Transcortical Approach to Deep-Seated Intraventricular and Intra-axial Tumors Using a Tubular Retractor System: A Technical Note and Review of the Literature

Abstract

Background Retraction of white matter overlying a brain lesion can be difficult without causing significant trauma especially when using traditional methods of bladed retractors. These conventional retractors can produce regions of focal pressure resulting in contusions and areas of infarct.

Methods In this article, we present a retrospective case series of six patients with deep-seated intraventricular and intra-axial tumors that were approached using a ViewSite Brain Access System (tubular retractor). The authors describe a unique method of creating a pathway using a dilated glove. We shall also review the relevant literature that reports this type of surgery. Cases included three cases with third ventricular colloid cysts, one case of a third ventricular arachnoid cyst, one case with a lateral ventricular neurocytoma, and a case with a deeply seated intra-axial metastatic tumor.

Results Gross total resection was achieved in five cases with small residual in the central neurocytoma operation, with no documented neurological deficit in any case. One case had persistent memory problems and one case had continuing decline from the metastatic disease.

Conclusion The introduction of tubular-shaped retractor systems has offered the advantage of reducing retraction pressures and distributing any remaining force in a more even and larger distributed area, thus reducing the risk of previous associated morbidity while also permitting great visualization of the target lesion.

Keywords

tubular retractor - intraventricular tumors - colloid cyst - minimal invasive surgery - balloon dilatation

