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| NI FEATURE: CENTS (CONCEPTS, ERGONOMICS, NUANCES, THERBLIGS, SHORTCOMINGS) |
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| Year : 2020 | Volume
: 68
| Issue : 4 | Page : 880-881 |
Gooseneck Flexible Brain Retractor—Utility of Flexible Gooseneck Tubing in Neurosurgery
Ramesh V V Chandra, B Chandramowliswara Prasad, T Goutham Hanu
Department of Neurosurgery, SVIMS, Tirupati, Andhra Pradesh, India
| Date of Web Publication | 26-Aug-2020 |
Correspondence Address:
Dr. Ramesh V V Chandra
Professor, Department of Neurosurgery, SVIMS, Tirupati - 517 507, Andhra Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.293456
Introduction: Brain retractor is an indispensable instrument in Neurosurgery craniotomy set. Gooseneck tubing is an engineering marvel and has many applications (Reading lamp, Microphone, Tablet/phone holder, etc). We present a brain retractor made with an ultra-light duty Gooseneck tubing and report its use in five craniotomies for various pathologies.
Methods and Results: The traditional flexible brain retractor (Leyla) consists of three principal parts: a flxation base, a flexible arm or arms, and a blade holder. We replaced the flexible arm by an ultra-light duty Gooseneck tubing in our new retractor. The retractor proved very useful in the five cranial surgeries done and no complications were noted during its use.
Conclusion: Gooseneck flexible Brain Retractor is a safe and cheaper alternative to the presently available brain retractor system. It has several advantages compared to traditional retractor. The efficacy and supremacy over traditional retractor systems need to be confirmed by further studies.
Keywords: Brain retractor, flexible gooseneck tubing, neurosurgery
Key Messages: A unique self retaining retractor using flexible gooseneck tubing with its applications in cranial surgeries is described
How to cite this article:
Chandra RV, Prasad B C, Hanu T G. Gooseneck Flexible Brain Retractor—Utility of Flexible Gooseneck Tubing in Neurosurgery. Neurol India 2020;68:880-1 |
Brain retraction helps in reaching the deepest parts of the brain and brain retractor is an indispensable instrument in Neurosurgery craniotomy set. The initial handheld brain retractors were introduced in 1885.[1] Flexible table-mounted brain retractors are in use since 1977 (Leyla retractor).[2] There has been no progress in the retractor systems after 1977 and all neurosurgeons use this retractor. Gooseneck tubing is an engineering marvel and has many applications [Reading lamp [Figure 1]a, Microphone, Tablet/phone holder etc].[3],[4],[5] We present a brain retractor using this technology and add another innovation in the field of brain retractors similar to tubular retractors.[6]
| » Procedure | |  |
The traditional flexible brain retractor (Leyla) consists of three principal parts: a flxation base, a flexible arm, and a blade holder. Leyla mechanical arm is composed of multiple portions inserted similar to a tulip with adjustable stainless steel wire inside. The arm needs to be adjusted frequently by adjusting the tension in the wire; this adjustment is subjective and excessive tension may lead to pressure/injury to the brain. This retractor needs two surgeons to operate-the main surgeon stabilizes the retractor and an assistant tightens it. The mobility of this arm is restricted and does not have six degrees of freedom throughout its movement. The retractor devised by us has the same components as a traditional retractor except for the flex arm. The flex arm is replaced by an ultra-light duty Gooseneck tubing. The presence of the gooseneck tubing offers flexibility and resilience to this retractor and allows a very passive and light retraction on the brain. The flex arm has six degrees of freedom throughout its movement [Figure 1]b and can be used to retract all regions of the brain without changing the fixation point. This retractor can be operated by a single surgeon without depending on an assistant. The flex arm and brain spatula are made of medical grade stainless steel, the durability needs to be tested in larger studies. This retractor is cheaper than the traditional retractor and approximate cost will be a fraction of it. The retractor is fixed to an elephant rod which is available in most of the neurosurgery operation theatres similar to a Leyla retractor [Figure 2]a. We performed five cranial surgeries using this retractor to test the ease of use and efficacy. The retractor proved very useful in all the cranial surgeries and no complications were noted during its use. The retractor was used in a variety of cranial cases (three brain tumors, two aneurysms) which included a convexity meningioma [Figure 2]b, Infra tentorial Supracerebellar approach for a pineal tumor [Figure 2]c and clipping of Anterior communicating aneurysm [Figure 2]d. | Figure 1: Showing a reading lamp made with gooseneck tubing (a) and the retractor based on flexible gooseneck tubing (b) the six-degree of freedom throughout the movement is demonstrated
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 | Figure 2: Intraoperative image showing the retractor fixed to the OT table through an elephant rod (a). Intraoperative photographs showing the retractor being used in a case of convexity meningioma (b), Infratentorial Supracerebellar approach for a pineal tumour (c) and clipping of Acom aneurysm (d)
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| » Conclusions | | |
Gooseneck flexible Brain Retractor is a safe and cheaper alternative to the presently available brain retractor system. The retraction provided is passive as it does not involve the active tightening of the flex arm. The efficacy, durability, and supremacy over traditional retractor systems need to be confirmed by further studies.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| » References | | |
| 1. | Kirkpatrick DB. The first primary brain-tumor operation. J Neurosurg 1984;61:809-13.  |
| 2. | Yasargil MG, Fox JL. The microsurgical approach to acoustic neurinomas. Surg Neurol 1974;2:393-8. |
| 3. | Schaak L, inventors. Gooseneck lighting apparatus with decorative jelly sleeve.US Patent 2006/0077672 A1. 2006. |
| 4. | Donnell KD, Inventors. Microphone mount. US Patent 5,010,803 A1. 1991. |
| 5. | Firnberg J, Inventor. Gooseneck video device holder. US Patent 2008/01584.11A1. 2008. |
| 6. | Ratre S, Yadav N, Parihar VS, Dubey A, Yadav YR. Endoscopic surgery of spontaneous basal ganglionic hemorrhage. Neurol India 2018;66:1694-703. [ PUBMED] [Full text] |
[Figure 1], [Figure 2]
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