty Test Score (EFS) were noted preoperatively. Subsequently, these patients were followed perioperatively and evaluated by Clavien-Dindo test (CDT) during the first month postoperatively. There was no statistically significant difference between genders, except EFS, which was higher in females than in males. EFS increased as age increased with a statistically significant positive correlation. The patients with the highest EFS underwent neurosurgical operations. There was a statistically significant and positive correlation between the length of hospital stay and EFS. EFS values increased as the ASA score increased and the positive correlation was statistically significant. The mild frality group had the highest CDT scores and were statistically significant. Frailty assessed by EFS has a statistically significant correlation with ASA and the CDT scores of the patients. EFS value was associated with length of hospital stay, unlike the ASA score. Both EFS and ASA were correlated with the CDT. Preoperative evaluation, especially in geriatric patients, is very important in determining postoperative complications, mortality, and length of hospital stay. Edmonton frailty index, Clavien-Dindo scoring, American society of anaesthesiologists.

The hemodynamic effects of ketofol versus fentanyl-propofol in neurosurgical operations

The hemodynamic effects of ketofol versus fentanyl-propofol in neurosurgical operations

Envisioning the Future of the Neurosurgical Operating Room with the Concept of the Medical Metaverse.

The medical metaverse can be defined as a virtual spatiotemporal framework wherein higher-dimensional medical information is generated, exchanged, and utilized through communication among medical personnel or patients. This occurs through the integration of cutting-edge technologies such as augmented reality (AR), virtual reality (VR), artificial intelligence (AI), big data, cloud computing, and others. We can envision a future neurosurgical operating room that utilizes such medical metaverse concept such as shared extended reality (AR/VR) of surgical field, AI-powered intraoperative neurophysiological monitoring, and real-time intraoperative tissue diagnosis. The future neurosurgical operation room will evolve into a true medical metaverse where participants of surgery can communicate in overlapping virtual layers of surgery, monitoring, and diagnosis.

Olfactory Evoked Potential Monitoring: Technical Note and Challenges Faced.

Despite the sustained progress in the realm of intraoperative neurophysiologic monitoring of the nervous system, little progress has been achieved in monitoring the olfactory pathway. Loss of olfactory function due to retraction-induced physical damage during operations has ill-appreciated negative consequences for the patients and is often underreported. Improvements in this area of neuromonitoring require a revisit of the technical challenges. We aim to describe the method to construct flexible, bipolar silver ball electrodes to stimulate the olfactory mucosa during cranial neurosurgery and suggest ways to overcome the challenges in eliciting olfactory evoked potentials. We analyze the potential difficulties in routinely eliciting olfactory evoked potential in neurosurgical operations and summarize ways to overcome them. We also describe the construction of a simple electrical stimulator electrode for the olfactory mucosa, its application, and potential recording sites in an effort to detect the potential during cranial neurosurgery. We created flexible, insulated bipolar silver electrodes and placed them atraumatically on the olfactory mucosa under endoscopic guidance, bilaterally, in 22 patients. We obtained an optimal position in less than 10 minutes in most cases. We also summarize the challenges faced and potential paths to overcome them. Though electrical stimulation of the olfactory mucosa using custom-made silver electrodes is possible and takes little time to place them as part of an intraoperative neurophysiologic monitoring setup, detecting the minute potential remains elusive.

Safety of labor, Valsalva maneuver, and neuraxial anesthesia for pregnant women after decompressive craniectomy: Case series and review of the literature.

Decompressive craniectomies are a neurosurgical operation aimed at normalizing intracranial pressure (ICP). Occasionally, there is delayed replacement of the skull resulting in an acquired skull defect. When managing laboring patients with an acquired skull defect there is often fear associated with traditional labor involving the Valsalva maneuver and with neuraxial anesthesia. These fears typically stem from potential ICP changes and risk of herniation. In reviewing the literature, only 15 cases are described detailing labor management after decompressive craniectomy (DC), mostly with incomplete labor histories. We aim to expand that literature by reporting two cases of safe labor with epidural anesthesia in patients with large skull defects. The first described patient underwent a cranioplasty during pregnancy because of trauma. Later, because of concerns for pre-eclampsia, induction of labor was initiated and she received neuraxial anesthesia via epidural. The patient ultimately underwent cesarean delivery 48 h after induction began due to nonreassuring fetal heart tones. The second patient underwent a cranioplasty because of infection prior to pregnancy. Once in labor, she was cleared by neurosurgery and the anesthesia team placed her epidural. She later underwent an uncomplicated standard vaginal delivery. The existing literature on labor following DC is sparse. Retrospective review of case reports can advance discussion and standardization regarding care for laboring women with a history of DC. We advocate that the Valsalva maneuver and epidural anesthesia is safe for pregnant women who are neurologically asymptomatic.

