Introduction: Paramount to functional preservation is a-traumatic surgical access and clear working corridors to subcortical regions. We describe an initial experience with a navigable trans-sulcal tubular retractor engineered to reach deep-seated tumors, hemorrhages and vascular lesions leveraging parafascicular approaches.
Methods: A "real-time" cohort analysis of patients (=22 years) undergoing craniotomies using a navigable tubular retractor (NTR) for brain tumors/lesions & hemorrhages was performed. Demographic characteristics, tumor/lesion location, pathology, size, surgical time, pre-operative deficits, surgical mortality were analyzed.
Results: 1032 adult patients undergoing NTR surgery between December 12, 2012-August 8, 2017 were included (tumor/lesion(t) n = 629; vascular(v) = 403) age range = 22 – 91 (mean age = 57.5t years; 57.8v years) including 298t, 225v males & 272t, 129v females. Locations included: subcortical (n=229t,n=188v), intra-ventricular (n=56t, n=10v), cortical n=21t, n=13v, cortical-subcortical n=62t, n=68v, brain stem n=5t, “other” n=6t and 8v. Pre-operative deficits were reported in 228/629 tumor subjects & the average lesion size=3.07t cm. There were 305 primary & 229 secondary metastatic tumors; gliomas (n=108) were the most frequently observed primary pathology, followed by astroctytomas (n=9), and meningiomas (n=6). Mean tumor surgical time=184.0 minutes. Intracranial hemorrhages (ICH) were observed in 344/405 subjects, followed by cavernomas (n=33) & intraventricular hemorrhages (n=10). The mean vascular operating time was 126.8 minutes. Vascular pre-operative deficits included: hemiplegia/paralysis (n=48), headache (n=16) & weakness (n=14). No deaths associated with NTR surgery were reported.
Conclusions: This experiential review represents the largest reported cohort of patients undergoing NTR surgery and demonstrates its utility in reaching a variety of lesions primarily located in the subcortical regions. Future trials and investigations are forthcoming. This preliminary analysis allows identification of NTR use demographics so that harmonized data collection can assess the NTR platform in clinical use. Data did not extend beyond the surgeries. A larger, physician-directed adult registry or use analysis is desirable.
Patient Care: This study represents the largest "real-world" adult cohort of patients undergoing surgical removal of brain tumors, vascular lesions or hemorrhages using a navigable trans-sulcal tubular retractor via the parafascicular route. These data give credence to the utility of a device specifically engineered to reach deep areas of the brain.
Learning Objectives: After the conclusion of this session, participants should be able to:
1. Describe the role of a navigable trans-sulcal tubular retractor in reaching deep-seated brain tumors and hemorrhages/vascular lesions in a large adult cohort;
2. Discuss the importance of using a device engineered for use with a parafascicular route in facilitating a-traumatic access;
3.Identify and list characteristics that are likely to contribute to successful removal of deep-seated tumors, lesions and hemorrhages.