Retractorless surgery for a pineal region tumor through an occipital transtentorial approach

Abstract

<jats:p>This video demonstrates surgical techniques of the occipital transtentorial approach to a pineal region tumor without using a fixed brain retractor, which may cause functional impairment or even tissue injury to the occipital visual cortex. There are several ways to facilitate retractorless surgery through this approach. A lateral-semiprone positioning of the patient can induce gravity retraction. The brain is relaxed by draining CSF fluid through lumbar drainage or lateral ventricular tap in the case of obstructive hydrocephalus. Dynamic retraction with handheld instruments after extensive dissection of the deep venous system, including basal veins, can provide a sufficient working space.</jats:p><jats:p>The video can be found here: <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="https://youtu.be/kQvEHiNcRow" ext-link-type="uri" xlink:type="simple">https://youtu.be/kQvEHiNcRow</jats:ext-link>.</jats:p>

Retractorless brain surgery: technical considerations

“…This could be achieved by relying on basic surgical steps that are amenable when applied properly, and in the absence of sophisticated intraoperative equipment. The main steps are proper patient positioning to benefit from the gravity, design of the craniotomy, choice of natural corridors to avoid brain transgression, proper arachnoid dissection, and CSF aspiration [1,6,[16][17][18][19][20][21][22]. Patient positioning and craniotomy design are two simple and effective steps to avoid fixed retraction, although not specific for.…”

“…Other measures to reduce intracranial pressure were applied infrequently in our patients, like lumbar drainage and ventricular tapping. Preplanned lumbar drain, although advised by some authors, was used in 2 cases (1.6%) only as it is not preferred by the authors, while intraoperative ventricular tapping was done in 4 cases (3.2%) where no access to basal cisterns to aspirate CSF [16,19].…”

Krause approach to pineal tumour with intraoperative oculomotor nerve monitoring

“…During surgery to treat lesions in this region, minimizing postoperative oculomotor nerve palsy (diplopia and ptosis) is crucial, so as not to compromise the quality of life of patients after surgery. 2 , 3 , 4 , 5 , 6 , 7 To prevent such complications, intraoperative localization of the oculomotor nerve and extra-ocular muscle monitoring is required. However, reports on intraoperative oculomotor nerve monitoring have been sparse.…”

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

“…With the careful and accurate use of the handheld suction device and operating instruments, the fixed retraction was replaced by retractorless technique, thus avoiding brain injuries related to a fixed retractor. Since then, the retractorless surgery has been performed in giant vestibular schwannomas, intracranial aneurysm clipping, and deep brain tumor resection [ 1 , 3 , 6 , 7 ]. A movement away from the use of fixed retractors has also been heralded as an advance in skull base surgery.…”