Introduction: Feasibility assessment of combining minimally invasive tubular brain retraction system (Nico Brain PathTM), high-resolution exoscope visualization and high-field intraoperative magnetic resonance imaging (iMRI) to maximize safe resection of deep-seated intrinsic brain tumors while minimizing iatrogenic injury to intervening healthy tissue. An exoscope is an endoscope-like device positioned above operative field that enables surgeon visualization on high resolution monitors.
Methods: Prospective IRB-approved multicenter database (IMRIS iMRI Neurosurgery Database, I-MiND) was used to identify patients with tumor resections performed with MRI-compatible Brain PathTM system placed via small navigated craniotomies with high-resolution exoscope visualization, for which high field iMRI was used to assess extent of resection. Safety and feasibility of this novel technique and impact upon extent of resection and outcomes were assessed.
Results: Seven patients with deep seated intrinsic brain tumors underwent surgical resection using combination of a tubular retractor, exoscope, and iMRI. Mean age was 51.2 years (range: 37-61, 6 males/1 female). Lesions included 5 gliomas (3 newly diagnosed glioblastomas, 1 recurrent anaplastic astrocytoma, and 1 WHO grade I angiocentric glioma), and 2 brain metastases (1 renal cell, 1 breast). Mean tumor diameter was 2.95 cm (range: 1.2-4.4). iMRI demonstrated complete resection in 3/7 cases (43%). Additional resection was performed after iMRI in 3/7 cases (43%) leading to complete resection in 6/7 cases. In select cases the tubular retraction system was left in place during iMRI acquisition without image distortion. There were no intraoperative complications. Immediately postoperative neurological function was stable in 5 cases (71%) and improved in 2 (28%) cases. Median hospital length of stay was 2 days (range: 1-4). Surgical videos will be provided with the presentation.
Conclusions: Combining a minimally invasive tubular brain retraction system, exoscope visualization, and iMRI as a novel strategy to facilitate resection of deep-seated intrinsic brain tumors is feasible, may decrease morbidity, and merits further investigation.
Patient Care: The application of the tubular retraction system and exoscope facilitates resection of deep seated instrinsic brain tumors through a minimally invasive exposure, and the additon of the intraoperative MRI provides immediate feedback to the surgeon to guide safe maiximal resection
Learning Objectives: To explore the feasibility and safety of combining minimally invasive tubular brain retraction system (Nico Brain PathTM), high-resolution exoscope visualization and high-field intraoperative magnetic resonance imaging (iMRI) to maximize safe resection of deep-seated intrinsic brain tumors.
References: Labib MA et al: The safety and feasibilty of image guided BrainPath-mediated transulcal hematoma evacuation: a multicenter study. Neurosurgery ahead of print. DOI: 10.1227/NEU.0000000000001316