Various aspects of radiosurgery – a review

Introduction and purpose Radiosurgery (RS) is an innovative treatment method that involves the precise administration of a large dose of ionizing radiation to the diseased area of ​​the body sparing healthy tissues maximally. The treatment is non-invasive and usually painless for the patient, and its greatest advantage is the immediate destruction of cancer cells. The method enables the treatment of tumors which are located within the brain tissue, but also of extracranial lesions in almost all organs of the human body. The aim of this article is to compare the structure, principles of operation, advantages, disadvantages and the use of Gamma Knife and CyberKnife in neurosurgery. These devices are used to perform radiosurgery and stereotactic radiotherapy procedures. They are an alternative to neurosurgical procedures, especially for cancerous tumors located in hard-to-reach places, and significantly reduce the risk of postoperative complications. Materials and methods The literature included in the PubMed, BioMed Central and Polish Medical Platform databases is searched by means of the words such as Gamma Knife, CyberKnife, radiosurgery, stereotactic radiotherapy. Quoted sources in selected works were also used. Conclusions Stereotactic radiosurgery is an element of radical, palliative or analgesic treatment of well-circumscribed small lesions, less than 5 cm in diameter. Gamma Knife and CyberKnife enable cancerous and non-cancerous treatment lesions. Both procedures are performed on an outpatient basis and are considered minimally invasive procedures, especially recommended for patients who cannot undergo neurosurgical surgery or require less invasive cancer treatment. Gamma Knife was designed for radiosurgery of lesions located intracranially and covering the upper parts of the cervical spine up to the level of the fourth cervical vertebra, while CyberKnife or modern linear accelerators are used for intracranial and extracranial radiosurgery.

Intraoperative monitoring of visual evoked potentials: experience of 240 operations

Background. Intraoperative monitoring (IOM) of visual evoked potentials (VEPs) is used to inform surgeons about impacts on the visual system in order to prevent iatrogenic visual impairment. The VEP monitoring use become widespread only in the last decade; nowadays, there is no generally accepted methodology for its implementation, and the effectiveness of VEP monitoring and the factors determining it have not been sufficiently studied.Aim. The aim of the study was to investigate the factors influencing the VEP monitoring feasibility and effectiveness.Materials and methods. Data from 240 consecutive neurosurgical operations performed using VEP monitoring were retrospectively reviewed. IOM data (registration parameters, presence and type of VEP changes), patient characteristics (gender and age, tumor type and location, presence of preoperative visual dysfunctions), anesthesia parameters and postoperative changes in vision were studied. Statistical analysis was performed using χ2 and Mann–Whitney tests.Results. VEPs were obtained in 91.3 % of eyes with completely or partially preserved vision. The main factors reducing the chances to record VEPs successfully are preoperative visual disorders and the use of inhalation anesthesia. A personalized approach to the selection of reference electrodes and frequency filtering parameters makes it possible to reduce the number of averagings required for VEP recording and accelerate informing surgeons. With successful monitoring 59.1 % of eyes had no noticeable VEP changes; 5.8 % of eyes had signs of intraoperative improvement; 35.1 % had signs of deterioration. Among the last category, 60.7 % of eyes had full VEPs recovery afterwards. After surgery, new visual disorders were detected in 2.6 % of eyes without signs of intraoperative deterioration, in 6.7 % – with temporary deterioration, and in 19.3 % – with signs of deterioration persisted until IOM is finished. Assessing the sensitivity and specificity of VEP monitoring is hampered by the possibility of complications in the early postoperative period and IOM influence on the course and results of the operation. The proportion of total resections was maximal when VEP monitoring was successful. In the subgroup without preoperative visual impairments, the alarms during monitoring were associated with decrease in proportion of total resections proportion due to increase in proportion of subtotal resections.Conclusion. VEP monitoring with a personalized approach allows effective monitoring of visual functions preservation during neurosurgical operations.

Exploring the Combination of Computer Vision and Surgical Neuroanatomy: A Workflow Involving Artificial Intelligence for the Identification of Skull Base Foramina

The skull base is a complex region in neurosurgery, featuring numerous foramina. Accurate identification of these foramina is imperative to avoid intraoperative complications and to facilitate educational progress in neurosurgical trainees. The intricate landscape of the skull base often challenges both clinicians and learners, necessitating innovative identification solutions. We aimed to develop a computer vision model that automates the identification and labeling of the skull base foramina from various image formats, enhancing surgical planning and educational outcomes. We employed a deep learning methodology, specifically using a convolutional neural network architecture. Our model was trained on a dataset comprising of 3560 high-resolution, annotated images of the skull base, taken from various perspectives and lighting conditions to ensure model generalizability. Model performance was quantitatively assessed using precision and recall metrics. The convolutional neural network model demonstrated strong performance, achieving an average precision of 0.77. At a confidence threshold of 0.28, the model reached an optimal precision of 90.4% and a recall of 89.6%. Validation on an independent test set of images corroborated the model's capability to consistently and accurately identify and label multiple skull base foramina across diverse imaging scenarios. This study successfully introduces a highly accurate computer vision model tailored for the identification of skull base foramina, illustrating the model's potential as a transformative tool in anatomical education and intraoperative structure visualization. The findings suggest promising avenues for future research into automated anatomical recognition models, suggesting a trajectory toward increasingly sophisticated aids in neurosurgical operations and education.

