Shao Jianning, Borghei-Razavi Hamid, Kshettry Varun R, Lim Michael, Recinos Pablo F
Section of Skull-Base Surgery, Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
Minimally Invasive Cranial Base and Pituitary Surgery Program, Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
Oper Neurosurg. 2020 Sep 15;19(4):E428-E431. doi: 10.1093/ons/opaa099.
Retraction injury can result in significant complications during intracranial operations. Alternative surgical techniques to minimize retraction pressure and duration of retraction can minimize the risk of retraction injury. We describe the use of a cottonoid "slider," which is a simple, cost-effective modification of a commonly used cottonoid, in multiple applications.
The cottonoid sliders are constructed preoperatively by overlaying an adhesive plastic incision drape on one side of a dry cottonoid patty and trimming the edges to fit the form of the cottonoid. Intraoperatively, the sliders can slide across the parenchymal surface atraumatically and are used for gentle retraction to expose desired areas. In addition, suction may be placed on the slider to clear fluid from the operative view. The plastic side of the slider prevents adherence to the parenchymal surface. Retractorless surgical techniques have been developed to minimize risk of retractor associated injury in intracranial surgery by reducing retraction pressure and duration. Given that the cottonoid sliders glide along the parenchyma, do not stick, and are used for dynamic retraction, the main objectives to minimize retraction injury can be met while not compromising operative efficiency.
Cottonoid sliders are a simple and cost-effective method of providing gentle exposure during intracranial surgery. This technique represents a valuable and cost-effective addition to the neurosurgical armamentarium.
牵开损伤可在颅内手术期间导致显著并发症。尽量减少牵开压力和牵开持续时间的替代手术技术可将牵开损伤风险降至最低。我们描述了一种棉片“滑块”的应用，它是对常用棉片的一种简单且经济有效的改良，可用于多种情况。
棉片滑块在术前通过将粘性塑料切口单覆盖在干燥棉片块的一侧并修剪边缘以适应棉片形状来构建。术中，滑块可无创伤地在脑实质表面滑动，用于轻柔牵开以暴露所需区域。此外，可在滑块上放置吸引装置以清除术野中的液体。滑块的塑料面可防止其粘附于脑实质表面。已开发出无牵开器手术技术，通过降低牵开压力和持续时间来将颅内手术中牵开器相关损伤的风险降至最低。鉴于棉片滑块可沿脑实质滑动、不粘连且用于动态牵开，在不影响手术效率的同时可实现将牵开损伤降至最低的主要目标。
棉片滑块是在颅内手术期间提供轻柔暴露的一种简单且经济有效的方法。该技术是神经外科手术器械库中有价值且经济有效的补充。
