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Clip-retraction of the superficial Sylvian vein to enhance visualization in “retractorless” aneurysm surgery

Acta Neurochirurgica volume 158, pages 229–232 (2016)Cite this article

Abstract

Background

According to microsurgical principles, the access to deep-seated cerebral lesions should be as atraumatic as possible. Temporary brain retraction is acceptable in certain situations and may be indispensable when the view of the lesion is obstructed.

Method

The utility of this method is illustrated in a case of a ruptured middle cerebral artery (MCA) aneurysm. Two temporary aneurysm clips were connected by a braided suture, thus forming a band with two points of attachment. The Sylvian fissure was opened in a standard fashion. Using one clip, the adventitia and arachnoid over the superficial Sylvian vein were grasped firmly enough to mobilize the superficial Sylvian vein. The distal clip was then attached to surrounding drapes, thus granting a direct view of the aneurysm in the depth of the fissure. Retraction with spatula was not necessary. Patency of the superficial Sylvian vein was demonstrated using idocyanine green angiography.

Results

We present a simple method for minimally traumatic brain retraction using aneurysm clips attached to the adventitia of Sylvian veins and held back by sutures.

Conclusion

The use of clips attached to the adventitia of the superficial Sylvian may be of help in retracting the Sylvian fissure. By virtue of enlarging the field of view into the deep Sylvian fissure, it may be of help in performing retractorless aneurysm surgery.

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Author information

Affiliations

  1. Department of Neurosurgery, University Hospital Göttingen, Georg-August University, Robert-Koch-Str. 40, 37075, Göttingen, Germany

    Bawarjan Schatlo

  2. Department of Surgery, University of Toronto, Toronto, Canada

    Ivan Radovanovic

  3. Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Canada

    Ivan Radovanovic

Authors
  1. Bawarjan Schatlo
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  2. Ivan Radovanovic
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Corresponding author

Correspondence to Bawarjan Schatlo.

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Funding

No funding was received for this research.

Conflict of Interest

None

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Cite this article

Schatlo, B., Radovanovic, I. Clip-retraction of the superficial Sylvian vein to enhance visualization in “retractorless” aneurysm surgery. Acta Neurochir 158, 229–232 (2016). https://doi.org/10.1007/s00701-015-2684-1

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  • DOI: https://doi.org/10.1007/s00701-015-2684-1

Keywords

  • Aneurysm surgery
  • Middle cerebral artery aneurysms
  • Microsurgery
  • Minimally invasive surgery
  • Indocyanine green
  • Clipping