Minimally invasive tubular retractor-assisted biopsy and resection of subcortical intra-axial gliomas and other neoplasms.

We describe our experience with the use of tubular retractors for accessing these deep-seated lesions. Fifty consecutive patients operated on for an intra-axial brain tumor (both biopsies and resection) from January 2016 to December 2017 by a single surgeon using tubular retractors with exoscopic visualization were prospectively identified and included in this consecutive case series. 35 patients (70%) underwent surgical resection and 15 (30%) underwent excisional biopsy for tumors located a median [interquartile range (IQR)] distance of 5.4 [4.5-6.1] cm below the cortical surface within the thalamus and/or basal ganglia in 12 (24%), centrum semiovale in 17 (34%), cerebellar in 8 (16%), peri-Rolandic in 6 (12%), visual tracts in 5 (10%), and intraventricular in 2 (4%). The median [IQR] percent resection was 100 [95-100]% and all patients had diagnostic tissue. Pathology was high grade glioma in 30 (60%), metastatic in 14 (28%), and cavernoma in 2 (4%). The postoperative median [IQR] KPS was 80 [80-90], where 18 (36%) had improved, 29 (58%) stable, and 3 (6%) worsened KPS as compared to preoperatively. The tubular retractor is a useful tool in the armamentarium of brain tumor surgery, and the exoscope provides an ergonomic means of visualizing the surgical field. It is meant to be used as a tool to access and resect deep-seated lesions while preserving and displacing superficial white matter tracts and cortical regions, provide a protected corridor to minimize inadvertent tiss...
Source: Journal of Neurosurgical Sciences - Category: Neurosurgery Tags: J Neurosurg Sci Source Type: research