Brain Retraction Technique Using Gelatin Sponge in the Subtemporal Approach -Technical Note-

Abstract

Wide exposure of lesions during the subtemporal approach often leads to temporal lobe injury caused by excessive retraction. A brain retraction technique using gelatin sponge pieces was developed to minimize intraoperative brain retraction during the subtemporal approach. After aspirating cerebrospinal fluid and slackening the temporal lobe, 2-3 pieces of gelatin sponge are inserted between the dura and surfaces of the anterior and posterior parts of the temporal lobe, then covered with cottonoids. The gelatin sponge pieces expand and thus expose the free margin of the tentorium with minimal brain retraction. This technique was used in 50 patients undergoing clipping for cerebral aneurysms. Although computed tomography indicated minor brain injury caused by retraction in three patients with ruptured aneurysm of the basilar artery bifurcation, no patients experienced new neurological deficits other than transient ipsilateral oculomotor nerve paresis. In conclusion, gelatin sponge, with its innate mechanical characteristics and ease of application, seems to offer an alternative retractor in neurosurgical interventions using the subtemporal approach for patients with unruptured aneurysm or non-severe subarachnoid hemorrhage.

Retractorless Surgery for Petroclival Meningiomas via the Subtemporal Approach: A Try to Reduce Brain Retraction Injury

“…To maintain the normal cortical elasticity and consistency is essential for the adjacent cortical protection. Kashimura et al [ 19 ] developed a brain retraction technique by using gelatin sponge pieces to reduce retraction injury. The gelatin sponge retracts the temporal lobe along with the form of the cortical surface, acting more mildly than a fixed retractor.…”

“…However, temporal lobe injury was significantly associated with the subtemporal approach [ 14 , 17 , 18 ]. To reduce temporal lobe injury related to brain manipulation or retraction remains one of the essential goals in such an approach [ 19 ].…”