Minimally invasive resection of intracranial lesions using tubular retractors: a large, multi-surgeon, multi-institution
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CLINICAL STUDY
Minimally invasive resection of intracranial lesions using tubular retractors: a large, multi‑surgeon, multi‑institutional series Daniel G. Eichberg1,5 · Long Di1 · Ashish H. Shah1 · Evan M. Luther1 · Christina Jackson2 · Lina Marenco‑Hillembrand3 · Kaisorn L. Chaichana3 · Michael E. Ivan1,4 · Robert M. Starke1 · Ricardo J. Komotar1,4 Received: 25 January 2020 / Accepted: 13 April 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Lesions located in subcortical areas are difficult to safely access. Tubular retractors have been increasingly used successfully with low complication profile to access lesions by minimizing brain retraction trauma and distributing pressure radially. Both binocular operative microscope and monocular exoscope are utilized for lesion visualization through tubular retractors. We present the largest multi-surgeon, multi-institutional series to determine the efficacy and safety profile of a transcortical-transtubular approach for intracranial lesion resections with both microscopic and exoscopic visualization. Methods We reviewed a multi-surgeon, multi-institutional case series including transcortical-transtubular resection of intracranial lesions using either BrainPath (NICO, Indianapolis, Indiana) or ViewSite Brain Access System (VBAS, Vycor Medical, Boca Raton, Florida) tubular retractors (n = 113). Results One hundred thirteen transtubular resections for intracranial lesions were performed. Patients presented with a diverse number of pathologies including 25 cavernous hemangiomas (21.2%), 15 colloid cysts (13.3%), 26 GBM (23.0%), two meningiomas (1.8%), 27 metastases (23.9%), 9 gliomas (7.9%) and 9 other lesions (7.9%). Mean lesion depth below the cortical surface was 4.4 cm, and mean lesion size was 2.7 cm. A gross total resection was achieved in 81 (71.7%) cases. Permanent complication rate was 4.4%. One patient (0.8%) experienced one early postoperative seizure ( 1 week follow-up). Mean post-operative hospitalization length was 4.1 days. Conclusion Tubular retractors provide a minimally invasive operative corridor for resection of intracranial lesions. They provide an effective tool in the neurosurgical armamentarium to resect subcortical lesions with a low complication profile. Keywords Tubular retractor · Minimally invasive surgery · Brain tumor · Exoscope · Microsurgery · Neurosurgery
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11060-020-03500-0) contains supplementary material, which is available to authorized users. * Daniel G. Eichberg [email protected] 1
Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
2
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
3
Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
4
Sylvester Comprehensive Cancer Center, Miami, FL, USA
5
University of Miami Hospital, 1321 N.W. 14th Street, West Building, Su
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