title: En Bloc removal of soft tumors within the brain parenchyma using spoon retractors: traction-dissection method. Technical note.
abstract: BACKGROUND
  En bloc removal of soft tumors within the brain parenchyma has rarely been performed. We describe a safe technique for en bloc removal of the tumors using a spoon retractor, which enables retraction while holding the soft mass upward.
  
  
  METHODS
  Dissection of a tumor mass is performed under traction of the surrounding brain tissue by retracting the mass using a spoon retractor. A dissection plane is first established in a relatively safe area, not opposite the critical area, after a corticotomy. The dissection plane is then extended toward the critical side. After circumferential dissection of the tumor mass, the dissection is continued spirally into deeper regions by retracting and holding the mass upward using a spoon retractor. In this way, the tumor is removed en bloc.
  
  
  CONCLUSIONS
  The traction-dissection method using spoon retractors is useful in performing en bloc removal of soft tumors within the brain parenchyma less invasively and provides an appropriate operating field even at depth, reducing intraoperative bleeding, and in vascular rich tumors, possibly preventing tumor seeding in cases of malignant tumors.
authors.affiliation: Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Kyoshima
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Tsuji
authors.forename: Toshihide
authors.initials: T
authors.lastname: Toriyama
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kitazawa
mesh_terms: D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D004210:Dissection; D005910:Glioma / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation* / Q000379:methods*; D014143:Traction