Abstract
Background: In microneurosurgery, maximizing retraction and minimizing injury to neural tissue is critical for safe and effective surgery. Retraction is necessary for essentially all surgical principles, but barotrauma to eloquent and delicate neural tissue must be avoided. This differentiates microneurosurgery from other surgical disciplines. Historically, self-retaining retractor systems have been favored for their stability and adjustability, but they can be cumbersome for microsurgical fields and constant pressure applied to the neural tissue can lead to focal ischemia. Retractorless surgery is an attractive alternative to self-retaining retractors, but repetitive microtrauma during the procedure is not desirable. Suture retraction of sylvian fissure and tonsils with 4–0 sutures were previously described. Here, we describe the novel use of arachnoid retraction in the sulci of the cerebral cortex using 10–0 nylon sutures.
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