Minimally-invasive transsulcal resection of intraventricular and periventricular lesions through a tubular retractor system: Multicentric experience and results

BACKGROUND: Conventional approaches to deep-seated cerebral lesions range from biopsy to trans-cortical or trans-callosal resection. While the former doesn\u27t reduce tumor burden, the latter are more invasive and associated with greater potential for irreparable injury to normal brain. Disconnection syndrome, hemiparesis, hemi-anesthesia or aphasia is not uncommon after such surgery, especially when lesion is large. By contrast, the trans-sulcal parafascicular approach utilizes naturally existing corridors and employs a tubular retractor to minimize brain injury. METHODS: A retrospective review of patients undergoing minimally invasive trans-sulcal parafascicular resection of ventricular and periventricular lesions, across 5 independent centers, were conducted. RESULTS: Twenty patients with lesions located in the lateral ventricle (n=9), the third ventricle (n=6) and periventricular region (n=4) are described in this report. Average age was 64 years (8M/12F). Average depth from cortical surface was 4.37 cm. A 13.5 mm diameter tubular retractor (Brainpath, NICO Corporation, Indianapolis, IN) of differing lengths was employed, aided by neuro-navigation. Gross-total resection was obtained in 17 patients. Pathologies included colloid cyst, subependymoma, glioma, meningioma, central neurocytoma, lymphoma and metastasis. Three patients experienced transient morbidity: memory loss (2), hemiparesis (1). One patient died 2 months postoperatively due to unrelated pulmonary illness. Follow-up ranged form 6 to 27 months (average 12 months). CONCLUSION: This technique is safe and effective for the treatment of intraventricular and periventricular lesions. Surgery-related morbidity is minimal and often transient. Lesions are satisfactorily resected and residuum occur when neoplasm involves vital structures. The tubular retractor minimizes trauma to brain incident on the surgeon\u27s path