Minimally Invasive Transsulcal Resection of Intraventricular and Periventricular Lesions Through a Tubular Retractor System: Multicentric Experience and Results.
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.
['Eliyas|Javed Khader|JK|', 'Glynn|Ryan|R|', 'Kulwin|Charles G|CG|', 'Rovin|Richard|R|', 'Young|Ronald|R|', 'Alzate|Juan|J|', 'Pradilla|Gustavo|G|', 'Shah|Mitesh V|MV|', 'Kassam|Amin|A|', 'Ciric|Ivan|I|', 'Bailes|Julian|J|']
D000328:Adult D000368:Aged D002551:Cerebral Ventricle Neoplasms D004867:Equipment Design D005260:Female D006801:Humans D008297:Male D008866:Microsurgery D008875:Middle Aged D019060:Minimally Invasive Surgical Procedures D044582:Neuroendoscopes D044583:Neuroendoscopy D016896:Treatment Outcome D055815:Young Adult
Intraventricular tumors Parafascicular dissection Transsulcal approach Tubular retraction system