Hiroshi Kashimura, Kuniaki Ogasawara, Yoshitaka Kubo, Shunsuke Kakino, Masayuki Sasoh, Hajime Takahashi, Kenji Suzuki, Akira Ogawa
Department of Neurosurgery, Iwate Medical University School of Medicine, Morioka, Iwate, Japan. hkashi@iwate-med.ac.jp
Neurologia medico-chirurgica 2008 MarWide 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.
Hiroshi Kashimura, Kuniaki Ogasawara, Yoshitaka Kubo, Shunsuke Kakino, Masayuki Sasoh, Hajime Takahashi, Kenji Suzuki, Akira Ogawa. Brain retraction technique using gelatin sponge in the subtemporal approach. Neurologia medico-chirurgica. 2008 Mar;48(3):143-6
PMID: 18362464
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