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

Mohamed Okasha; Georgia Ineson; Jonathan Pesic-Smith; Surash Surash

doi:10.1055/s-0040-1719025

Journal of Neurological Surgery Part A: Central European Neurosurgery, Inhaltsverzeichnis

J Neurol Surg A Cent Eur Neurosurg 2021; 82(03): 270-277
DOI: 10.1055/s-0040-1719025

Technical Note

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

Mohamed Okasha

¹Department of Neurosurgery, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland

,

Georgia Ineson

²Medical School, Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom of Great Britain and Northern Ireland

,

Jonathan Pesic-Smith

¹Department of Neurosurgery, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland

,

Surash Surash

¹Department of Neurosurgery, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland

› Institutsangaben

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

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