A peel-away sheath introducer is a flexible medical device used primarily in vascular access procedures. It consists of a thin-walled plastic tube (the sheath) and an internal dilator that allows the sheath to be introduced into a vessel or body cavity. Once access is achieved, the sheath enables the introduction of catheters, pacemaker leads, or other devices.

What makes it unique is its “peel-away” capability: After insertion, the sheath can be split longitudinally and removed without displacing the indwelling catheter or device. This is done by pulling apart the two pre-scored halves of the sheath using small side wings or tabs.

• Central venous catheter placement
• Peritoneal dialysis catheter introduction
• Temporary pacing wire insertion
• Electrophysiology procedures

A ventriculoatrial shunt (VAS) proves to be an excellent alternative in the hydrocephalus treatment. Its usage is a viable option when ventriculoperitoneal shunt (VPS) is contraindicated in any age of patients.

A report highlights a successful case involving a 6-month-old patient who underwent VAS catheter positioning. The child presented with hydrocephalus and biliary atresia, making him a candidate for a liver transplant. Notably, a VPS was considered a relative contraindication in this scenario.

The VAS emerges as a viable option for patients in whom a VPS might be contraindicated. This case demonstrates the successful application of a VAS in a pediatric patient ¹⁾.

• Brain surgery
• Structural tissue retraction
• Intracranial trajectory control

• Splittable introducer sheath
• Tear-away sheath
• Disposable vascular sheath

Common sizes: 7F to 24F
Materials: Medical-grade polyurethane or PTFE
Sterile, single-use
Often included in vascular access kits

In a technical note and retrospective case series Siomin et al. ²⁾ propose a low-cost, minimally invasive technique for resecting deep-seated brain lesions using a 19F peel-away sheath introducer and so-called “dynamic” retraction.

• Improvised Device Misuse:

The 19F peel-away sheath is a vascular introducer, not a neurosurgical retractor. Its intraaxial use is unsafe and non-validated, and its deployment in delicate brain regions borders on reckless.

• “Dynamic Retraction” = Euphemism:

This term conceals the absence of trajectory control or stable visualization. Manual dynamic retraction lacks the biomechanical integrity of dedicated MIS systems, increasing the risk of cortical and subcortical injury.

• Small, Heterogeneous Cohort:

Combining diverse pathologies (GBM, metastases, cysts) in one case series prevents any meaningful extrapolation. The sample is too small to reach safety or efficacy conclusions.

• No Objective Outcomes:

Gross total resection is claimed without imaging confirmation protocols. Functional outcomes are anecdotal. No mention of validated scales (e.g., mRS, KPS, RANO).

• No Comparator Arm:

Without parallel use of standard tubular retractors or image-guided MIS systems, claims of equivalence or superiority are speculative at best.

• No Real Cost Analysis:

“Cost-effective” is asserted without breakdowns of device pricing, hospital stay, complication management, or reinterventions.

• Performative Minimalism:

The procedure is labeled “minimally invasive,” yet lacks essential MIS elements: rigid tubular control, navigated access, and standardized closure techniques.

• Marketing Disguised as Science:

The article has the tone of a promotional piece rather than an objective technical report. It risks encouraging substandard neurosurgery in low-resource settings.

This publication represents a dangerous oversimplification of MIS principles. Far from offering a viable alternative, it undermines surgical safety in favor of expediency. The technique should not be adopted without rigorous validation and biomechanical studies.

'Do not recommend for clinical adoption.'
'Further research required with ethical oversight, controls, and functional imaging.'