title: Comparison of endoscope- versus microscope-assisted resection of deep-seated intracranial lesions using a minimally invasive port retractor system.
abstract: OBJECTIVE
  Tubular brain retractors may improve access to deep-seated brain lesions while potentially reducing the risks of collateral neurological injury associated with standard microsurgical approaches. Here, microscope-assisted resection of lesions using tubular retractors is assessed to determine if it is superior to endoscope-assisted surgery due to the technological advancements associated with modern tubular ports and surgical microscopes.
  
  
  METHODS
  Following institutional approval of the tubular port, data obtained from the initial 20 patients to undergo transportal resection of deep-seated brain lesions were analyzed in this study. The pathological entities of the resected tissues included metastatic tumors (8 patients), glioma (7), meningioma (1), neurocytoma (1), radiation necrosis (1), primitive neuroectodermal tumor (1), and hemangioblastoma (1). Surgery incorporated endoscopic (5 patients) or microscopic (15) assistance. The locations included the basal ganglia (11 patients), cerebellum (4), frontal lobe (2), temporal lobe (2), and parietal lobe (1). Cases were reviewed for neurological outcomes, extent of resection (EOR), and complications. Technical data for the port, surgical microscope, and endoscope were analyzed.
  
  
  RESULTS
  EOR was considered total in 14 (70%), near total (> 95%) in 4 (20%), and subtotal (< 90%) in 2 (10%) of 20 patients. Incomplete resection was associated with the basal ganglia location (p < 0.05) and use of the endoscope (p < 0.002). Four of 5 (80%) endoscope-assisted cases were near-total (2) or subtotal (2) resection. Histopathological diagnosis, presenting neurological symptoms, and demographics were not associated with EOR. Complication rates were low and similar between groups.
  
  
  CONCLUSIONS
  Initial experience with tubular retractors favors use of the microscope rather than the endoscope due to a wider and 3D field of view. Improved microscope optics and tubular retractor design allows for binocular vision with improved lighting for the resection of deep-seated brain lesions.
authors: Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
authors: Christopher S
authors: CS
authors: Hong
authors: Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
authors: Daniel M
authors: DM
authors: Prevedello
authors: Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
authors: J Bradley
authors: JB
authors: Elder
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000295:instrumentation*; D008875:Middle Aged; D044583:Neuroendoscopy / Q000295:instrumentation*; D038361:Neuronavigation / Q000295:instrumentation*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: EOR = extent of resection; GTR = gross-total resection; NTR = near-total resection; STR = subtotal resection; diagnostic and operative techniques; endoscope; minimally invasive; operative microscope; port retractor; tubular retractor