Stereotactic excision of deep brain lesions using probe guided brain retractor

Patil, Arun Angelo

doi:10.1007/bf01476067

Cited by 10 publications

(1 citation statement)

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“…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.…”

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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

Bander

Jones

Kovanlıkaya

et al. 2016

JNS

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Brain retraction systems are frequently required to achieve surgical exposure of deep-seated brain lesions. Retraction, however, is associated with complications that include brain edema, vascular compromise causing ischemia, and direct damage to surrounding cortex. 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. obJective Brain retraction systems are frequently required to achieve surgical exposure of deep-seated brain lesions. Spatula-based systems can be associated with injury to the cortex and deep white matter, particularly adjacent to the sharp edges, which can result in uneven pressure on the parenchyma over the course of a long operation. The use of tubular retractor systems has been proposed as a method to overcome these limitations. There have been no studies assessing the degree of brain injury associated with the use of tubular retractors. methods Twenty patients were retrospectively identified at Weill Cornell Medical College who underwent resection of deep-seated brain lesions between 2005 and 2014 with the aid of a METRx tubular retractor system. Using the Brainlab software, pre- and postoperative images were analyzed to assess volume, depth, extent of resection, and change in postoperative MR FLAIR hyperintensity and restricted diffusion on diffusion-weighted imaging (DWI). results The mean preoperative tumor volume was 16.25 ± 17.6 cm 3 . Gross-total resection was achieved in 75%, near-total resection in 10%, and subtotal resection in 15% of patients. There was a small but not statistically significant increase in average FLAIR hyperintensity volume by 3.25 ± 10.51 cm 3 (p = 0.16). The average postoperative volume of DWI high signal area with restricted diffusion on apparent diffusion coefficient maps was 8.35 ± 3.05 cm 3 . Assuming that the volume of restricted diffusion on DWI around tumor was 0 preoperatively, this represented a statistically significant increase on DWI (p < 0.001). coNclusioNs Although tubular retractors do not appear to significantly increase FLAIR signal in the brain, DWI intensity around the retractors can be identified. These data indicate that although tubular retractors may minimize damage to surrounding tissues, they still cause cytotoxic edema and cellular damage. Objective comparison against o...

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