Abstract
Background Tubular approach surgery now includes complex spinal and cranial procedures. Aided
by modified instrumentation and frameless stereotaxy, minimal access surgery is being
offered for a growing array of neurosurgical conditions.
Methods This article explores the flexibility and adaptability of the tubular retractor system
for multiple indications by highlighting the 12-year experience of the primary surgeon
using a tubular retractor system reported for the entire neuroaxis including intracranial,
foramen magnum, and the craniocaudal extent of the spine for intra- and extradural
pathologies. For this article we have not analyzed our experience with degenerative
spinal disease. Patient characteristics, pathology, resection results, length of hospital
stay, and complications are discussed.
Results From August 2005 through March 2017, 538 patients underwent neurosurgical procedures
with mini-tubular access. Of these, the 127 patients who underwent mini-tubular access
operations for nontraditional indications are discussed here. There were 65 women
and 61 men with an average age of 53.5 years. The cases by anatomical location are
as follows: 27 cranial cases, 11 foramen magnum decompressions, and 89 for spinal
indications. The cranial pathologies included primary and metastatic tumors. The spinal
pathologies included intra- and extradural spinal tumors, spina bifida occulta, syringomyelia,
and other cystic lesions in the spine. In the vast majority of the patients where
gross total resection was the goal, it was achieved. The mean length of stay was 2.94
days.
Conclusions This report demonstrates that mini-tubular access surgery can be adapted to pathologies
in the entire neuroaxis with outcomes that are comparable with open techniques. Limited
tissue dissection, smaller incisions, and limited bone resection make the mini-tubular
access approach a desirable option when feasible. Greater experience with all of these
techniques is needed before the definitive status of these procedures in the neurosurgical
armamentarium can be demonstrated.
Keywords
tubular retractor - serial dilation - deep brain lesion - spinal surgery - minimal
access
