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Minim Invasive Neurosurg 2011; 54(01): 5-11
DOI: 10.1055/s-0031-1273734
Original Article

Minimally Invasive Trans-Portal Resection of Deep Intracranial Lesions

S. M. Raza
A2010-09-0310-279-1   The Johns Hopkins Neuro-Oncology Surgical Outcomes Research Laboratory, Department of Neurosurgery, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
,
P. F. Recinos
A2010-09-0310-279-1   The Johns Hopkins Neuro-Oncology Surgical Outcomes Research Laboratory, Department of Neurosurgery, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
,
J. Avendano
A2010-09-0310-279-1   The Johns Hopkins Neuro-Oncology Surgical Outcomes Research Laboratory, Department of Neurosurgery, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
,
H. Adams
A2010-09-0310-279-1   The Johns Hopkins Neuro-Oncology Surgical Outcomes Research Laboratory, Department of Neurosurgery, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
,
G. I. Jallo
A2010-09-0310-279-1   The Johns Hopkins Neuro-Oncology Surgical Outcomes Research Laboratory, Department of Neurosurgery, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
,
A. Quinones-Hinojosa
A2010-09-0310-279-1   The Johns Hopkins Neuro-Oncology Surgical Outcomes Research Laboratory, Department of Neurosurgery, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Abstract

Background: The surgical management of deep intra-axial lesions still requires microsurgical approaches that utilize retraction of deep white matter to obtain adequate visualization. We report our experience with a new tubular retractor system, designed specifically for intracranial applications, linked with frameless neuronavigation for a cohort of intraventricular and deep intra-axial tumors.

Methods: The ViewSite Brain Access System (Vycor, Inc) was used in a series of 9 adult and pediatric patients with a variety of pathologies. Histological diagnoses either resected or biopsied with the system included: colloid cyst, DNET, papillary pineal tumor, anaplastic astrocytoma, toxoplasmosis and lymphoma. The locations of the lesions approached include: lateral ventricle, basal ganglia, pulvinar/posterior thalamus and insular cortex. Post-operative imaging was assessed to determine extent of resection and extent of white matter damage along the surgical trajectory (based on T2/FLAIR and diffusion restriction/ADC signal).

Results: Satisfactory resection or biopsy was obtained in all patients. Radiographic analysis demonstrated evidence of white matter damage along the surgical trajectory in one patient. None of the patients experienced neurological deficits as a result of white matter retraction/manipulation.

Conclusion: Based on a retrospective review of our experience, we feel that this accesss system, when used in conjunction with frameless neuronavigational systems, provides adequate visualization for tumor resection while permitting the use of standard microsurgical techniques through minimally invasive craniotomies. Our initial data indicate that this system may minimize white matter injury, but further studies are necessary.

Key words

intraventricular - basal ganglia/thalamus - tube retractor - minimally invasive - frameless stereotaxis


Publikationsverlauf

Publikationsdatum:
20. April 2011 (online)

© 2011. Georg Thieme Verlag KG Stuttgart · New York

Thieme Medical Publishcers

 

  • References

  • 1 Greenberg IM. Self-retaining retractor and handrest system for neurosurgery.. Neurosurgery 1981; 8: 205-208
    Suche in Google Scholar
  • 2 Rosenorn J, Diemer NH. Reduction of regional cerebral blood flow during brain retraction pressure in the rat.. J Neurosurg 1982; 56: 826-829
    Suche in Google Scholar
  • 3 Rosenorn J, Diemer N. The risk of cerebral damage during graded brain retractor pressure in the rat.. J Neurosurg 1985; 63: 608-611
    Suche in Google Scholar
  • 4 Zhong J, Dujovny M, Perlin AR. et al Brain retraction injury.. Neurol Res 2003; 25: 831-838
    Suche in Google Scholar
  • 5 Greenfield JP, Cobb WS, Tsouris AJ. et al Stereotactic minimally invasive tubular retractor system for deep brain lesions.. Neurosurgery 2008; 63 (04) 334-339 discussion 339–340
    Suche in Google Scholar
  • 6 Kelly PJ, Kall BA, Goerss SJ. Computer-interactive stereotactic resection of deep-seated and centrally located intraaxial brain lesions.. Appl Neurophysiol 1987; 50: 107-113
    Suche in Google Scholar
  • 7 Kelly PJ, Goerss SJ, Kall BA. The stereotaxic retractor in computer-assisted stereotaxic microsurgery. Technical note.. J Neurosurg 1988; 69: 301-306
    Suche in Google Scholar
  • 8 Moshel YA, Link MJ, Kelly PJ. Stereotactic volumetric resection of thalamic pilocytic astrocytomas.. Neurosurgery 2007; 61: 66-75 discussion 75
    Suche in Google Scholar
  • 9 Ogura K, Tachibana E, Aoshima C. et al New microsurgical technique for intraparenchymal lesions of the brain: transcylinder approach.. Acta Neurochir (Wien) 2006; 148: 779-785 discussion 785
    Suche in Google Scholar
  • 10 Herrera SR, Shin JH, Chan M. et al Use of transparent plastic tubular retractor in surgery for deep brain lesions.. Surgical Technology International 2010; XIX: 1-4
    Suche in Google Scholar
  • 11 Albin MS, Bunegin L. The insidiousness of brain retractor pressure: another “Smoking gun”?. Anesth Analg 2003; 96: 306 author reply 306–307
    Suche in Google Scholar
  • 12 Donaghy RM, Numoto M, Wallman LJ. et al Pressure measurement beneath retractors for protection of delicate tissues.. Am J Surg 1972; 123: 429-431
    Suche in Google Scholar
  • 13 Barlas O, Karadereler S. Stereotactically guided microsurgical removal of colloid cysts.. Acta Neurochir (Wien) 2004; 146: 1199-1204
    Suche in Google Scholar
  • 14 Kelly PJ. Future perspectives in stereotactic neurosurgery: stereotactic microsurgical removal of deep brain tumors.. J Neurosurg Sci 1989; 33: 149-154
    Suche in Google Scholar