Transtubular micro-endo-assisted approach for intraventricular and deep-seated brain lesions

Abstract

OBJECTIVE: Intraventricular and deep-seated brain lesions present a surgical challenge due to their accessibility, illumination, and relationship to neural and vascular structures. To minimize tissue damage and its complications caused by access and brain retraction, several minimally invasive endoscopic approaches have been developed; but none replace contemporary microsurgical technique. We present a transtubular micro-endo-assisted approach as an alternative to maximize the benefts and minimize the difculties of pure endoscopic approaches and contemporary microsurgical techniques. MATERIAL AND METHODS: Through a 2-3 cm craniotomy and a minimal corticotomy, we introduce a tubular retractor guided by neuronavigation, which allows controlled movements and protects the surrounding parenchyma. We performed a retrospective and observational analysis including medical records, radiological fndings, surgical treatment and outcome. RESULTS: This approach with microsurgical endoscopic-assisted technique was applied to 56 patients. Where this minimally invasive approach avoids excessive brain retraction and its complications. It combines bimanual microsurgical technique, using standard microsurgical instruments, and neuroendoscopy, allowing better, wider and angled vision and illumination. This tubular retractor system displaces brain parenchyma, causing less tissue damage. At the end, a smaller corticotomy is observed. CONCLUSION: The transtubular micro-endo-assisted approach combines the advantages of contemporary surgical techniques, improving their weaknesses. It is a safe technique, allowing treatment of solid, bleeding and larger intraventricular and/or deep-seated lesions.