Herrera Sebastian R, Shin John H, Chan Michael, Kouloumberis Pelagia, Goellner Eduardo, Slavin Konstantin V
Department of Neurosurgery, University of Illinois, Chicago, IL, USA.
Surg Technol Int. 2010 Apr;19:47-50.
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.
为了暴露深部轴内病变，常常需要进行脑组织牵开，人们一直在寻找一种能够保护其下方脑组织的理想牵开器。尽管有多种牵开器可供使用，但脑牵开损伤的发生率仍然很高，据报道为5%至10%。最近开发的透明管状牵开器在深部轴内肿瘤和脑内血肿手术中似乎具有多种优势。我们在16例开颅手术中使用了一种新的市售透明管状牵开器。其中14例患者接受了深部肿瘤和囊肿手术，包括2例脑室内肿瘤和2例深部脑内出血手术。在所有患者中，管状牵开器通过小的皮质切开术指向病变，并由导航系统引导。每个病变都通过牵开器的内腔完全切除。在所有病例中，管状牵开器都能很好地显示其下方的病变情况，便于进行手术切除、分离和止血。牵开器的管状结构允许旋转并改变入路角度，而不会对脑组织施加额外压力，而使用可塑或其他带状牵开器时不可避免地会出现这种压力。本系列患者术后常规CT扫描均未发现血肿。透明管状牵开器为深部可视化和在牵开的脑组织上均匀分布力量提供了一种独特的方法。尽管这些牵开器最初是为切除深部皮质下肿瘤而设计的，但它们也可用于进入和清除脑内血肿。根据我们的经验，使用管状牵开器能够安全地暴露深部脑内病变，并降低牵开相关并发症的发生率。
