Neural surfaces coverage with "collagen films and cigarettes": A revisited and modified method of protection and retraction during microsurgical approaches to craniospinal lesions.
OBJECTIVE
Despite the surgical cotton patties application and meticulous manipulation, mechanical contact between the different microsurgical instruments and neurovascular structures may jeopardize its integrity through laceration or cerebrospinal perfusion. We present a technique based on using collagen films and cigarettes, both to protect and retract such structures, and compared it with the cottonoid technique.


METHODS
During the last 3 years, collagen in "film and cigarette format" has been used in several microsurgical procedures for the treatment of craniospinal lesions by the first author. The collagen films were broken into pieces and adapted to the exposed neural surface measurements to protect and/or retract during microsurgical dissection. At the same time, handmade collagen "cigarettes" were used as retractors to keep open the neural lips of the transsulcal and transfissural corridors. To investigate the relevance of this technique for minimizing surgical morbidity, a blind third-party observer quantified the tissue preservation by a postoperative magnetic resonance imaging (MRI) protocol, in a short series with randomized cotton patty vs. collagen film protection.


RESULTS
Only two of the 20 examined "collagen group" cases exhibited areas of additional abnormal signal, as against 16 cases of the "cotton patty group." Furthermore, a statistically significant difference between both the groups based on the radiological results was also demonstrated.


CONCLUSIONS
The results of the present series support the usefulness of the neurovascular coverage and retraction with collagen films and cigarettes, respectively. It seems to be a good alternative to surgical cotton patties and other materials owing to its hemostatic, protection, retraction, and dissection capacity.
Gutiérrez Morales
Julio César
JC
Department of Neurosurgery, Hospital Universitario Central de Asturias, Principado de Asturias, Spain. gutierrezhcas@hotmail.com
Gutiérrez Morales
Sandra E
SE
Ruiz Moya
Bernardino E
BE
Palomeque
Manuel Lago
ML
García
Antonio López
AL
D000818:Animals; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D002560:Cerebrovascular Circulation; D003094:Collagen / Q000627:therapeutic use; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008833:Microcirculation; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods; D010841:Pia Mater / Q000473:pathology; D011859:Radiography; D012996:Solutions; D013116:Spinal Cord / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D013552:Swine
D012996:Solutions; D003094:Collagen