Transparent Tubular Retractor in Cranial Surgery: A Retrospective Analysis
Introduction The fourth Industrial Revolution has touched nearly all aspects of neurosurgery and the newer tubular retractor systems are a testimony to this fact. They aid in providing better visualization with minimal damage to those neural structures, which happen to be innocent bystanders overlying the path of deep-seated lesions. In addition to providing better patient outcomes they are surgeon friendly with their ergonomic design and improved stability, thereby causing minimal fatigue, and aid in procedures requiring precision and perseverance. A retrospective study conducted at a single institute analyzed the efficacy of transparent tubular retractors during cranial surgery for deep-seated lesions.
Materials and Methods This retrospective study was conducted between April 2015 and July 2018 in a single institute wherein 22 patents with various deep-seated intracranial lesions were operated using the transparent tubular retractor, View Site Brain Access System (VBAS, Vycor Medical Inc.).
Observation Of the 22 cases, 45% were of spontaneous intracerebral hemorrhage; 27% were high-grade gliomas; and the rest were colloid cyst, cystic tumors, and metastatic tumors in equal proportion. Total tumor excision was achieved in 27%, while 90% excision was achieved in 45% cases. The overall complication rate was 13%.
Conclusion The transparent tubular retractors contribute to minimal invasiveness by causing uniform distribution of retraction pressure and minimal disruption of fiber tracts. Their use has a definite role in improving surgical outcomes for deep-seated intracranial lesions.
09. Dezember 2019 (online)
Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India
- 1 Assina R, Rubino S, Sarria CE, Gandhi CD, Prestigiacomo CJ. The history of brain retractors throughout the development of neurological surgery. Neurosurgery Focus 2014; 36 (04) E8
- 2 Greenfield JP, Cobb WS, Tsouris AJ, Schwartz TH. Stereotactic minimally invasive tubular retractor system for deep brain lesions. Neurosurgery 2008; 63 (4, Suppl 2): 334-339, discussion 339–340
- 3 Donaghy RM, Numoto M, Wallman LJ, Flanagan ME. Pressure measurement beneath retractors for protection of delicate tissues. Am J Surg 1972; 123 (04) 429-431
- 4 Bennett MH, Albin MS, Bunegin L, Dujovny M, Hellstrom H, Jannetta PJ. Evoked potential changes during brain retraction in dogs. Stroke 1977; 8 (04) 487-492
- 5 Andrews RJ, Bringas JR. A review of brain retraction and recommendations for minimizing intraoperative brain injury. Neurosurgery 1993; 33 (06) 1052-1063
- 6 Kelly PJ, Goerss SJ, Kall BA. The stereotaxic retractor in computer-assisted stereotaxic microsurgery. Technical note. J Neurosurg 1988; 69 (02) 301-306
- 7 Harris AE, Hadjipanayis CG, Lunsford LD, Lunsford AK, Kassam AB. Microsurgical removal of intraventricular lesions using endoscopic visualization and stereotactic guidance. Neurosurgery 2005; 56 (01) 125-132
- 8 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
- 9 Eliyas JK, Glynn R, Kulwin CG. et al. Minimally invasive transsulcal resection of intraventricular and periventricular lesions through a tubular retractor system: multicentric experience and results. World Neurosurg 2016; 90: 556-564
- 10 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
- 11 Rosenørn J, Diemer NH. Reduction of regional cerebral blood flow during brain retraction pressure in the rat. J Neurosurg 1982; 56 (06) 826-829
- 12 Rosenørn J, Diemer N. The risk of cerebral damage during graded brain retractor pressure in the rat. J Neurosurg 1985; 63 (04) 608-611
- 13 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
- 14 Greenfield JP, Cobb WS, Tsouris AJ, Schwartz TH. Stereotactic minimally invasive tubular retractor system for deep brain lesions. Neurosurgery 2008; 63 (ONS Supplement 4): ONS334-ONS340
- 15 Chen CJ, Caruso J, Starke RM. et al. Endoport-assisted microsurgical treatment of a ruptured periventricular aneurysm. Case Rep Neurol Med 2016; 2016: 8654262
- 16 Ding D, Przybylowski CJ, Starke RM. et al. A minimally invasive anterior skull base approach for evacuation of a basal ganglia hemorrhage. J Clin Neurosci 2015; 22 (11) 1816-1819
- 17 Ding D, Starke RM, Crowley RW, Liu KC. Endoport-assisted microsurgical resection of cerebral cavernous malformations. J Clin Neurosci 2015; 22 (06) 1025-1029
- 18 Rymarczuk GN, Davidson L, Severson MA, Armonda RA. Use of a minimally invasive retractor system for retrieval of intracranial fragments in wartime trauma. World Neurosurg 2015; 84 (04) 1055-1061
- 19 Labib MA, Shah M, Kassam AB. et al. The safety and feasibility of image-guided brain path-mediated trans sulcal hematoma evacuation: a multicenter study. Neurosurgery 2017; 80 (04) 515-524