Publikationsverlauf

Eingereicht: 20. Oktober 2019

Angenommen: 20. Dezember 2019

Artikel online veröffentlicht:
15. Dezember 2020

• References

• 1 McKISSOCK W. The surgical treatment of colloid cyst of the third ventricle; a report based upon twenty-one personal cases. Brain 1951; 74 (01) 1-9
• 2 Ellenbogen RG. Transcortical surgery for lateral ventricular tumors. Neurosurg Focus 2001; 10 (06) E2
• 3 Zhong J, Dujovny M, Perlin AR, Perez-Arjona E, Park HK, Diaz FG. Brain retraction injury. Neurol Res 2003; 25 (08) 831-838
• 4 Kelly PJ, Kall BA, Goerss SJ. Computer-interactive stereotactic resection of deep-seated and centrally located intraaxial brain lesions. Appl Neurophysiol 1987; 50 (1–6): 107-113
• 5 Kelly PJ, Goerss SJ, Kall BA. The stereotaxic retractor in computer-assisted stereotaxic microsurgery. Technical note. J Neurosurg 1988; 69 (02) 301-306
• 6 Kelly PJ. Future perspectives in stereotactic neurosurgery: stereotactic microsurgical removal of deep brain tumors. J Neurosurg Sci 1989; 33 (01) 149-154
• 7 Greenfield JP, Cobb WS, Tsouris AJ, Schwartz TH. Stereotactic minimally invasive tubular retractor system for deep brain lesions. Neurosurgery 2008; 63 (04) (Suppl. 02) 334-339 , discussion 339–340
• 8 Harada S, Nakamura T. Retraction induced brain edema. Acta Neurochir Suppl (Wien) 1994; 60: 449-451
• 9 Cohen-Gadol AA. Minitubular transcortical microsurgical approach for gross total resection of third ventricular colloid cysts: technique and assessment. World Neurosurg 2013; 79 (01) 207.e7-207.e10
• 10 Herrera SR, Shin JH, Chan M, Kouloumberis P, Goellner E, Slavin KV. Use of transparent plastic tubular retractor in surgery for deep brain lesions: a case series. Surg Technol Int 2010; 19: 47-50
• 11 Raza SM, Recinos PF, Avendano J, Adams H, Jallo GI, Quinones-Hinojosa A. Minimally invasive trans-portal resection of deep intracranial lesions. Minim Invasive Neurosurg 2011; 54 (01) 5-11
• 12 Recinos PF, Raza SM, Jallo GI, Recinos VR. Use of a minimally invasive tubular retraction system for deep-seated tumors in pediatric patients. J Neurosurg Pediatr 2011; 7 (05) 516-521
• 13 Hong CS, Prevedello DM, Elder JB. Comparison of endoscope- versus microscope-assisted resection of deep-seated intracranial lesions using a minimally invasive port retractor system. J Neurosurg 2016; 124 (03) 799-810
• 14 White T, Chakraborty S, Lall R, Fanous AA, Boockvar J, Langer DJ. Frameless stereotactic insertion of ViewSite brain access system with microscope-mounted tracking device for resection of deep brain lesions: technical report. Cureus 2017; 9 (02) e1012
• 15 Otani Y, Kurozumi K, Ishida J. et al. Combination of the tubular retractor and brain spatulas provides an adequate operative field in surgery for deep-seated lesions: case series and technical note. Surg Neurol Int 2018; 9: 220
• 16 Iyer R, Chaichana KL. Minimally invasive resection of deep-seated high-grade gliomas using tubular retractors and exoscopic visualization. J Neurol Surg A Cent Eur Neurosurg 2018; 79 (04) 330-336
• 17 Mampre D, Bechtle A, Chaichana KL. Minimally invasive resection of intra-axial posterior fossa tumors using tubular retractors. World Neurosurg 2018; 119: e1016-e1020
• 18 Eichberg DG, Buttrick SS, Sharaf JM. et al. Use of tubular retractor for resection of colloid cysts: single surgeon experience and review of the literature. Oper Neurosurg (Hagerstown) 2019; 16 (05) 571-579
• 19 Singh H, Patir R, Vaishya S, Miglani R, Kaur A. Syringe port: a convenient, safe, and cost-effective tubular retractor for transportal removal of deep-seated lesions of the brain. World Neurosurg 2018; 114: 117-120
• 20 Almubarak AO, Alobaid A, Qoqandi O, Bafaquh M. Minimally invasive brain port approach for accessing deep-seated lesions using simple syringe. World Neurosurg 2018; 117: 54-61
• 21 Almenawer SA, Crevier L, Murty N, Kassam A, Reddy K. Minimal access to deep intracranial lesions using a serial dilatation technique: case-series and review of brain tubular retractor systems. Neurosurg Rev 2013; 36 (02) 321-329 , discussion 329–330
• 22 Newman WC, Engh JA. Stereotactic-guided dilatable endoscopic port surgery for deep-seated brain tumors: technical report with comparative case series analysis. World Neurosurg 2019; 125: e812-e819
• 23 Ratre S, Yadav YR, Parihar VS, Kher Y. Microendoscopic removal of deep-seated brain tumors using tubular retraction system. J Neurol Surg A Cent Eur Neurosurg 2016; 77 (04) 312-320
• 24 Bander ED, Jones SH, Kovanlikaya I, Schwartz TH. Utility of tubular retractors to minimize surgical brain injury in the removal of deep intraparenchymal lesions: a quantitative analysis of FLAIR hyperintensity and apparent diffusion coefficient maps. J Neurosurg 2016; 124 (04) 1053-1060
• 25 Ogura K, Tachibana E, Aoshima C, Sumitomo M. New microsurgical technique for intraparenchymal lesions of the brain: transcylinder approach. Acta Neurochir (Wien) 2006; 148 (07) 779-785 , discussion 785
• 26 Scranton RA, Fung SH, Britz GW. Transulcal parafascicular minimally invasive approach to deep and subcortical cavernomas: technical note. J Neurosurg 2016; 125 (06) 1360-1366
• 27 Norton SP, Dickerson EM, Kulwin CG, Shah MV. Technology that achieves the triple aim: an economic analysis of the BrainPath™ approach in neurosurgery. Clinicoecon Outcomes Res 2017; 9: 519-523
• 28 Gassie K, Wijesekera O, Chaichana KL. Minimally invasive tubular retractor-assisted biopsy and resection of subcortical intra-axial gliomas and other neoplasms. J Neurosurg Sci 2018; 62 (06) 682-689