Microsurgical resection of deep-seated lesions using transparent tubular retractor: pediatric case series

Abstract

Microsurgery using a transparent tubular retractor guided by a neuronavigation system facilitated accurate and effective removal of these deep-seated brain lesions.

Seizures in Children with Brain Tumours — Epidemiology, Significance, Management, and Outcomes

“…The studies by Jo et al [223] and Gaggero et al [35] are of special note because all the patients were infants, under the age of 5 and 3 years, respectively. In the first small series of 14 patients of mean age 2.7 years (32 months) [223], total resection of the epileptogenic lesion was achieved in 71%, as was total seizure freedom an average of 35 months post-operatively.…”

“…But how successful is tumour resection in terms of controlling or eliminating seizures? [214][215][216][217][218][219][220][221][222][223] published over the past two decades in which seizure outcomes in children and adolescents undergoing surgery to remove epileptogenic brain neoplasms were examined. Across these 26 studies are 741 patients, ranging in age from one month to 21 years of age, with a mean age of 9.1 years and a mean duration of post-operative follow-up of more than four years (overall mean=52 months, with individual study means ranging from 12 to 148 months).…”

“…In the first small series of 14 patients of mean age 2.7 years (32 months) [223], total resection of the epileptogenic lesion was achieved in 71%, as was total seizure freedom an average of 35 months post-operatively. In addition, all 14 infants experienced a significant reduction in seizure frequency, either being totally seizure free or having seizures limited to auras alone [223]. There also were no deaths and no reported operative complications.…”

Real-Time Ultrasound-Guided Catheter Navigation for Approaching Deep-Seated Brain Lesions: Role of Intraoperative Neurosonography with and without Fusion with Magnetic Resonance Imaging

“…Second, the method requires a straight path from the surface to the target, as the catheter cannot be easily curved. A tubular retraction system can allow dissection through the white matter with relatively even pressure, and provide a straight surgical corridor [12][13][14][15][16] . However, targeting the retractor depends on frameless stereotaxy, with its risks of error as noted above.…”

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

“…27 The frequency of retraction-based injury has been estimated to be approximately 10% in skull base surgery and 5% in intracranial aneurysm operations. 4 Techniques such as intermittent retraction, 24 endonasal trajectories, 3,6,10,17 and those that use tubular retractors 1,2,7,9,[11][12][13][14][15][16][18][19][20][21][22][23]25 have been used to minimize these injuries.Previously, we reported the successful use of a METRx spinal tubular retractor system, paired with the Brainlab frameless navigation system, for resection of deep-seated intracranial lesions. 9 The advantages of this tubular retractor system include equal distribution of retraction pressure abbreviatioNs ADC = apparent diffusion coefficient; DWI = diffusion-weighted imaging; GTR = gross-total resection; NTR = near-total resection; STR = subtotal resection.…”