Minimally invasive surgery with tubular retractor system for deep-seated or intraventricular brain tumors: Report of 13 cases and technique description

Abstract

Abstract Background Surgical treatment of tumors in those areas of the brain considered difficult to reach is becoming accessible thanks to minimally invasive surgery. Through the use of tubular retractor systems, a circular displacement and a symmetrical distribution of the brain are provided, reducing the complications of prolonged retraction, as well as the risk of edema and infarction. This has become an ideal method to reach areas such as deep parenchymal, subcortical and intraventricular regions. Methods From January 2015 to November 2018, we selected thirteen cases of patients diagnosed with intraparenchymal or intraventricular tumors. Surgical resection was performed with the assistance of a microscope, neuroendoscope, and brain tubular retractors. The volumetric study and the depth of the tumor were obtained on the MRI using the neuronavigation system. Depth was measured from the entry point on the cortical surface to the area closest to the tumor. Results Gross total resection was achieved in eight patients, subtotal resection in three, partial removal in one case and one biopsy was performed. One patient developed hydrocephalus and one a cerebrospinal fluid fistula as a post-surgical complication. Conclusions Minimally invasive surgery for tumor excision could allow directly access deep brain lesions and decrease injury to the surrounding brain tissue, as well as prevent adhesions from it in tubular retractors. Simultaneously, the microsurgical and endoscopic technique could shorten the surgical time. The purpose is to reduce the morbidity associated with conventional surgical procedures and the days of hospitalization in the ICU, improving quality of life.