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LETTER TO EDITOR
Year : 2016  |  Volume : 64  |  Issue : 5  |  Page : 1080

Falx stitch for retraction of the superior sagittal sinus–technical note


Achantha Lakshmipathy Neurosurgical Centre, Voluntary Health Services Taramani, Chennai, Tamil Nadu, India

Date of Web Publication12-Sep-2016

Correspondence Address:
Shyam S Krishnan
Achantha Lakshmipathy Neurosurgical Centre, Voluntary Health Services Taramani, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.190239

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How to cite this article:
Krishnan SS, Devareddy G, Vasudevan MC. Falx stitch for retraction of the superior sagittal sinus–technical note. Neurol India 2016;64:1080

How to cite this URL:
Krishnan SS, Devareddy G, Vasudevan MC. Falx stitch for retraction of the superior sagittal sinus–technical note. Neurol India [serial online] 2016 [cited 2019 Nov 13];64:1080. Available from: http://www.neurologyindia.com/text.asp?2016/64/5/1080/190239




Sir,

In general, in interhemispheric approach, craniotomy is made upto the midline and the dura is reflected towards the superior sagittal sinus. Retraction on brain decreases when the craniotomy crosses the midline. The retraction of falx and superior saggital sinus is safe and increases the corridor for surgery.[1] However, in some patients, the superior sagittal sinus is large with bilateral multiple venous lakes preventing the opening of the dura more medially, thus restricting access to the interhemispheric fissure. The surgeon, therefore, has to retract the brain in order to reach the midline. Brain should not be retracted more than 2 cm away from the falx because this may cause retraction injury to the cortex.[2] The retraction of falx and superior sagittal sinus permits an increase in the surgical corridor and allows a better view while performing surgeries. In general, a Leyla retractor or a dural stitch is used to retract superior saggital sinus. In the presence of a large superior sagittal sinus, however, sinus retraction may not be sufficient; hence, the technique used by us may be beneficial. We take a stitch in the falx and spread it in a “V” pattern along the dural edge that will retract the dural sinus almost upto the level of the falx, thereby availing the maximum possible working space, and at the same time, avoiding excessive retraction to the brain [Figure 1],[Figure 2],[Figure 3].
Figure 1: (a) Figure showing the reflected dura (arrow) and the large superior sagittal sinus (star) before taking the falx stitch. (b) Diagrammatic representation of the same view

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Figure 2: (a) Figure showing significant increase in the operative corridor after taking the falx stitch (arrow head). (b) Diagrammatic representation of the same view

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Figure 3: (a) Scale showing the dimension of the operative field before taking the falx stitch. (b) Scale showing increase in the operative exposure by 0.5 cm after taking the falx stitch

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  References Top

1.
Salcman M, Heros RC, Laws ER Jr, Sonntag VKH. Falx and parasaggital meningiomas. In: Salcman M, Heros RC, Laws ER Jr, Sonntag VKH, eds. Operative Neurosurgery, Volume 1. 2nd ed. New York: Springer Verlag; 2004.p. 121-37.  Back to cited text no. 1
    
2.
Chang EC, Barker FG II, Curry WT. Surgical approach to falcine meningiomas. Hinoja AQ, editor. Schmidek and Sweet Operative Neurosurgical Techniques-Indications, Methods, and Results. 6th ed. China: Elsevier Saunders; 2012. p. 410-16.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]

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