Combination of the tubular retractor and brain spatulas provides an adequate operative field in surgery for deep-seated lesions: Case series and technical note.

Published on Nov 1, 2018in Surgical Neurology International
· DOI :10.4103/SNI.SNI_62_18
Yoshihiro Otani8
Estimated H-index: 8
(Okayama University),
Kazuhiko Kurozumi24
Estimated H-index: 24
(Okayama University)
Sources
Abstract
Background: Surgeries for deep-seated lesions are challenging because making a corridor and observing the interface between lesions and normal brain tissue are difficult. The ViewSite Brain Access System, which is a clear plastic tubular retractor system, is used for resection of deep-seated lesions. However, the tapered shape of this system may result in limitation of the surgical field and cause brain injury to observe the interface between lesions and normal tissue. In this study, we evaluated the usefulness of the combination of ViewSite and brain spatulas. Methods: Nine patients were retrospectively identified who underwent resection of deep-seated lesions with the combination of Viewsite and brain spatulas. We assessed the extent of resection, prognosis, and quantitative brain injury from postoperative diffusion-weighed imaging (DWI). Results: There were four total radiographically confirmed resections. Subtotal resection in four patients and partial resection in one with central neurocytoma were achieved because these tumors were strongly adherent to the choroid plexus and ependymal veins. Only one case of metastatic tumor relapsed 6 months after surgery. The mean postoperative high signal on DWI was 3.68 ± 0.80 cm3. Conclusions: The combination of ViewSite and brain spatulas provides wide and adequate operative fields to observe the interface between lesions and normal tissue, and to prevent brain injury from excessive retraction pressure on the brain derived from repositioning of the ViewSite. Postoperative 3D volumetric analysis shows minimal damage to normal brain tissue. This report may provide new insight into the use of the ViewSite tubular retractor.
📖 Papers frequently viewed together
References2
Newest
#1Tomotsugu Ichikawa (Okayama University)H-Index: 23
#2Yoshihiro Otani (Okayama University)H-Index: 8
Last. Isao Date (Okayama University)H-Index: 62
view all 7 authors...
Objective The best chance of curing craniopharyngioma is achieved by microsurgical total resection; however, its location adjacent to critical structures hinders complete resection without neurologic deterioration. Unrecognized residual tumor within microscopic blind spots might result in tumor recurrences. To improve outcomes, new techniques are necessary to visualize tissue within these blind spots. We examined the success of hybrid microscopic-endoscopic neurosurgery for craniopharyngioma in ...
Source
#1Koichiro Ogura (Toyota)H-Index: 3
#2E. TachibanaH-Index: 1
Last. M. SumitomoH-Index: 1
view all 4 authors...
Background. Although various minimally invasive approaches, including endoscopic, stereotaxic, and ultrasound-guided surgery, have been introduced to minimize damage to healthy brain tissue, the microsurgical technique has retained a significant role in contemporary neurosurgery. A new microsurgical approach to intraparenchymal brain lesions, namely, the transcylinder approach, was developed to realize both minimal surgical access and sufficient microsurgical technique.
Source
Cited By5
Newest
#1Thibault Passeri (University of Paris)H-Index: 4
#2Lorenzo Giammattei (University of Paris)H-Index: 2
Last. Sébastien Froelich (University of Paris)H-Index: 22
view all 8 authors...
BACKGROUND Surgery for deep-seated brain tumors remains challenging. Transcortical approaches often require brain retraction to ensure an adequate surgical corridor, thus possibly leading to brain damage. Various techniques have been developed to minimize brain retraction such as self-retaining retractors, endoscopic approaches, or tubular retractor systems. Even if they evenly distribute the mechanical pressure over the parenchyma, rigid retractors can also cause some degree of brain damage and...
Source
#1Mohamed Okasha (RVI: Royal Victoria Infirmary)H-Index: 1
#2Georgia Ineson (Newcastle University)H-Index: 1
Last. Surash Surash (RVI: Royal Victoria Infirmary)H-Index: 2
view all 4 authors...
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 ret...
Source
#2D.E. Semenov (MSMU: I.M. Sechenov First Moscow State Medical University)
Last. A.Yu. Kudashev (MSMU: I.M. Sechenov First Moscow State Medical University)
view all 7 authors...
This review is devoted to various techniques for reduction of brain damage during retraction. Searching for reports was carried out in Russian and English languages using the PubMed database (n=721) without restrictions on language, date and study design according to the following keywords: «brain retraction injury», «spatula brain retractors», «tubular brain retractors», «retractorless neurosurgery». Primary screening and exclusion of duplicate manuscripts allowed us to single out the main grou...
Source
#1Nikolas Echeverry (FAU: Florida Atlantic University)H-Index: 5
#2Samuel Mansour (FAU: Florida Atlantic University)H-Index: 5
Last. Brian Snelling (Boca Raton Regional Hospital)H-Index: 16
view all 0 authors...
In neurosurgery, parenchymal injury resulting from focal exertion of pressure on retracted tissue is a common complication associated with the use of plate and self-sustaining retractors to access deep intraparenchymal lesions. Tubular retractors, including Vycor, BrainPath, and METRx, were developed to reduce retraction injuries via radial dispersion of force. Our study seeks to compare these retraction systems and assess their respective indications, benefits, and associated complications. A s...
Source
#1Stephen Z. Shapiro (FAU: Florida Atlantic University)H-Index: 4
#2Kenneth A. Sabacinski (FAU: Florida Atlantic University)H-Index: 2
Last. Brian Snelling (Boca Raton Regional Hospital)H-Index: 16
view all 7 authors...
Abstract Background Traditional manual retraction to access deep-seated brain lesions has been associated with complications related to vascular compromise of cerebral tissue. Various techniques have been developed over time to minimize injury, such as self-sustaining retractors, neuronavigation, and endoscopic approaches. Recently, tubular retractors such as the ViewSite Brain Access System (VBAS; Vycor Medical Inc.) have been developed to reduce mechanical damage from retraction by dispersing ...
Source
This website uses cookies.
We use cookies to improve your online experience. By continuing to use our website we assume you agree to the placement of these cookies.
To learn more, you can find in our Privacy Policy.