ONS Advance Access: The Use of Semitranslucent Rubber Pledgets During Microsurgical Dissection of Cerebellopontine Angle Tumors: Technical Note

Complete resection of cerebellopontine angle (CPA) tumors can be challenging, particularly if they abut or adhere to adjacent neurovascular structures. Preservation of hearing and/or cranial nerve function is the goal, but this is often difficult. The surface of the brainstem and cranial nerves may be injured by microsurgical dissection, mechanical pressure due to cerebellar retraction, inadvertent lacerations or suction, electrocautery, or dehydration. Cotton pads are often used as a barrier to protect neural tissues during surgical dissection. The microfibers of these cotton pads promote hemostasis but also can adhere to vital structures. Removal or relocation of cotton pads often results in bleeding from the covered surface, especially after a long procedure. Moreover, cotton pads are opaque and must be removed to inspect the underlying anatomical structures. Repetitive manipulation of cotton pads may result in permanent damage to neural tissues. We describe the alternative use of rubber pledgets fashioned from talc-free latex surgical gloves. These pledgets provide a nonadherent semitransparent medium that preserves the plane of dissection between tumor and brain and also enables visualization of the anatomical structures that lie beneath.

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