Stitch retractor—simple and easy technique to retract brain

Abstract 

Background

Self-retaining brain retractors are commonly used during intracranial surgery, and they are indispensable during microneurosurgery. There is a common severe complication due to the use of self-held retractors, that is, formation of a hemorrhagic infarct area in the brain region exposed to traction. All the more, present retractor systems are fixed and rigid and obstruct surgeons during surgery. Sometimes these retractors create glare in the microscope that distracts the surgeon. We hereby propose a simple and easy method of retraction of brain especially the temporal lobe using the transsylvian approach and vermis using the transvermian approach.

Methods

This is retrospective analysis of 47 patients in 4 years in which we have used our stitch retractor. We have analyzed their outcome, postoperative scan, and ease of performing surgery.

Results

In 47 patients, there was only 1 postoperative contusion, and the longest period it was kept for is 6 hours. The other advantage was that it does not obstruct in any way while doing dissections and surgery. There was no glare while operating under a microscope.

Conclusion

We hereby propose a simple and easy method of retraction of brain especially the temporal lobe using the transsylvian approach and vermis using the transvermian approach. It is minimally traumatic, reducing insult to the brain. It allows the surgeon to dissect without any obstruction and glare in the way. The biggest advantage of the present stitch retractor is that it is very cheap and simple to use.

Abbreviations: BRP, brain retraction pressure, CBF, cerebral blood flow, EEG, electroencephalogram, MAP, mean arterial pressure, rCPP, regional cerebral perfusion pressure, SPECT, single photon emission computed tomography, SSEP, somatosensory evoked potential

Keywords: Stitch retractor, Sylvian fissure, Transsylvian approach, Transvermian approach, Temporal lobe, Brain retraction pressure, Self-retaining brain retractors