Joshua Bakhsheshian1, Ben A Strickland1, Christina Jackson2, Kaisorn L Chaichana2, Ronald Young3, Gustavo Pradilla4, Jefferson W Chen5, Julian Bailes6, Gabriel Zada1. 1. Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California. 2. Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland. 3. Brain and Spine Center of South Florida, Delray, Florida. 4. Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia. 5. Department of Neurological Surgery, School of Medicine, University of California, Irvine, California. 6. Department of Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois.
Abstract
BACKGROUND: Recent advancements have aimed to optimize visualization and minimize insult to healthy cortical and subcortical tissue through the use of tubular-based retractors. OBJECTIVE: To investigate outcomes following resection of cerebral metastases using an integrated tubular retraction system with an exoscope and neuronavigation. METHODS: A multicenter retrospective analysis of surgical outcomes in consecutive patients who underwent resection of a brain metastasis using a tubular retraction system and exoscope was performed. RESULTS: Twenty-five patients were included, with a mean age of 61 yr (24-81 yr). Primary sources included lung (n = 13), breast (n = 3), renal cell (n = 3), and other (n = 6). Locations were frontal (n = 5), parietal (n = 8), cerebellar (n = 8), occipital (n = 3), and splenium (n = 1). Most lesions had a maximum diameter > 3.0 cm (n = 20) and a tumor depth > 4 cm (n = 14). Conversion to open (microscopic) craniotomy was not required in any case. Gross total resection was achieved in 20 cases (80.0%) and subtotal resection in 5 cases (20.0%). Median hospital stay was 2 d (1-12 d). All patients underwent postoperative radiation therapy. Perioperative complications developed in 1 patient (4.0%; hemiparesis and subsequent deep vein thrombosis). At 3-mo follow-up, no mortalities were observed, 19 patients (76.0%) demonstrated neurological improvements, 5 patients (20.0%) had a stable neurological exam, and 1 patient (4.0%) had a neurological decline. CONCLUSION: Utilization of a channel-based, navigable retractor and exoscope is a feasible option for surgical resection of metastatic brain lesions.
BACKGROUND: Recent advancements have aimed to optimize visualization and minimize insult to healthy cortical and subcortical tissue through the use of tubular-based retractors. OBJECTIVE: To investigate outcomes following resection of cerebral metastases using an integrated tubular retraction system with an exoscope and neuronavigation. METHODS: A multicenter retrospective analysis of surgical outcomes in consecutive patients who underwent resection of a brain metastasis using a tubular retraction system and exoscope was performed. RESULTS: Twenty-five patients were included, with a mean age of 61 yr (24-81 yr). Primary sources included lung (n = 13), breast (n = 3), renal cell (n = 3), and other (n = 6). Locations were frontal (n = 5), parietal (n = 8), cerebellar (n = 8), occipital (n = 3), and splenium (n = 1). Most lesions had a maximum diameter > 3.0 cm (n = 20) and a tumor depth > 4 cm (n = 14). Conversion to open (microscopic) craniotomy was not required in any case. Gross total resection was achieved in 20 cases (80.0%) and subtotal resection in 5 cases (20.0%). Median hospital stay was 2 d (1-12 d). All patients underwent postoperative radiation therapy. Perioperative complications developed in 1 patient (4.0%; hemiparesis and subsequent deep vein thrombosis). At 3-mo follow-up, no mortalities were observed, 19 patients (76.0%) demonstrated neurological improvements, 5 patients (20.0%) had a stable neurological exam, and 1 patient (4.0%) had a neurological decline. CONCLUSION: Utilization of a channel-based, navigable retractor and exoscope is a feasible option for surgical resection of metastatic brain lesions.
Authors: Anna L Roethe; Philipp Landgraf; Torsten Schröder; Martin Misch; Peter Vajkoczy; Thomas Picht Journal: Acta Neurochir (Wien) Date: 2020-05-19 Impact factor: 2.216
Authors: Henry Ruiz-Garcia; Lina Marenco-Hillembrand; Jennifer L Peterson; Katherine Tzou; Timothy D Malouff; Kaisorn L Chaichana; Daniel M Trifiletti; Laura Vallow Journal: Transl Cancer Res Date: 2020-01 Impact factor: 1.241