title: Use of transparent plastic tubular retractor in surgery for deep brain lesions: a case series.
abstract: Brain tissue retraction is frequently required to reach deep intra-axial lesions, and the quest for an ideal retractor that would protect the underlying brain tissue continues. Despite the availability of multiple retractors, the incidence of brain retraction injury remains high and has been reported to be 5% to 10%. A recently developed transparent tubular retractor appears to provide several advantages in surgery for deep intra-axial tumors and intracerebral hematomas. We used a new commercially available transparent tubular retractor in 16 craniotomies. Fourteen of these patients were operated upon for deep tumors and cysts, including two intraventricular tumors and two for deep intracerebral hemorrhages. In all patients, the tubular retractor was directed toward the lesion through a small corticotomy and guided by a navigation system. Each lesion was completely removed through the retractor's lumen. In all cases, the tubular retractors provided excellent visualization of the underlying pathology and facilitated its surgical removal, dissection, and hemostasis. The tubular nature of the retractor allowed the rotation and changing the angle of approach without putting extra pressure on the brain tissue, which inevitably occurs when malleable or other ribbon-type retractors are used. There were no hematomas on routine postoperative CT scans in this series. Transparent tubular retractors provide a unique means of deep visualization and even force distribution at the retracted brain tissue. Although these retractors were originally designed for the removal of deep subcortical tumors, they may be used to access and evacuate intracerebral hematomas. In our experience, the use of tubular retractors allows one to achieve safe access to deep intracerebral lesions and decreases the rate of retraction-related complications.
authors.affiliation: Department of Neurosurgery, University of Illinois, Chicago, IL, USA.
authors.forename: Sebastian R
authors.initials: SR
authors.lastname: Herrera
authors.forename: John H
authors.initials: JH
authors.lastname: Shin
authors.forename: Michael
authors.initials: M
authors.lastname: Chan
authors.forename: Pelagia
authors.initials: P
authors.lastname: Kouloumberis
authors.forename: Eduardo
authors.initials: E
authors.lastname: Goellner
authors.forename: Konstantin V
authors.initials: KV
authors.lastname: Slavin
mesh_terms: D001921:Brain / Q000601:surgery*; D001932:Brain Neoplasms / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000601:surgery; D004867:Equipment Design; D006801:Humans; D009493:Neurosurgery / Q000295:instrumentation*; D025321:Surgery, Computer-Assisted; D013525:Surgical Instruments