title: Minimal access to deep intracranial lesions using a serial dilatation technique: case-series and review of brain tubular retractor systems.
abstract: Surgical access to deep intracranial lesions causing the least amount of iatrogenic trauma to the surrounding brain tissue remains a challenging task. In this article, we evaluate the use of a set of sequential tubes that dilate and provide retraction of the overlying brain tissue acting as a surgical corridor for deep-seated brain lesions resection. In addition, we conducted a comprehensive review of the literature of previously described techniques using variable brain tubular retractor systems. We discuss the adaptation of a system designed for spinal use to intracranial pathologies and evaluate the outcomes for the patients involved in the study. Moreover, the advantages and limitations of the described technique were presented. Between August 2005 and 2011, a total of 30 patients with deep brain lesions were operated on using an incremental increase of tubing size for brain retraction guided by a frameless navigation device. Of these, seven cases were intraventricular, and 23 were intraparenchymal. Gross total resection was achieved in 70 % of cases, and the remaining had planned subtotal resections due to involvement of an eloquent area. In conclusion, the technique of serial dilatation of the brain tissue can be used in conjunction with a microscope or endoscope to provide satisfactory access to deep intracranial pathologies. It appears to minimize the associated retraction injury to the surrounding tissue by gradually dilating the white fiber tracts. This operative approach may be considered as an effective and safe alternative for brain tumor resections in selected cases, especially deep-seated lesions.
authors.affiliation: Division of Neurosurgery, McMaster University, 100 Main Street East, Suite 42B, Hamilton, ON, Canada L8N 3W4. Dr_menawer@hotmail.com
authors.forename: Saleh A
authors.initials: SA
authors.lastname: Almenawer
authors.forename: Louis
authors.initials: L
authors.lastname: Crevier
authors.forename: Naresh
authors.initials: N
authors.lastname: Murty
authors.forename: Amin
authors.initials: A
authors.lastname: Kassam
authors.forename: Kesava
authors.initials: K
authors.lastname: Reddy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001254:Astrocytoma / Q000601:surgery; D001927:Brain Diseases / Q000601:surgery*; D001932:Brain Neoplasms / Q000601:surgery; D002550:Cerebral Veins / Q000601:surgery; D002551:Cerebral Ventricle Neoplasms / Q000601:surgery; D002675:Child, Preschool; D003399:Craniotomy; D004106:Dilatation / Q000379:methods*; D004724:Endoscopy; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000009:adverse effects; D008875:Middle Aged; D038361:Neuronavigation; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D013238:Stereotaxic Techniques; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed; D055815:Young Adult