Stereotactic-guided dilatable endoscopic port surgery for deep-seated brain tumors: technical report with comparative case series analysis.

Stereotactic-guided dilatable endoscopic port surgery for deep-seated brain tumors: technical report with comparative case series analysis.

World Neurosurg. 2019 Feb 07;:

Authors: Newman WC, Engh JA

Abstract
OBJECTIVE: Deep-seated brain tumors are often best treated with primary surgical excision. Traditional microsurgical techniques may cause retraction injury and extensive brain dissection. To mitigate this risk, stereotactic-guided tubular retractors were developed, but the risk of shear injury remains. We created a stereotactic-guided dilatable port system to create a corridor for deep brain tumor surgery along the trajectory of a brain needle in order to minimize iatrogenic brain injury.
METHODS: Eight patients participated (6 colloid cysts, 1 metastasis, and 1 intraventricular meningioma). 5 patients underwent frameless and 3 underwent frame-based stereotactic targeting. We used a tans-sulcal trajectory using a 2.6mm stereotactic needle. At target depth, the cannula was removed and the balloon was inflated to 14mm. The balloon was deflated and removed prior to placing the port. Pre- and 3-month post-operative MRI scans were used to measure T2 signal change and residual cannulation defect. These patients were compared to a case-matched cohort of standard endoscopic port surgery (SEPS) patients.
RESULTS: All patients had total lesional resection without new neurologic deficits. Patients undergoing dilatable endoscopic port surgery (DEPS) had significantly smaller residual cannulation defects (p<0.05), but there was no significant difference in postoperative T2-signal change or diffusion restriction volumes at 3 months (p>0.05).
CONCLUSIONS: DEPS may be a safe alternative to SEPS or microsurgery for deep-seated brain tumors. The degree of iatrogenic injury from this technique, based on MRI analysis, may be equivalent to or an improvement upon standard port surgery techniques though larger sample sizes are needed to validate this.

PMID: 30738944 [PubMed - as supplied by publisher]

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