A Review of Brain Retraction and Recommendations for Minimizing Intraoperative Brain Injury

Andrews, Russell J.; Bringas, John

doi:10.1227/00006123-199312000-00014

Cited by 130 publications

(64 citation statements)

References 115 publications

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“…1) In our cases, the hyperperfusion syndrome may have been related to the compression with a spatula and injury to the superficial sylvian vein, but the hyperperfusion area did not correspond with the compressed area and did not contain damaged venous returns. Therefore, other causes may be considered for the occurrence of hyperperfusion.…”

Section: Discussionmentioning

confidence: 50%

Hyperperfusion Syndrome After Clipping an Unruptured Cerebral Aneurysm -Two Case Reports-

Sugino

Ohtaki

Wanibuchi

et al. 2010

Neurol. Med. Chir.(Tokyo)

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A 68-year-old woman presented with severe headache 9 days after undergoing successful clipping of a right middle cerebral artery aneurysm. Postoperative imaging revealed increased perfusion and diffuse edema in the right frontotemporal cortex. A 57-year-old woman exhibited perseveration soon after undergoing successful clipping of an anterior communicating artery aneurysm. Postoperative imaging studies revealed increased perfusion and diffuse edema in the left frontal and insular cortex. The symptoms and diffuse edema gradually resolved in both patients. These two cases of hyperperfusion syndrome occurred in a series of 190 patients treated by clipping of unruptured cerebral aneurysms. Hyperperfusion syndrome is a rare complication following aneurysm surgery, especially surgery for unruptured cerebral aneurysms without temporary clipping.

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Section: Discussionmentioning

confidence: 50%

Hyperperfusion Syndrome After Clipping an Unruptured Cerebral Aneurysm -Two Case Reports-

Sugino

Ohtaki

Wanibuchi

et al. 2010

Neurol. Med. Chir.(Tokyo)

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“…The primary cause of perioperative stroke is hypoperfusion due to temporary or permanent occlusion of a vessel, intraoperative retraction, or systemic hypotension. 1,46 Inadvertent permanent occlusion of a feeding or perforating artery occurs in 3.1% of patients undergoing aneurysm surgery and is a primary cause of intraoperative complications. 18 In these patients, the prompt and accurate recognition of insufficient collateral circulation is crucial to a good neurological outcome.…”

Section: Neuromonitoring Methodsmentioning

confidence: 99%

Detection of cerebral ischemia in neurovascular surgery using quantitative frequency-domain near-infrared spectroscopy

Calderon-Arnulphi

Alaraj

Amin‐Hanjani

et al. 2007

JNS

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Object There is great value in monitoring for signs of ischemia during neurovascular procedures. Current intraoperative monitoring techniques provide real-time feedback with limited accuracy. Quantitative frequency-domain near-infrared spectroscopy (Q-NIRS) allows measurement of tissue oxyhemoglobin (HbO2), deoxyhemoglobin (HHb), and total hemoglobin (tHb) concentrations and brain tissue oxygen saturation (SO2), which could be useful when monitoring for evidence of intraoperative ischemia. Methods Using Q-NIRS, the authors monitored 25 neurovascular procedures including aneurysm clip placement, arteriovenous malformation resection, carotid endarterectomy, superficial temporal artery–middle cerebral artery (MCA) bypass surgery, external carotid artery–MCA bypass surgery, encephaloduromyosynangiosis, and balloon occlusion testing. The Q-NIRS technology provides measurable cerebral oxygenation values independent from those of the scalp tissue. Thus, alterations in the variables measured with Q-NIRS quantitatively reflect cerebral tissue perfusion. Bilateral monitoring was performed in all cases. Five of the patients exhibited evidence of clinical ischemic events during the procedures. One patient suffered blood loss with systemic hypotension and developed diffuse brain edema intraoperatively, one patient suffered an ischemic event intraoperatively and developed an occipital stroke postoperatively, and one patient showed slowing on electroencephalography intraoperatively during carotid clamping; in two patients balloon occlusion testing failed. In all cases of ischemic events occurring during the procedure, Q-NIRS monitoring showed a decrease in HbO2, tHb, and SO2, and an increase in HHb. Conclusions Quantitative frequency-domain near-infrared spectroscopy provides quantifiable and continuous real-time information about brain oxygenation and hemodynamics in a noninvasive manner. This continuous intraoperative oxygenation monitoring is a promising method for detecting ischemic events during neurovascular procedures.

