title: A novel combination of two minimally invasive surgical techniques in the management of refractory radiation necrosis: Technical note.
abstract: BACKGROUND
  Minimally-invasive approaches are attractive alternative to standard craniotomy for large intracranial tumors with potentially lesser morbidity. In this report, we describe a sequential combination of two minimally-invasive surgical techniques to treat a large intracranial tumor.
  
  
  METHODS
  A 49year-old woman presented with a history of breast cancer and large left parietal metastasis with significant perilesional edema. This was initially managed by whole brain radiation therapy and stereotactic radiosurgery. The patient underwent laser ablation of the tumor followed by internal tumor debulking using an exoscopic-assisted tubular retractor system. Post-operative MRI showed gross total coverage of the tumor by laser ablation and alleviation of mass effect. The patient recovered well and discharged on second postoperative day.
  
  
  CONCLUSIONS
  The minimally-invasive combination of laser ablation followed by internal debulking using a tubular retractor device could be done safely and effectively as a minimally invasive alternative to standard craniotomy for large intracranial tumors.
authors.affiliation: The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, The Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.
authors.forename: Ghaith
authors.initials: G
authors.lastname: Habboub
authors.affiliation: The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, The Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.
authors.forename: Mayur
authors.initials: M
authors.lastname: Sharma
authors.affiliation: The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, The Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.
authors.forename: Gene H
authors.initials: GH
authors.lastname: Barnett
authors.affiliation: The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, The Neurological Institute, Cleveland Clinic, Cleveland, OH, United States. Electronic address: mohamma3@ccf.org.
authors.forename: Alireza M
authors.initials: AM
authors.lastname: Mohammadi
mesh_terms: D001921:Brain / Q000473:pathology*; D001929:Brain Edema / Q000209:etiology / Q000473:pathology; D001932:Brain Neoplasms / Q000150:complications / Q000532:radiotherapy* / Q000556:secondary; D005260:Female; D006801:Humans; D053685:Laser Therapy; D008175:Lung Neoplasms / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009336:Necrosis; D011832:Radiation Injuries / Q000601:surgery*; D016634:Radiosurgery; D011878:Radiotherapy / Q000009:adverse effects*
keywords: BrainPath; LITT; Laser ablation; Minimally invasive surgery; NeuroBlate; Tubular retraction