Download PDF
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
1   Department of Neurosurgery, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
,
Georgia Ineson
2   Medical School, Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom of Great Britain and Northern Ireland
,
Jonathan Pesic-Smith
1   Department of Neurosurgery, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
,
Surash Surash
1   Department of Neurosurgery, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

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


Publication History

Received: 20 October 2019

Accepted: 20 December 2019

Article published online:
15 December 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • 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
    CrossrefPubMedSearch in Google Scholar
  • 2 Ellenbogen RG. Transcortical surgery for lateral ventricular tumors. Neurosurg Focus 2001; 10 (06) E2
    CrossrefPubMedSearch in Google Scholar
  • 3 Zhong J, Dujovny M, Perlin AR, Perez-Arjona E, Park HK, Diaz FG. Brain retraction injury. Neurol Res 2003; 25 (08) 831-838
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 5 Kelly PJ, Goerss SJ, Kall BA. The stereotaxic retractor in computer-assisted stereotaxic microsurgery. Technical note. J Neurosurg 1988; 69 (02) 301-306
    CrossrefPubMedSearch in Google Scholar
  • 6 Kelly PJ. Future perspectives in stereotactic neurosurgery: stereotactic microsurgical removal of deep brain tumors. J Neurosurg Sci 1989; 33 (01) 149-154
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 8 Harada S, Nakamura T. Retraction induced brain edema. Acta Neurochir Suppl (Wien) 1994; 60: 449-451
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar