title: Bubbles in the head: a new method for brain retraction during craniotomy.
abstract: BACKGROUND
  A key aspect of neurosurgery is the challenge of ensuring adequate visualization through brain retraction whilst ensuring that underlying brain remains protected. Self-retaining retractors (SRR) are specially designed for this purpose. Their limitation however is the potential for ischaemic damage that accompanies any pressure on the cerebral cortex.
  
  
  METHODS
  We use balloon tips of Fogarty catheters to provide gentle brain retraction during surgery for skull base and midline tumours as well as aneurysms of anterior circulation. Following completion of the craniotomy and dural opening, the balloon tip is inserted under the frontal or temporal lobes or into the interemispheric fissure, and then inflated. This results in distension of the arachnoid, thereby favouring the dissection process.
  
  
  CONCLUSIONS
  Diverting the brain from operative view with a more elastic, less traumatic, and easily adjustable Fogarty catheter balloon tip is a safe and effective tool that can either act as a substitute for SRR or alternatively minimise their duration of use.
authors.affiliation: Division of Neurosurgery, Civil Hospital, Alessandria, Italy. giannantonios@hotmail.com
authors.forename: Giannantonio
authors.initials: G
authors.lastname: Spena
authors.forename: Pietro
authors.initials: P
authors.lastname: Versari
mesh_terms: D001921:Brain / Q000033:anatomy & histology / Q000098:blood supply / Q000601:surgery*; D002404:Catheterization / Q000295:instrumentation*; D057785:Catheters / Q000639:trends*; D003399:Craniotomy / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D019635:Neurosurgical Procedures / Q000295:instrumentation* / Q000379:methods; D019291:Skull Base / Q000601:surgery*