Use of a novel navigable tubular retractor system in 1826 minimally invasive parafascicular surgery (MIPS) cases involving deep-seated brain tumors, hemorrhages and malformations

Abstract

Abstract Objectives This retrospective, observational experiential study aimed to examine the utility of Minimally Invasive Parfasicular Surgery (MIPS) with Brainpath® and/or Myriad™ in a large, diverse patient cohort and to compare observational characteristics with those in the existing MIPS-BrainPath/Myriad medical literature. Patients and methods Demographic and surgical data from June 2, 2012 to April 30, 2019 were retrospectively extracted from a secure MIPS case summary database. Descriptive statistics were performed. Results 1826 cases were extracted for analysis: 668 vascular; 1109 tumor; 47 unclassified and 2 “other.” Predominate vascular locations were subcortical and intraventricular. The average age for the vascular and tumor groups were 57.1 and 53.3\xa0years respectively with a greater number of pediatric patients in the tumor group. Mean operating times were 176.0\xa0min (tumor group) and 120.6 (vascular group). Hemorrhages and malformations averaged 5.27\xa0cm3 vs. 2.76\xa0cm in the tumor cohort. There were more male patients. Of the vascular cases, most were intracranial hemorrhages (n\xa0=\xa0563, 84.5%); most tumor cases were primary brain tumors (n\xa0=\xa0522, 47.7%) with 335 secondary tumors or metastatic brain tumors. Thirty-four percent of the entire cohort experienced at least one presurgical deficit related to the brain defect; headaches were the most commonly observed symptom. Deaths or infections directly related to MIPS were not captured within the database. Conclusion These data support current, yet limited, medical literature observations demonstrating the versatility and utility of MIPS-BrainPath and/or Myriad for reaching and removing tumors and vascular anomalies located in eloquent brain regions in a variety of patient types.