Tumor Resection Utilizing a Minimally Invasive Spinal Retractor with a Novel Cranial Adaptor

Abstract

Objective: This article describes a method of performing an intracerebral tumor resection utilizing a novel dilator attachment with a system designed for minimally invasive spinal surgery.

Methods: A novel dilator was designed and utilized in conjunction with a retractor system originally designed for minimally invasive spine surgery. Tumor resection was then performed utilizing a method less invasive than a typical cortisectomy but allowing more freedom than could be accomplished with an endoscope.

Results: Two patients underwent a standard craniotomy followed by tumor resection using the novel dilator with the Pipeline Minimally Invasive Retractor System^® (DePuy Spine, Raynham, MA). The dilator was introduced into the tumor cavity followed by sequential insertion of the working ports until a working port of 20 mm had been inserted. Both patients had adequate resection of their tumors with minimal neurological deficit.

Conclusion: Tumor resection can safely be accomplished using a minimally invasive spine retractor system with a novel dilator adapted for the system. This reduces the size of the cortisectomy and therefore reduces the risk of post-operative neurological damage while still allowing ample room for adequate tumor resection.

Key words

craniotomy - dilator - tumor resection

References

• 1 Foley KT, Holly LT, Schwender JD. Minimally invasive lumbar fusion.  Spine. 2003;  28 ((Suppl)) S26-S35
• 2 Khoo LT, Fessler RG. Microendoscopic decompressive laminotomy for the treatment of lumbar stenosis.  Neurosurgery. 2002;  51 S146-S154
• 3 Foley KT, Gupta SK. Percutaneous pedicle screw fixation of the lumbar spine: Preliminary clinical results.  J Neurosurg. 2002;  97 7-12
• 4 Khoo LT, Palmer S, Laich DT. et al . Minimally invasive percutaneous posterior lumbar interbody fusion.  Neurosurgery. 2002;  51 ((Suppl)) S166-S181
• 5 Lowery GL, Kulkarni SS. Posterior percutaneous spine instrumentation.  Eur Spine J. 2000;  9 ((Suppl 1)) S126-S130
• 6 Cohen AR. Ventriculoscopic surgery.  Clin Neurosurg. 1994;  41 546-562
• 7 Decq P, Le Guerinel C, Palfi S. et al . A new device for endoscopic third ventriculostomy.  J Neurosurg. 2000;  93 509-512
• 8 Hopf NJ, Grunert P, Fries G. et al . Endoscopic third ventriculostomy: Outcome analysis of 100 consecutive procedures.  Neurosurgery. 1999;  44 795-806
• 9 Manwaring KH, Fritsch MJ. Endoscopic aqueductal stenting as an option for obstructive hydrocephalus.  Neurosurgery. 1998;  43 712-713
• 10 Abdou MS, Cohen AR. Endoscopic treatment of colloid cysts of the third ventricle.  J Neurosurg. 1998;  89 1062-1068
• 11 Bergsneider M. Complete microsurgical resection of colloid cysts with a dual-port endoscopic technique.  Neurosurgery. 2007;  60 ((Suppl 1)) 33-43
• 12 King WA, Ullman JS, Frazee JG. et al . Endoscopic resection of colloid cysts: Surgical considerations using the rigid endoscope.  Neurosurgery. 1999;  44 1103-1111
• 13 Rodziewicz GS, Smith MV, Hodge Jr CJ. Endoscopic colloid cyst surgery.  Neurosurgery. 2000;  46 655-662
• 14 Sandhu FA, Santiago P, Fessler RG. et al . Minimally invasive sur-gical treatment of lumbar synovial cysts.  Neurosurgery. 2004;  54 107-112
• 15 Schroeder HW, Gaab MR. Endoscopic aqueductoplasty: Technique and results.  Neurosurgery. 1999;  45 508-518
• 16 Teo C, Burson T, Misra S. Endoscopic treatment of the trapped fourth ventricle.  Neurosurgery. 1999;  44 1257-1262

Correspondence