Stereotactic minimally invasive tubular retractor system for deep brain lesions.

Abstract:

OBJECTIVE:Deep-seated supratentorial intraparenchymal and intraventricular brain lesions can be difficult to access without causing significant trauma to the overlying cortex and intervening white matter tracts. Traditional brain retractors use multiple blades, which do not exert pressure in an equally distributed fashion. Tubular retractors offer an advantage. Although a commercially available frame-based tubular retractor system is on the market (COMPASS; Compass, Inc., Rochester, MN), we modified existing off-the-shelf equipment at our institution into a frameless tubular brain retractor. METHODS:We used 14- to 22-mm METRx (Medtronic, Minneapolis, MN) tubular retractors in combination with a frameless stereotactic navigation system to remove 10 deep lesions. Histological findings included 6 periventricular metastases, 1 insular glioblastoma multiforme, 1 periventricular glioblastoma multiforme, 1 intraventricular meningioma, and 1 hippocampal cavernous malformation. RESULTS:Radiographic gross total resection was achieved in all patients. One patient experienced a transient worsening of an existing preoperative Wernicke's aphasia; otherwise, there were no intra- or postoperative complications. One patient with radiographic gross total resection of a metastatic lesion experienced a local recurrence of disease, requiring stereotactic radiosurgery. CONCLUSION:A frameless stereotactic tubular retractor system for deep brain lesions can be assembled with equipment already available at many institutions. Use of this system can decrease incision and craniotomy size, decrease retractor-induced trauma to overlying cortex, and help prevent damage to underlying white matter tracts.

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

Greenfield JP,Cobb WS,Tsouris AJ,Schwartz TH

doi

10.1227/01.neu.0000334741.61745.72

subject

Has Abstract

pub_date

2008-10-01 00:00:00

pages

334-9; discussion 339-40

issue

4 Suppl 2

eissn

0148-396X

issn

1524-4040

pii

00006123-200810002-00019

journal_volume

63

pub_type

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