Objective: A retrospective study was conducted to analyze the clinical data of patients treated by retractorless surgery and explore the clinical feasibility and practical application of this strategy.
Methods: A total of 194 patients undergone retractorless surgery in Beijing Tiantan Hospital from Nov 2013 to Oct 2014 were retrospectively reviewed. Complications related to microsurgical approaches, disease types, neurological function score and intraoperative compression or stretching were analyzed.
Results: Of the 194 cases, there were 127 (65%) patients with cerebrovascular diseases and 67 (35%) patients with intracranial tumors. Sixty patients had anterior circulation aneurysms, of them, 21 aneurysms were accessed through frontal-lateral approaches and 39 reached via pterional approaches. Two patients with posterior inferior cerebellar artery (PICA) aneurysms were treated by far-lateral approaches. Fifteen patients with cerebellopontine angle (CPA) tumors were treated by retrosigmoid approaches. Elven patients with supratentorial tumors were treated by anterior and posterior interhemispheric approaches. Twenty patients with posterior fossa tumors were treated by suboccipital posterior median and paramedian approaches. Two patients with petroclival region lesions were treated by subtemporal approaches. Damage of tissues surrounding the approach occurred in 4 cases (2%). One patient received secondary procedures (0.52%) and 2 patients died after operation (1%). No change of postoperative neurological function was seen in 62.3% of cases, improvement of postoperative neurological function was seen in 29.4% and neurological function deterioration 8.24%.
Conclusions: Compared with the retractor surgery, retractorless surgery does not increase the rate of damage of tissues surrounding the approach. With the proficiency in micro-neurosurgery methods, retractorless surgery can reduce the postoperative complications.