An attempt to identify brain tumour tissue in neurosurgery by mechanical indentation measurements

BackgroundThe intraoperative differentiation between tumour tissue, healthy brain tissue, and any sensitive structure of the central nervous system is carried out in modern neurosurgery using various multimodal technologies such as neuronavigation, fluorescent dyes, intraoperative ultrasound or the use of intraoperative MRI, but also the haptic experience of the neurosurgeon. Supporting the surgeon by developing instruments with integrated haptics could provide a further objective dimension in the intraoperative recognition of healthy and diseased tissue.MethodsIn this study, we describe intraoperative mechanical indentation measurements of human brain tissue samples of different tumours taken during neurosurgical operation and measured directly in the operating theatre, in a time frame of maximum five minutes. We present an overview of the Young’s modulus for the different brain tumour entities and potentially differentiation between them.ResultsWe examined 238 samples of 75 tumour removals. Neither a clear distinction of tumour tissue against healthy brain tissue, nor differentiation of different tumour entities was possible on solely the Young’s modulus. Correlation between the stiffness grading of the surgeon and our measurements could be found.ConclusionThe mechanical behaviour of brain tumours given by the measured Young’s modulus corresponds well to the stiffness assessment of the neurosurgeon and can be a great tool for further information on mechanical characteristics of brain tumour tissue. Nevertheless, our findings imply that the information gained through indentation is limited.

Neurosurgical Importance on Temporal Branch of the Facial Nerve.

We aimed to determine anatomic features of the temporal branch (TB) of the facial nerve and its relation to various anatomic landmarks on the face in order to prevent damage in the surgical approach after head trauma or in planned neurosurgical interventions. Nine male cadavers preserved with formalin, were bilaterally dissected under a microscope at the laboratory of anatomy department of the university. The anatomical features of the branch and branching pattern of facial nerve and its relationships with adjacent neurovascular structures were evaluated using descriptive statistical data. The mean distance at the lateral canthus level between the far most anterior branch and far most posterior branch of the TB (APD) was 14.93 mm. The mean distance to the tragus of the entrance point of the TB to the orbicularis oculi muscle (ETT) was 74.72 mm. The mean distance between the origin point of the TB to the tragus (TT) was 24.50 mm. The angle between the far most anterior branch and far most posterior branch at the level of the lateral canthus (APA) was minimum 15°, maximum 40° and the mean value of APA was 24.61°. The number of branches originating from the TB (NB) were one to three branches which lay under the zygomatic arch and two to five branches upper the zygomatic arch, respectively. The number of anastomosis between the TB and zygomatic branch (AN) varies between 1 and 4; AN was found to be less intense in 10 sides and very intense in eight sides. The APA and APD value is mentioned for the first time in this study and nerve angle is considered to be as important as temporal branching in directing facial neurosurgical operations. We found that the unsafety zone may be exist for a 40 degree and 1.5 cm long area at the lateral canthus level, especially on the zygomatic arc where branching pattern is greater and 2.5 cm in front of the tragus. The data is significant for neurosurgeons to reach exactly this area without causing postoperative complications such as facial paralysis.

Developing a Knowledge Base from Oncological Patients’ Neurosurgical Operations Data

Developing a Knowledge Base from Oncological Patients’ Neurosurgical Operations Data

1088 The Quality of Information Recorded in Neurosurgical Operation Notes: A Closed Loop Audit

Abstract Introduction Operation notes are critically important documents which serve as record for significant events in the lives of patients. They serve multiple functions, but chiefly to help guide peri-operative management. Surgeons must keep records that are accurate, thorough, and readable. This is fundamental part of the GMC’s Good Medical Practice as well as the Royal College of Surgeons of England Good Surgical Practice guidelines which lays out 18 various parameters for what should be included in an operation note. Aim This retrospective audit aimed to evaluate the compliance of neurosurgical operation notes with the Royal College of Surgeons guidelines, identifying areas for improvement. Method All neurosurgical procedures between October 1 and October 31, 2023, at a Major Trauma Centre in the West Midlands were retrospectively audited. Two independent reviewers used a standardized proforma in Microsoft Excel for data extraction, comparing compliance. Results 91 operation records were examined and found high compliance (100%) in key fields: date, surgeon's name, assistant's name, operative procedure, operative diagnosis, and signature. Negligible compliance was found in identification of prosthesis (0%), estimated blood loss (1%), extra procedures (1%), elective/emergency classification (1%), time (4%), and problems/complications (19.8%). Notably, detailed post-op instructions were lacking in over 1 in 3 operation notes, with 19.7% omitting DVT prophylaxis, and 20% neglecting clip/suture removal instructions. Conclusions While certain aspects showed exemplary compliance, critical deficiencies were identified, particularly in post-operative instructions. A template proforma for post op instructions is required in addition to more targeted guidelines for operation notes within neurosurgery.

