The Microcisternal Drainage Technique

Authors

Arnau Benet, Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan; Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Kosumo Noda, Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan.
Michael T. Lawton, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Rokuya Tanikawa, Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan. Electronic address: superbypass@gmail.com.

Document Type

Article

Abstract

BACKGROUND: Microsurgical dissection of arachnoid cisterns requires a combination of anatomic knowledge and microsurgical skill. The latter relies on experience and microsurgical dexterity, which depend on visual identification of cisternal microvasculature. We describe a novel standardized operative sequence to allow for bloodless arachnoid dissection when cisternal anatomy is challenging. METHODS: We used the reported technique in 1928 cases over the past 5 years (2018-2022). The outer arachnoid was incised to enter the cisternal space. A cotton pledget was placed in contact with an inner membrane and gently pushed laterally and superficially with the suction cannula at medium suction power. When the arachnoid membranes dried, arachnoid trabeculae were cut and microvasculature were released at the convexity of their loops and gently transposed off the dissection trajectory. The same principle was used to release parent and perforating arteries from the aneurysm dome. RESULTS: The microcisternal drainage technique enabled safe and efficient access through adhered arachnoid in all cases. A complex anterior communicating artery aneurysm in a 52-year-old lady demonstrated the use of the microcisternal drainage technique during access through the pericallosal cistern. This technique was used in all cases where cisternal dissection was needed. CONCLUSIONS: The microcisternal drainage technique uses deliberate and strategic suction, dynamic retraction, and nuanced scissor cuts to enable precise and bloodless microdissection of adherent arachnoid cisterns. This technique combines common neurosurgical maneuvers in a novel standardized sequence to improve efficiency and safety during arachnoid dissection.

Publication Date

4-25-2023

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

176

First Page

60

Last Page

65

PubMed ID

37105274

Digital Object Identifier (DOI)

10.1016/j.wneu.2023.04.087

Recommended Citation

Benet, Arnau; Noda, Kosumo; Lawton, Michael T.; and Tanikawa, Rokuya, "The Microcisternal Drainage Technique" (2023). Neurosurgery. 1844.
https://scholar.barrowneuro.org/neurosurgery/1844