An expandable chamber for safe brain retraction: new technologies in the field of transcranial endoscopic surgery.

Elena Roca; Anna Gobetti; Giovanna Cornacchia; Oscar Vivaldi; Barbara Buffoli; Giorgio Ramorino

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An expandable chamber for safe brain retraction: new technologies in the field of transcranial endoscopic surgery.

Author: Elena ROCA ¹ ; Anna GOBETTI ² ; Giovanna CORNACCHIA ³ ; Oscar VIVALDI ⁴ ; Barbara BUFFOLI ⁵ ; Giorgio RAMORINO ²
Author Information

1. Head and Neck Department, Neurosurgery, Istituto Ospedaliero Fondazione Poliambulanza, 25124 Brescia, Italy. rocaelena@gmail.com.
2. Materials Science and Technology at Department of Mechanical and Industrial Engineering, University of Brescia, 25123 Brescia, Italy.
3. Metallurgy at Department of Mechanical and Industrial Engineering, University of Brescia, 25123 Brescia, Italy.
4. Head and Neck Department, Neurosurgery, Istituto Ospedaliero Fondazione Poliambulanza, 25124 Brescia, Italy.
5. Anatomy and Physiopathology Division, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy.
Publication Type:Journal Article
Keywords: Brain retraction; Brain retraction injury; Brain retractor design; Retraction complication; Spatula; Transcranial endoscopic surgery
MeSH: Humans; Brain/surgery*; Neurosurgical Procedures/methods*; Neurosurgery; Brain Neoplasms; Endoscopy
From: Journal of Zhejiang University. Science. B 2023;24(4):326-335
CountryChina
Language:English
Abstract: Neurosurgery is a highly specialized field: it often involves surgical manipulation of noble structures and cerebral retraction is frequently necessary to reach deep-seated brain lesions. There are still no reliable methods preventing possible retraction complications. The objective of this study was to design work chambers well suited for transcranial endoscopic surgery while providing safe retraction of the surrounding brain tissue. The chamber is designed to be inserted close to the intracranial point of interest; once it is best placed it can be opened. This should guarantee an appreciable workspace similar to that of current neurosurgical procedures. The experimental aspect of this study involved the use of a force sensor to evaluate the pressures exerted on the brain tissue during the retraction phase. Following pterional craniotomy, pressure measurements were made during retraction with the use of a conventional metal spatula with different inclinations. Note that, although the force values necessary for retraction and exerted on the spatula by the neurosurgeon are the same, the local pressure exerted on the parenchyma at the edge of the spatula at different inclinations varied greatly. A new method of cerebral retraction using a chamber retractor (CR) has been designed to avoid any type of complication due to spatula edge overpressures and to maintain acceptable pressure values exerted on the parenchyma.