Sriamornrattanakul Kitiporn, Ariyaprakai Chanon
Division of Neurosurgery, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Asian J Neurosurg. 2024 Jun 24;19(3):490-500. doi: 10.1055/s-0044-1787885. eCollection 2024 Sep.
Although many authors have recommended the retractorless technique to avoid retractor-induced brain injury, others usually use brain retractors with a meticulous technique to facilitate the surgery, especially for sylvian fissure dissection. The intrasylvian retraction technique was described for sylvian fissure opening, but no clinical evidence was found. We evaluate the efficacy and safety of this technique for the distal transsylvian approach. We reviewed the video records of clinical cases where the distal transsylvian approach was performed using the intrasylvian retraction technique for aneurysm treatment and middle cerebral artery (MCA) bypass between September 2018 and August 2022. Operative techniques are described. The efficacy and safety of the technique were assessed by full exposure of the sylvian fissure and new postoperative perisylvian hematoma, respectively. One hundred twenty-five cases were included and had an average age of 53.5 (range 16-85) years. Women comprised 73.6%. Aneurysm surgery, pure MCA revascularization, and aneurysm surgery with MCA revascularization were 106 (84.8%), 12 (9.6%), and 7 cases (5.6%), respectively. The most common aneurysm location was the internal carotid artery-posterior communicating artery junction in 37 cases (34.9%), followed by the anterior communicating artery in 27 (25.5%). Full exposure of the Sylvian fissure was achieved in all cases. No perisylvian hematoma was detected by immediate postoperative computed tomography in any patient. Using an appropriate technique for brain retractor application, sylvian fissure dissection was safely performed. The intrasylvian retraction technique effectively facilitated sylvian fissure dissection and provided wide exposure for the distal transsylvian approach.
尽管许多作者推荐采用无牵开器技术以避免牵开器导致的脑损伤，但其他作者通常会采用精细技术使用脑牵开器来辅助手术，尤其是在进行外侧裂分离时。已有文献描述了外侧裂内牵开技术用于打开外侧裂，但未发现临床证据。我们评估了该技术用于经外侧裂远端入路的有效性和安全性。我们回顾了2018年9月至2022年8月期间使用外侧裂内牵开技术进行动脉瘤治疗和大脑中动脉（MCA）搭桥的经外侧裂远端入路临床病例的视频记录。描述了手术技术。分别通过外侧裂的充分暴露和术后新出现的外侧裂周围血肿来评估该技术的有效性和安全性。纳入125例病例，平均年龄53.5岁（范围16 - 85岁）。女性占73.6%。动脉瘤手术、单纯MCA血管重建以及动脉瘤手术联合MCA血管重建分别为106例（84.8%）、12例（9.6%）和7例（5.6%）。最常见的动脉瘤位置是颈内动脉 - 后交通动脉交界处，共37例（34.9%），其次是前交通动脉，共27例（25.5%）。所有病例均实现了外侧裂的充分暴露。术后即刻计算机断层扫描未在任何患者中检测到外侧裂周围血肿。通过采用合适的脑牵开器应用技术，安全地进行了外侧裂分离。外侧裂内牵开技术有效地促进了外侧裂分离，并为经外侧裂远端入路提供了广泛的暴露。