Radiomic white matter parameters of functional integrity of the corticospinal tract in high-grade glioma

Tractography has become a widely available tool for the planning of neurosurgical operations as well as for neuroscientific research. The absence of patient interaction makes it easily applicable. However, it leaves uncertainty about the functional relevance of the identified bundles. We retrospectively analyzed the correlation of white matter markers with their clinical function in 24 right-handed patients who underwent first surgery for high-grade glioma. Morphological affection of the corticospinal tract (CST) and grade of paresis were assessed before surgery. Tractography was performed manually with MRTrix3 and automatically with TractSeg. Median and mean fractional anisotropy (FA) from manual tractography showed a significant correlation with CST affection (p = 0.008) and paresis (p = 0.015, p = 0.026). CST affection correlated further most with energy, and surface-volume ratio (p = 0.014) from radiomic analysis. Paresis correlated most with maximum 2D column diameter (p = 0.005), minor axis length (p = 0.006), and kurtosis (p = 0.008) from radiomic analysis. Streamline count yielded no significant correlations. In conclusion, mean or median FA can be used for the assessment of CST integrity in high-grade glioma. Also, several radiomic parameters are suited to describe tract integrity and may be used to quantitatively analyze white matter in the future.

Turning the operating room into a mixed-reality environment: a prospective clinical investigation for cerebral aneurysm clipping.

The overall aim of this study was to demonstrate the potential benefit of a novel mixed-reality-head-mounted display (MR-HMD) on the spatial orientation of surgeons. In a prospective clinical investigation, the authors applied for the first time a new multicamera navigation technology in an operating room setting that allowed them to directly compare MR-HMD navigation to standard monitor navigation. In the study, which included 14 patients with nonruptured middle cerebral artery aneurysms, the authors investigated how intuitively and effectively surgical instruments could be guided in 5 different visual navigation conditions. The authors demonstrate that multicamera tracking can be reliably integrated in a clinical setting (usability score 1.12 ± 0.31). Moreover, the technology captures large volumes of the operating room, allowing the team to track and integrate different devices and instruments, including MR-HMDs. Directly comparing mixed-reality navigation to standard monitor navigation revealed a significantly improved intuition in mixed reality, leading to navigation times that were twice as fast (2.1×, p ≤ 0.01). Despite the enhanced speed, the same targeting accuracy (approximately 2.5 mm, freehand tool use) in comparison to monitor navigation could be observed. Intraoperative planning strategies with mixed reality clearly outperformed classic preoperative planning: surgeons scored the mixed-reality plan as the best trajectory in 63% of the cases (chance level 33%). The incorporation of mixed reality in neurosurgical operations marks a significant advancement in the field. The use of mixed reality in brain surgery enhances the spatial awareness of surgeons, enabling more instinctive and precise surgical interventions. This technological integration promises to refine the execution of complex procedures without compromising accuracy.

Polyrethane Foams Combined with Vaseline Prevents 1st Degree Pressure Injuries in Neurosurgical Surgery Patients: Literature Review

Introduction: In the world of healthcare, the prevention of pressure injuries in neurosurgical patients in the operating room is an important aspect to prevent serious complications, such as infection and impaired circulation. Grade 1 pressure injuries, although often considered minor, can have a serious impact on patients' recovery and quality of life. Therefore, effective prevention strategies are urgently needed. Objective: This literature review aims to evaluate the use of Polyurethane Foams combined with Vaseline as a method of preventing 1st degree pressure injuries in neurosurgical patients in the operating room. Methods: The method of writing this literature review article uses a narrative review approach. The data used is secondary data obtained from several databases such as Google Schoolar, PubMed, Science Direct, and Research Gate. The literature search in the preparation of the article uses a period of publication years ranging from 2016 to 2024. Results: Preliminary results show that this combination can significantly reduce the risk of 1st degree pressure injuries. Conclusion: Polyurethane Foams and Vaseline were selected based on their specific properties which were considered to support healing and provide protection. The Munro Scale measurement tool was used as a reference for interventions carried out in moderate and high-risk patients.