A new minimally invasive tubular brain retractor system for surgery of deep intracerebral hematoma

Abstract

Access to deep-seated brain lesions with traditional fixed and rigid brain retractors can be difficult without causing significant trauma to the surrounding brain. Tubular retractors offer an advantage of low retracting pressure. We developed a new inexpensive and simple tubular retractor which requires very small cortisectomy. The new tubular retractor was made up of silicone with inner diameter of 15, 18 and 23 mm and outer diameter of 17, 20 and 25 mm, respectively. This tube (1 mm thick) was cut in longitudinal direction. It was folded to make a small-diameter tube so that it could be introduced through a small cortisectomy. Margins of cortisectomy were gently and slowly retracted by Killian nasal speculum. Folded retractor, held by tissue forceps, was introduced inside the opened Killian nasal speculum. Tissue forceps and nasal speculum were removed leaving tubular retractor in place, which comes back to its normal tubular configuration after release. Surgery was performed using rigid Karl Storz 0° telescope (30 cm long and 4 mm in diameter) or microscope. Near-total removals of intracerebral hematomas, 37 hypertensive and 3 traumatic, was done using this retractor without any complication.

Management of colloid cyst of third ventricle

“…As a last resort to control bleeding, fluid can be replaced by air and coagulation of the bleeding point can be performed. Fluid should be replaced with air as wastage of time in repositioning of the retractor and does not require any holder (62). There is increased range of viewing angles of the endoscope that facilitates resection of the cyst through a smaller opening.…”

Endoscopic decompression of cervical spondylotic myelopathy using posterior approach

“…[16,17] Different methods like laminectomy, laminoplasty, arcocristectomy (involving multiple partial superior laminectomies), etc. have been used to increase spinal canal diameter and remove compression from root or spinal canal in cervical compression.…”

Indigenous Inexpensive Practice Models for Skill Development in Neuroendoscopy

“…From the top of the foam a tubular retractor, described by Yadav et al . [12] was passed. The telescope was fixed in the holder, and instruments were used to perform dissection and cutting.…”

“…One can use neuroendoscopy either as a solo modality in neurosurgery, such as endoscopic third ventriculostomy,[8] cerebrospinal fluid rhinorrhea,[9] pituitary surgeries,[7] craniopharyngioma,[10] colloid cyst,[2] hematoma evacuations, odontoid resection,[4] trigeminal neuralgia,[11] and surgery with the help of tubular retractor. [12] Neuroendoscopic techniques are associated with a tough learning curve. Young neurosurgeons and residents generally get very less hands-on exposure for neuroendoscopy.…”