The history of brain retractors throughout the development of neurological surgery

Assina, Rachid; Rubino, Sebastian; Sarris, Christina E.; Gandhi, Chirag D.; Prestigiacomo, Charles J.

doi:10.3171/2014.2.focus13564

Cited by 41 publications

(23 citation statements)

References 27 publications

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“…Brain manipulation/retraction is an essential step to access deep lesions in the brain parenchyma or the base of the skull. Throughout the development of neurosurgery, retraction was developed from simple handheld to selfretaining retractors for the sake of freeing the surgeons' hands, minimizing fatigue and tremors, especially with the introduction of micro-neurosurgery [1,2].…”

Section: Discussionmentioning

confidence: 99%

“…Brain retraction plays an important rule to reach deep seated lesions to protect surrounding structures and to avoid brain matter transgression. From simple hand retractors to more advanced self-retaining systems, the development continued to improve their efficacy and to minimize defects like assistant fatigue, hand tremors, retractor slippage and brain injury [1,2].. Retraction injury to neural and vascular structures is the most devastating and unwanted complication of fixed retractors. There are several aspects of retraction injury that may occur especially with excessive, prolonged retraction for large lesions.…”

Section: Introductionmentioning

confidence: 99%

“…Methods and techniques to minimize those side effects like special retractors did not gain popularity [1,2].…”

Section: Introductionmentioning

confidence: 99%

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Retractorless brain surgery: technical considerations

Nazim

Elborady

2021

Egypt J Neurol Psychiatry Neurosurg

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Background Retraction is necessary to access deep areas in the brain and skull base, but prolonged and forceful use of fixed retraction might be injurious. Several techniques were developed, in the concept of minimally invasive neurosurgery, to eliminate or minimize the use of fixed retractors. The authors discuss the technical considerations and limits in applying dynamic retraction in brain surgery for a variety of lesions using different approaches. Results We retrospectively collected 123 cases with brain lesions in diverse locations, were dynamic retraction, using the tools in the operator hands and was achieved successfully instead of fixed retraction. Cases with aneurysms were excluded, although retraction was applied during clipping only. Superficial and large masses that do not require fixed retraction as a routine were excluded also. We relied mainly on patient positioning to benefit from the gravity, proper design of the craniotomy, arachnoid dissection, cerebrospinal fluid aspiration, and internal decompression of the mass when possible. Different approaches for different lesions were utilized in our patients, subfrontal or pterional and their modifications in 45.5% of cases, suboccipital in 21.1%, retrosigmoid in 13%, the interhemispheric approach in 10.5%, transcortical to lateral ventricles in 7.3%, and posterior subtemporal in 2.4%. Dynamic retraction with the surgical tools was used successfully in all cases except 7 patients (5.6%) where we had to use fixed retraction transiently. Conclusion Several considerations are helpful and amenable to achieve successful brain surgery without fixed retraction. Utilizing the gravity, unlocking of the brain, choosing the surgical corridor, cerebrospinal fluid suctioning, and mastering of the microsurgical techniques are the keys.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Retractorless brain surgery: technical considerations

Nazim

Elborady

2021

Egypt J Neurol Psychiatry Neurosurg

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“…Many tools have been developed for effective and safe retraction during brain surgery. In the 1960s, a retractor called a brain elevator was designed [16]. Since then, several retractors with different sizes and shapes have been developed [17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Tumor retractor: a simple and novel instrument for brain tumor surgery

et al. 2020

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Background: It is important to secure a surgical space during brain tumor surgery. One of the commonly used methods is to retract the brain. We hypothesized that the tumor can be retracted and that the normal brain tissue retraction can be minimized during surgery, and thus, the degree of collateral damage caused by brain retraction would be reduced. Methods: The tumor retractor had a 90°, hard, and sharp tip for fixation of the tumor. The distal part of the retractor has a malleable and thin blade structure. By adjusting the angle of the distal malleable part of the tumor retractor, the operator can make the retracting angle additionally. Retractors with thin blade can be used in a conventional selfretraction system. To pull and hold the tumor constantly, the tumor retractor is held by a self-retraction system. The surgical technique using a tumor retractor is as follows: The first step is to fix the retractor to the tumor. The second step is to pull the retractor in the operator's desired direction by applying force. After the tumor is pulled by adjusting the degree of force and angle, the surgical arm should be held in place to maintain the tumor retracted state. Results: The tumor retractor was used to minimize the brain retraction, pulling the tumor in the opposite direction from the surrounding brain tissue. In clinical cases, we can apply the tumor retractor with good surgical outcomes. Conclusions: A tumor retractor can be used to pull a tumor and minimize the brain retraction.

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“…At the end of surgery it leaves behind a negligible neurosurgical footprint. 1 The fourth Industrial Revolution has touched nearly all aspects of neurosurgery and the newer tubular retractor systems are a testimony to this fact. They aid in providing better visualization with minimal damage to the neural structures, which happen to be innocent bystanders overlying the path for deep-seated lesions.…”

Section: Introductionmentioning

confidence: 99%

Transparent Tubular Retractor in Cranial Surgery: A Retrospective Analysis

Sundaravadhanan

2019

Indian Journal of Neurosurgery

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Introduction The fourth Industrial Revolution has touched nearly all aspects of neurosurgery and the newer tubular retractor systems are a testimony to this fact. They aid in providing better visualization with minimal damage to those neural structures, which happen to be innocent bystanders overlying the path of deep-seated lesions. In addition to providing better patient outcomes they are surgeon friendly with their ergonomic design and improved stability, thereby causing minimal fatigue, and aid in procedures requiring precision and perseverance. A retrospective study conducted at a single institute analyzed the efficacy of transparent tubular retractors during cranial surgery for deep-seated lesions. Materials and Methods This retrospective study was conducted between April 2015 and July 2018 in a single institute wherein 22 patents with various deep-seated intracranial lesions were operated using the transparent tubular retractor, View Site Brain Access System (VBAS, Vycor Medical Inc.). Observation Of the 22 cases, 45% were of spontaneous intracerebral hemorrhage; 27% were high-grade gliomas; and the rest were colloid cyst, cystic tumors, and metastatic tumors in equal proportion. Total tumor excision was achieved in 27%, while 90% excision was achieved in 45% cases. The overall complication rate was 13%. Conclusion The transparent tubular retractors contribute to minimal invasiveness by causing uniform distribution of retraction pressure and minimal disruption of fiber tracts. Their use has a definite role in improving surgical outcomes for deep-seated intracranial lesions.

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The history of brain retractors throughout the development of neurological surgery

Cited by 41 publications

References 27 publications

Retractorless brain surgery: technical considerations

Retractorless brain surgery: technical considerations

Tumor retractor: a simple and novel instrument for brain tumor surgery

Transparent Tubular Retractor in Cranial Surgery: A Retrospective Analysis

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