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Case of the Month - June 2017

65 female patient  years. Right hemiparesis and generalized tonic-clonic seizures. History of biopsy by navigation in another institution with previous pathologies of 1 year ago that reported Diffuse Astrocytoma.

Patient underwent minimally invasive resection with transcortical tubular brain retractor under microscope and fusion of images with neuronavigation with CT and volumetric vial and contrasted MRI.

Small 3 cm craniotomy, used for previous approach.

Tubular Retractors for Glial Tumor Resection  Deep

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In this case, it was decided to use a tubular retractor because it was a deep lesion in relation to the ventricle, where an introduction could be made through the previous craniotomy, avoiding brain retraction. The retractor was rearranged according to the parameters used by neuronavigation. The ultrasonic aspirator was balanced and calibrated to perform a guided resection, avoiding injury to the tracts of the ascending activating reticular system and the ipsilateral cortico-spinal tract.  

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The main advantages of using these retractors are: 

1. Decreased retraction of the brain.

2. Deep visualization in intra- or periventricular primary tumors.

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References

 

  1. Herrera SR, Kouloumberis P, Shin SH, et al. Use of Transparent Plastic Tubular Retractor in Surgery for Deep Brain Lesions: A Case Series. Surgical Overview. Surgical technology international XIX.

  2. Ratre S, Yadav YR, Parihar VS, et al. Microendoscopic Removal of Deep-Seated Brain Tumors Using Tubular Retraction System. J Neurol Surg A 2016; 77: 312–320. 

  3. Almenawer SA, Crevier L, Murty  N. Minimal access to deep intracranial lesions using a serial dilatation technique. Neurosurg Rev (2013) 36: 321–330 

  4. Ratre S, Yadav YR, Parihar VS, et al. Microendoscopic Removal of Deep-Seated Brain Tumors Using Tubular Retraction System. J Neurol Surg A 2016; 77: 312–320.  

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