Retractorless surgery for intracranial aneurysms.

Microsurgical clipping of intracranial aneurysms often requires access to the subarachnoid space deep in the brain. In the past, fixed retractors have been used to maintain the surgical corridor. However, studies have shown that fixed retraction leads to brain injuries. Here we present strategies to replace conventional fixed retractor blades with dynamic retraction so that the brain is no longer under constant pressure. We show that dynamic retraction without fixed retractors, when combined with optimal patient position and neuroprotective anesthetics, can provide the surgeon with adequate visualization of aneurysms and the patient with excellent surgical outcomes.