Resection of Deep-Seated Brain Lesions with the Use of an Expandable Soft Tubular Retractor—Case Series

Introduction Deep-seated brain lesions represent a neurosurgical challenge. A microsurgical resection requires a wide corridor and has a high incidence of brain retraction injury. Endoscope-assisted microsurgery through an expandable endoport can represent a solution.

Aim We present a series of three different cases where an expandable endoport enabled a resection of a deep-seated lesion. Our aim was to show that the expandable soft endoport enables a good surgical result with less perioperative complications.

Materials and Methods The technique was used in a patient with a subependymoma in the frontal horn of the left lateral ventricle, a patient with a glioblastoma in the left parietal periventricular region, and a child with a germinoma in the third ventricle and the pituitary-infundibular region.

A 2-cm skin incision was made followed by 1.5 cm trephination. The polyvinyl sheet was cut in 7 × 7 cm square piece and rolled into a tubular shape, which was wrapped around neuronavigational probe and inserted via minimal brain incision. The roll was expanded with a balloon dilatation to 7 mm of diameter. This surgical corridor was kept without usual spatulas during bimanual microsurgical lesionectomy under endoscopic visualization.

Results Subependymoma was completely removed from the ventricle, the glioblastoma was largely resected and the germinoma could be completely removed from the third ventricle and largely resected from the infundibular area. There was no hematoma in any of the patient. Patients had no new neurological problems. MRI revealed only a minimal white matter injury along the surgical corridor.

Conclusion The expandable tubular retractor in conjunction with neuronavigation provided a safe access and an excellent visualization of the underlying lesion. The tubular shape of the retractor permitted the use of standard microsurgical techniques through minimally invasive craniotomies without putting extra pressure on the brain tissue.

Keywords deep-seated lesion; retractor; endoscopy; minimally invasive; expandable