title: Use of a minimally invasive tubular retraction system for deep-seated tumors in pediatric patients.
abstract: OBJECTIVE
  Microsurgical removal is the preferred treatment for most deep-seated, intraaxial tumors in the pediatric population. The feasibility of surgery as an option has improved with advances in surgical technology and technique. Tubular retractors disperse retraction forces over a greater surface area than do conventional retractors, which can lower the risk of ischemic complications. The authors describe their experience utilizing a new tubular retractor system specifically designed for cranial applications in conjunction with frameless neuronavigation.
  
  
  METHODS
  The Vycor ViewSite retractor was used in 4 pediatric patients (ages 15 months and 9, 10, and 16 years) with deep-seated intraaxial tumors. The lesions included a papillary tumor of the pineal region, a low-grade astrocytoma in the occipital lobe, a dysembryoplastic neuroepithelial tumor arising from the basal ganglia, and an intraventricular low-grade glioma. The extent of white matter damage along the surgical trajectory (based on T2 or FLAIR and diffusion restriction/apparent diffusion coefficient signals) and the extent of resection were assessed on postoperative imaging.
  
  
  RESULTS
  Satisfactory resection or biopsy was achieved in all patients. A comparison of pre- and postoperative MR imaging studies revealed evidence of white matter damage along the surgical trajectory in 1 patient. None of the patients demonstrated new neurological deficits postoperatively.
  
  
  CONCLUSIONS
  Obtaining surgical access to deep-seated, intraaxial tumors is challenging. In this small series of pediatric patients, the combination of the ViewSite tubular retractor and frameless neuronavigation facilitated the surgical approach. The combination of these technologies adds to the armamentarium to safely approach tumors in deep locations.
authors.affiliation: Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 44195, USA. recinov@ccf.org
authors.forename: Pablo F
authors.initials: PF
authors.lastname: Recinos
authors.forename: Shaan M
authors.initials: SM
authors.lastname: Raza
authors.forename: George I
authors.initials: GI
authors.lastname: Jallo
authors.forename: Violette Renard
authors.initials: VR
authors.lastname: Recinos
mesh_terms: D000293:Adolescent; D001254:Astrocytoma / Q000473:pathology / Q000601:surgery; D001480:Basal Ganglia Diseases / Q000473:pathology / Q000601:surgery; D001706:Biopsy; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D002551:Cerebral Ventricle Neoplasms / Q000473:pathology / Q000601:surgery; D002648:Child; D038524:Diffusion Magnetic Resonance Imaging; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000473:pathology / Q000601:surgery; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000295:instrumentation*; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D038361:Neuronavigation / Q000295:instrumentation*; D009778:Occipital Lobe / Q000473:pathology / Q000601:surgery; D010871:Pinealoma / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis; D013724:Teratoma / Q000473:pathology / Q000601:surgery