Balloon needle for the atraumatic transcortical ventricular approach: Technical note

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Surg Neurol 1990 ;33 :226-7

Balloon Needle for the Atraumatic Transcortical Ventricular Approach: Technical Note Ignacio Madrazo, M .D., D .Sc., Rebecca Franco-Bourland, Ph .D., Maricarmen Aguilera, M.D., Pedro Reyes, M .D., and Gabriel Guizar-Sahagun, M .D . Department of Neurosurgery, Hospital de Especialidades, Centro Medico La ; Rata Department of Experimental Neurology and Neurosurgery, Centro Medico Siglo XXI, Instituto Mexicano del Seguro Social ; Department of Biochemistry, Instituto National de la Nutrition "Salvador Zubiran," Mexico City, Mexico

Madrazo 1, Franco-Bourland R, Aguilera M, Reyes P, Guizar-Sahagun G . Balloon needle for the atraumatic rranscorrical ventricular approach : technical note. Surg Neurol 1990 ;33226-7 . We have designed a double-lumen inflatable needle for the atraumatic dissection of brain substance . This balloon needle has been successfully used for the ventricular approach in brain grafting procedures to obtain a rounded corticotomy with a diameter of 1 .5-2 cm in the treatment of Parkinson's disease . Neurological balloon needle ; Transcortical atraumatic ventricular approach KEY WORDS :

Address reprint requests to. Ignacio Madrazo, M .D ., D.Sc ., Calzada

de Tlalpan #4430, 14300-Mexico, D .F . Mexico . Received September 25, 1989 ; accepted November 13, 1989 .

FIGURE l . (A) Inflatable balloon dissecting

We describe a double-lumen inflatable needle for the atraumatic dissection of brain substance, which we have successfully used to gain access to the lateral ventricle in brain grafting procedures to treat Parkinson's disease [2-5] . The needle consists of a 10-cm-long teflon cannula, with a stylet, which has several holes in the 1-cmlong tip . Just above the tip the needle is covered with a soft latex inflatable balloon connected to a syringe adapter (Figure I A) . With the deflated balloon needle in place (Figure 1 B), brain dissection down into the ventricle is achieved by very slowly inflating the balloon, in approximately 1-2 minutes, with 15-20 mL of saline (Figure IC) . Th cavity is kept open and widened by placement of two 1 .5-cm-wide self-retaining brain retractors to hold the parenchyma in place for the duration of the surgical procedure (Figure 2) . In our particular case, the added advantage of using this balloon needle have been : 1 . immediate knowledge of the moment the ventricular cavity is reached by cerebrospinal fluid (CSF) drainage into the cannula,

e

needle. (B) Transcortical approach to the lateral ventricle with a deflated ballon needle . Upon reaching the ventricle, the blood-free ventricular CSF drains immediately into the cannula and is removed for biochemical analyses . (C) Once in place. a n atraumatic parenchymal dissection is made by very slowly inflating the balloon with saline.

1990, Published by Elsevier Science Publishing Co ., Inc .

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Surg Neurol 1990 ;33 :226-7

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FIGURE 2 . Rounded corticotomy . The cavity is kept open with two 1 .5-cm-wide self-retaining brain retractors throughout the surgical procedure .

2. blood-free ventricular CSF sampling for biochemical analyses (11, and 3. almost complete elimination of postoperative seizures due to brain tissue damage . This work was partially supported by the FIIRESIN (Interinstitutional Research Foundation for Studies on the Regeneration of the Nervous System, M€xico) . We thank Miss Maria del Carmen Rodriguez for her secretarial assistance .

References 1, Franco-Bourland RE, Madrazo 1 . Trasplantes al cerebro . Aspectos bioquimicos. Bol Syntex Infor Med 1988;14 :5-6 .

2 . Madrazo 1 . Drucker-Colin R, Diu V, Mart(nez-Mata J, Torres C, Becerril JJ . Open microsurgery dautograft of adrenal medulla to the right caudate nucleus in two patients with intractable Parkinson's disease . N Engl J Med 1987 ;326 :831-4 . 3 . Madruo I, Drucker-Colin R, Le6n V, Torres C . Adrenal medulla transplanted to caudate nucleus for treatment of Parkinson's disease . report of 10 cases . Surg Forum 1987 ;38 :510-2 . 4 . Madruo 1, Drucker-Colin R, Madruo M, ZSrate A, Leon V, Torres C, Reyes P . Tecnica quir6rgica del injerto aut6logo de m€dula suprarrenal al n6cleo caudado para tratamiento de la enfermedad de Parkinson . Gac Med Mex 1988 ;124 :365-9 . 5 . Madrazo I, Leon V, Torres C, Aguilera MC, Varela G, Alvarez F, Fraga A, Drucker-Colin R, Ostrosky F, Skurovich M, Franco R . Transplantation of fetal substantia nigra and adrenal medulla to the caudate nucleus in two patients with Parkinson's disease . N Engl J Med 1988 ;318 :51 .