A Novel Foley Catheter-Based Brain Retraction Method for the Interhemispheric Approach: Technical Considerations and an Illustrative Video

• Published in: World neurosurgery Vol. 185; pp. e1030 - e1039
• Main Authors: Zaimoglu, Murat, Gökalp, Elif, Gurses, Muhammet Enes, Ozpiskin, Omer, Alpergin, Baran Can, Tekneci, Ozan, Eroglu, Umit
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2024
• Subjects: Adult; Aged; Brain Neoplasms - diagnostic imaging; Brain Neoplasms - surgery; Brain retraction; Catheters; Contusion; Epidermal Cyst - diagnostic imaging; Epidermal Cyst - surgery; Female; Humans; Interhemispheric approach; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - surgery; Ischemia; Male; Middle Aged; Neurosurgical Procedures - methods; Postoperative complications; Retrospective Studies; Young Adult; CC; Brain retraction; MRI; Contusion; AP; mRS; CT; CTA; SSS; Interhemispheric approach; Ischemia; CSF; Gd; Postoperative complications; TR; ACA
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2024.03.015

Management of interhemispheric pathologies requires surgical intervention through a restricted anatomical corridor ensconced within critical cerebral structures. The use of retractors to facilitate operative access may cause damage to cerebral tissue. The development of an innovative retraction technique designed to alleviate cerebral damage in such cases is imperative. In this study, we present a novel and gentle retraction method to facilitate the interhemisferic approach. We retrospectively examined data of 9 right-handed patients who underwent surgical resection of interhemispheric lesions between 2021 and 2022. All patients underwent surgery for the first time because of this pathology. All operative specimens were histologically confirmed. Clinical characteristics, operative details, and follow-up data were retrospectively analyzed. The new retraction technique was successfully applied to 8 tumor patients and 1 patient with an aneurysm. Eight patients had an anterior interhemispheric approach, and 1 patient had a posterior interhemispheric approach. Complete surgical excision was achieved in all patients with no postoperative complications. Postoperative Gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) showed no signs of ischemia or contusion. All patients exhibited significant improvements in their symptoms. An illustrative video that elucidates the removal of an interhemispheric epidermoid tumor, employing the anterior ipsilateral interhemispheric approach, featuring the novel retraction method. The ideal retraction technique during the interhemispheric approach is still a challenge. Our novel retraction technique may help minimize brain parenchymal damage during surgical resection of interhemispheric lesions.