title: Brain retraction technique using gelatin sponge in the subtemporal approach.
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.
authors: Department of Neurosurgery, Iwate Medical University School of Medicine, Morioka, Iwate, Japan. hkashi@iwate-med.ac.jp
authors: Hiroshi
authors: H
authors: Kashimura
authors: Kuniaki
authors: K
authors: Ogasawara
authors: Yoshitaka
authors: Y
authors: Kubo
authors: Shunsuke
authors: S
authors: Kakino
authors: Masayuki
authors: M
authors: Sasoh
authors: Hajime
authors: H
authors: Takahashi
authors: Kenji
authors: K
authors: Suzuki
authors: Akira
authors: A
authors: Ogawa
mesh_terms: D015331:Cohort Studies; D004210:Dissection / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D015503:Surgical Sponges; D013702:Temporal Lobe / Q000601:surgery*