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

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.

概要

神经外科作为高度专业化领域,常涉及对精细结构的手术操作,其中大脑牵拉术常用于触及大脑深层病灶,但目前尚无可靠的方法预防系列牵拉并发症的发生。本研究拟设计一种适用于经颅内镜手术的新技术,以保证周围脑组织的安全牵拉。新技术设计将可扩展腔插入颅内病灶点附近,置于最佳位置后即可被打开,保证了神经外科手术中可观的操作空间。本研究涉及使用力传感器评估牵拉阶段施加在脑组织上的压力值试验。翼点开颅术后,在牵拉过程中使用不同倾角的传统金属抹刀测量压力,尽管牵拉和施加在抹刀上的力相同,但抹刀边缘以不同倾角施加在实质脑组织上的局部压力变化却很大。综上,本研究通过设计一种腔式牵开器,用于大脑牵拉,避免由于边缘超压引起牵拉并发症,以保持施加在实质脑组织上的压力值适宜。