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“…Techniques such as optimal patient positioning for gravity retraction, dynamic retraction, and flexible microsurgical instrumentation have all been used to reduce or eliminate the use of standard retractors. 3,26 During MVD for HFS, fixed cerebellar retraction has historically been used to expose the cranial nerves. 15,17,25 When performing the operations in the 2008 study, the previous cranial nerve neurosurgical team at our institution routinely used both fixed and dynamic cerebellar retraction.…”

Section: Retractorless Surgerymentioning

confidence: 99%

Reduction in high-frequency hearing loss following technical modifications to microvascular decompression for hemifacial spasm

Frederickson

Balzer

Crammond

et al. 2015

JNS

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M icrovascular decompression (MVD) is a safe and efficacious procedure for the treatment of hemifacial spasm (HFS), a debilitating condition that reduces patients' quality of life. Severe sensorineural hearing loss (SNHL) across all frequencies is a known complication of the operation, with reported rates ranging from 1.4% to 20%. 4,12,[18][19][20][21]24 In addition to severe SNHL, however, a recent report has raised concern that as many as one-half of patients undergoing MVD for HFS may experience high-frequency (4-8 kHz) hearing loss.28 Although this type of hearing loss is not as obviously apparent upon clinical follow-up as severe SNHL, high-frequency hearing loss (HFHL) can profoundly reduce the quality of life of patients. 5,10 Although the prior report implicated noise from the high-speed surgical drill as the cause of HFHL following MVD, we conducted this study to examine the incidence of HFHL, with an emphasis on retractorless MVD for treatment of HFS.abbreviatioNs BAEP = brainstem auditory evoked potential; HFHL = high-frequency hearing loss; HFS = hemifacial spasm; MVD = microvascular decompression; SNHL = sensorineural hearing loss; SPL = sound pressure level. obJect Microvascular decompression is a safe and effective procedure to treat hemifacial spasm, but the operation poses some risk to the patient's hearing. While severe sensorineural hearing loss across all frequencies occurs at a low rate in experienced hands, a recent study suggests that as many as one-half of patients who undergo this procedure may experience ipsilateral high-frequency hearing loss (HFHL), and as many as one-quarter may experience contralateral HFHL. While it has been suggested that drill-related noise may account for this finding, this study was designed to examine the effect of a number of techniques designed to protect the vestibulocochlear nerve from operative manipulation on the incidence of HFHL. methods Pure-tone audiometry was performed both preoperatively and postoperatively on 67 patients who underwent microvascular decompression for hemifacial spasm during the study period. A change of greater than 10 dB at either 4 kHz or 8 kHz was considered to be HFHL. Additionally, the authors analyzed intraoperative brainstem auditory evoked potentials from this patient cohort. results The incidence of ipsilateral HFHL in this cohort was 7.4%, while the incidence of contralateral HFHL was 4.5%. One patient (1.5%; also included in the HFHL group) experienced an ipsilateral nonserviceable hearing loss. coNclusioNs The reduced incidence of HFHL in this study suggests that technical modifications including performing the procedure without the use of fixed retraction may greatly reduce, but not eliminate, the occurrence of HFHL following microvascular decompression for hemifacial spasm.

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A Review of Brain Retraction and Recommendations for Minimizing Intraoperative Brain Injury

Cited by 130 publications

References 115 publications

Hyperperfusion Syndrome After Clipping an Unruptured Cerebral Aneurysm -Two Case Reports-

Hyperperfusion Syndrome After Clipping an Unruptured Cerebral Aneurysm -Two Case Reports-

Detection of cerebral ischemia in neurovascular surgery using quantitative frequency-domain near-infrared spectroscopy

Reduction in high-frequency hearing loss following technical modifications to microvascular decompression for hemifacial spasm

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