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Minimally Invasive Transsulcal Resection of Intraventricular and Periventricular Lesions Through a Tubular Retractor
Javed Khader Eliyas1, Ryan Glynn2, Charles G Kulwin3
1Section of Neurosurgery, University of Chicago, Chicago, Illinois, USA; Department of Neurosurgery, NorthShore University Health System, Evanston, Illinois, USA.
Background:
Conventional approaches to deep-seated cerebral lesions range from biopsy to transcortical or transcallosal resection. Although the former does not reduce tumor burden, the latter are more invasive and associated with greater potential for irreparable injury to normal brain. Disconnection syndrome, hemiparesis, hemianesthesia, or aphasia is not uncommon after such surgery, especially when lesion is large. By contrast, the transsulcal parafascicular approach uses naturally existing corridors and a tubular retractor to minimize brain injury.
Methods:
A retrospective review of patients undergoing minimally invasive transsulcal parafascicular resection of ventricular and periventricular lesions, across 5 independent centers, was conducted.
Results:
Twenty patients with lesions located in the lateral ventricle (n = 9), the third ventricle (n = 6) and periventricular region (n = 4) are described in this report. Average age was 64 years (8 male/12 female). The average depth from cortical surface was 4.37 cm. A 13.5-mm-diameter tubular retractor (BrainPath [NICO Corporation, Indianapolis, Indiana, USA]) of differing lengths was used, aided by neuronavigation. Gross total resection was obtained in 17 patients. Pathologies included colloid cyst, subependymoma, glioma, meningioma, central neurocytoma, lymphoma, and metastasis. Three patients experienced transient morbidity: memory loss (2), hemiparesis (1). One patient died 3 months postoperatively as a result of unrelated pulmonary illness. Follow-up ranged from 6 to 27 months (average, 12 months).
Conclusions:
This technique is safe and effective for the treatment of intraventricular and periventricular lesions. Surgery-related morbidity is minimal and often transient. Lesions are satisfactorily resected and residuum occurs only when the neoplasm involves vital structures. The tubular retractor minimizes trauma to brain incident in the surgeon's path.
Insights
Minimally invasive transsulcal parafascicular surgery using a tubular retractor offers a safe and effective option for deep-seated brain lesions. This approach minimizes brain injury and results in minimal, often transient, patient morbidity.
Area of Science:
- Neurosurgery
- Minimally Invasive Techniques
- Neuro-oncology
Background:
- Conventional surgical approaches for deep-seated cerebral lesions carry risks of significant brain injury and neurological deficits.
- The transsulcal parafascicular approach utilizes natural brain corridors and a tubular retractor to minimize surgical trauma.
Observation:
- A retrospective review of 20 patients with intraventricular and periventricular lesions treated with the transsulcal parafascicular approach was conducted across five centers.
- The average patient age was 64 years, with lesions located in the lateral ventricle, third ventricle, or periventricular region at an average depth of 4.37 cm.
- Neuronavigation and a 13.5-mm tubular retractor (BrainPath) were employed for lesion resection.
Findings:
- Gross total resection was achieved in 17 out of 20 patients, with pathologies including colloid cysts, gliomas, meningiomas, and metastases.
- Three patients experienced transient morbidity (memory loss, hemiparesis), and one patient died from an unrelated cause three months post-surgery.
- Follow-up ranged from 6 to 27 months, with an average of 12 months, demonstrating satisfactory resection and minimal residual tumor when vital structures were not involved.
Implications:
- The transsulcal parafascicular approach is a safe and effective technique for treating intraventricular and periventricular lesions.
- This minimally invasive method significantly reduces surgery-related morbidity, which is often transient.
- The use of a tubular retractor is key to minimizing brain trauma during the surgical pathway.
