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The Egyptian Journal of Neurology, Psychiatry and Neurosurgery

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Open Access 01-12-2021 | Intracranial Hypertension | Research

Retractorless brain surgery: technical considerations

Authors: Wael Mohamed Nazim, Mohamed Abdelrahman Elborady

Published in: The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Issue 1/2021

Abstract

Background

Retraction is necessary to access deep areas in the brain and skull base, but prolonged and forceful use of fixed retraction might be injurious. Several techniques were developed, in the concept of minimally invasive neurosurgery, to eliminate or minimize the use of fixed retractors. The authors discuss the technical considerations and limits in applying dynamic retraction in brain surgery for a variety of lesions using different approaches.

Results

We retrospectively collected 123 cases with brain lesions in diverse locations, were dynamic retraction, using the tools in the operator hands and was achieved successfully instead of fixed retraction. Cases with aneurysms were excluded, although retraction was applied during clipping only. Superficial and large masses that do not require fixed retraction as a routine were excluded also. We relied mainly on patient positioning to benefit from the gravity, proper design of the craniotomy, arachnoid dissection, cerebrospinal fluid aspiration, and internal decompression of the mass when possible.

Different approaches for different lesions were utilized in our patients, subfrontal or pterional and their modifications in 45.5% of cases, suboccipital in 21.1%, retrosigmoid in 13%, the interhemispheric approach in 10.5%, transcortical to lateral ventricles in 7.3%, and posterior subtemporal in 2.4%.

Dynamic retraction with the surgical tools was used successfully in all cases except 7 patients (5.6%) where we had to use fixed retraction transiently.

Conclusion

Several considerations are helpful and amenable to achieve successful brain surgery without fixed retraction. Utilizing the gravity, unlocking of the brain, choosing the surgical corridor, cerebrospinal fluid suctioning, and mastering of the microsurgical techniques are the keys.

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Title: Retractorless brain surgery: technical considerations
Authors: Wael Mohamed Nazim
Mohamed Abdelrahman Elborady
Publication date: 01-12-2021
Publisher: Springer Berlin Heidelberg
Keywords: Intracranial Hypertension
Craniotomy
Edema
Published in: The Egyptian Journal of Neurology, Psychiatry and Neurosurgery / Issue 1/2021
Electronic ISSN: 1687-8329
DOI: https://doi.org/10.1186/s41983-021-00329-w

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Springer Medicine

Retractorless brain surgery: technical considerations

Abstract

Background

Results

Conclusion

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Springer Medicine

Abstract

Background

Results

Conclusion

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