Retractorless brain surgery: technical considerations

Abstract Background Retraction is necessary to access deep areas in the brain and skull base, but prolonged forceful use of fixed retraction might be injurious. Several techniques were developed, concept minimally invasive neurosurgery, eliminate or minimize retractors. The authors discuss technical considerations limits applying dynamic surgery for a variety lesions using different approaches. Results We retrospectively collected 123 cases with diverse locations, retraction, tools operator hands was achieved successfully instead retraction. Cases aneurysms excluded, although applied during clipping only. Superficial large masses that do not require as routine excluded also. relied mainly on patient positioning benefit from gravity, proper design craniotomy, arachnoid dissection, cerebrospinal fluid aspiration, internal decompression mass when possible. Different approaches utilized our patients, subfrontal pterional their modifications 45.5% cases, suboccipital 21.1%, retrosigmoid 13%, interhemispheric approach 10.5%, transcortical lateral ventricles 7.3%, posterior subtemporal 2.4%. Dynamic surgical used all except 7 patients (5.6%) where we had transiently. Conclusion are helpful amenable achieve successful without Utilizing unlocking brain, choosing corridor, suctioning, mastering microsurgical keys.