The impact of minimizing brain retraction in XXXX surgery: evaluation using magnetic resonance imaging.

@entity1 @entity39 @entity4 @entity16 @entity51 @entity439 @entity1188 @entity130 @entity438
BACKGROUND: Recent advances in skull base and microsurgical techniques minimize the need for brain retraction. OBJECTIVE: We studied the impact of such techniques in 36 @entity1 (51 @entity439 ) using magnetic resonance imaging (MRI). METHODS: Preoperative and 24 hours postoperative MR imaging was performed in @entity1 undergoing microsurgical clipping of @entity438 . Images were evaluated for parenchymal signal changes. During surgery, use and time of brain retraction were recorded. The degree of @entity130 was quantified using a 0 to 3 scale (grade 0 = normal surface; 1 = pial/ @entity16 ; 2 = gray matter injury; 3 = contusion/ @entity39 ). RESULTS: Brain retraction by use of a brain spatula was used in all @entity1 . Retraction times ranged from 14 to 290 minutes (mean, 84.1). Cortical surface changes were grade 0 in 86% and grade 1 in 14%; none showed grade 2 or 3 changes. In the postoperative MRI, 4 @entity1 presented with parenchymal alterations, 4 with @entity4 (11.1%), and 1 @entity1 had additional contusion (2.8%). All lesions were confined to the temporal pole. The grade of cortical surface changes was not related to lesions found on MR imaging. No @entity1 showed retraction-related @entity51 . CONCLUSION: The incidence of evident mechanical parenchymal injury ( @entity1188 or contusion) is very low when appropriate microsurgical and skull base techniques are used. Minor pia- @entity130 should nevertheless continue to be attended through future advances.
