Use of Tubular Retractors for Minimally Invasive Resection of Deep-Seated Cavernomas
Use of Tubular Retractors for Minimally Invasive Resection of Deep-Seated Cavernomas
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DOI：
10.1093/ons/opz184
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发表时间：
2020-06-01
影响因子：
2.3
通讯作者：
Starke, Robert M.
中科院分区：
文献类型：
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作者：
Eichberg, Daniel G.;Di, Long;Starke, Robert M.
背景：位于皮质下或功能区的海绵状血管瘤是难以安全进入的病变。管状牵开器，其径向地分布牵开压力，已经越来越成功地使用。这些牵开器在皮质下海绵状血管瘤切除术中可能是有益的。目的：回顾一个单一机构的病例系列，以确定经皮质-经前庭海绵状血管瘤切除术的安全性和有效性，并描述我们的经前庭手术技术。方法：我们回顾了一个单一的机构的经皮质-经前庭海绵状血管瘤切除术使用BrainPath或（NICO，Indianapolis，印第安纳州）或ViewSite Brain Access System（VycorMedical，博卡拉顿，佛罗里达）管状牵开器。当存在发育性静脉异常（DVA）时，所有病例均避免DVA切除（n = 4）。所有患者均患有幕上海绵状血管瘤，皮质表面下平均深度为44.1 mm。平均术后临床随访时间为20.4周。早期神经功能缺损率为10%（n = 2）;永久性神经功能缺损率为0%。1例患者（5%）发生术后早期癫痫发作（术后< 1周）。无患者发生迟发性癫痫发作（> 1周随访）。恩格尔1级癫痫控制在最后的临床随访中，87.5%的患者术前epilepsy.CONCLUSION：管状牵开器提供了一个低姿态，微创手术走廊切除皮质下海绵状血管瘤。在我们的20例患者中，没有永久性神经系统并发症，所有患者均实现了长期癫痫控制。因此，管状牵开器似乎是切除皮质下海绵状血管瘤的一种安全有效的工具。
BACKGROUND: Cavernomas located in subcortical or eloquent locations are difficult lesions to access safely. Tubular retractors, which distribute retraction pressure radially, have been increasingly employed successfully. These retractors may be beneficial in subcortical cavernoma resection.OBJECTIVE: To review a single institution's case series to determine the safety profile and efficacy of transcortical-transtubular cavernoma resections and to describe our transtubular operative technique.METHODS: We reviewed a single institution's transcortical-transtubular cavernoma resections using either BrainPath (NICO, Indianapolis, Indiana) or ViewSite Brain Access System (VycorMedical, Boca Raton, Florida) tubular retractors performed from2013 to 2018 (n = 20).RESULTS: Gross total resection was achieved in all patients. When a developmental venous anomaly (DVA) was present, avoidance of DVA resection was achieved in all cases (n = 4). All patients had a supratentorial cavernoma with mean depth below cortical surface of 44.1 mm. Average postoperative clinical follow-up was 20.4 wk. Early neurologic deficit rate was 10% (n = 2); permanent neurologic deficit rate was 0%. One patient (5%) experienced early postoperative seizures (< 1 wk postop). No patients experienced late seizures (> 1 wk follow-up). Engel class 1 seizure control at final clinical follow-up was achieved in 87.5% of patients presenting with preoperative epilepsy.CONCLUSION: Tubular retractors provide a low-profile, minimally invasive operative corridor for resection of subcortical cavernomas. There were no permanent neurologic complications in our series of 20 cases, and long-term seizure control was achieved in all patients. Thus, tubular retractors appear to be a safe and efficacious tool for resection of subcortical cavernomas.