title: Minimally Invasive Transsulcal Resection of Intraventricular and Periventricular Lesions Through a Tubular Retractor System: Multicentric Experience and Results.
abstract: 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.
authors.affiliation: Section of Neurosurgery, University of Chicago, Chicago, Illinois, USA; Department of Neurosurgery, NorthShore University Health System, Evanston, Illinois, USA.
authors.forename: Javed Khader
authors.initials: JK
authors.lastname: Eliyas
authors.affiliation: Chicago Medical School, Rosalind Franklin University, Chicago, Illinois, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Glynn
authors.affiliation: Department of Neurosurgery, Indiana University, Indianapolis, Indiana, USA; Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA.
authors.forename: Charles G
authors.initials: CG
authors.lastname: Kulwin
authors.affiliation: Aurora Neuroscience Center, Milwaukee, Wisconsin, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Rovin
authors.affiliation: Department of Neurosurgery, Indiana University, Indianapolis, Indiana, USA; Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Young
authors.affiliation: American Center for Spine and Neurosurgery, Chicago, Illinois, USA.
authors.forename: Juan
authors.initials: J
authors.lastname: Alzate
authors.affiliation: Department of Neurosurgery, Emory University, Atlanta, Georgia, USA.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Pradilla
authors.affiliation: Department of Neurosurgery, Indiana University, Indianapolis, Indiana, USA; Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA.
authors.forename: Mitesh V
authors.initials: MV
authors.lastname: Shah
authors.affiliation: Aurora Neuroscience Center, Milwaukee, Wisconsin, USA.
authors.forename: Amin
authors.initials: A
authors.lastname: Kassam
authors.affiliation: Department of Neurosurgery, NorthShore University Health System, Evanston, Illinois, USA.
authors.forename: Ivan
authors.initials: I
authors.lastname: Ciric
authors.affiliation: Section of Neurosurgery, University of Chicago, Chicago, Illinois, USA; Department of Neurosurgery, NorthShore University Health System, Evanston, Illinois, USA. Electronic address: jbailes@northshore.org.
authors.forename: Julian
authors.initials: J
authors.lastname: Bailes
mesh_terms: D000328:Adult; D000368:Aged; D002551:Cerebral Ventricle Neoplasms / Q000473:pathology* / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation* / Q000379:methods*; D044582:Neuroendoscopes; D044583:Neuroendoscopy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Intraventricular tumors; Parafascicular dissection; Transsulcal approach; Tubular retraction system