Abstract
The surgical management of deep brain tumors is often challenging due to the limitations of stereotactic needle biopsies and the morbidity associated with transcortical approaches. We present a novel microscopic navigational technique utilizing the Viewsite Brain Access System (VBAS) (Vycor Medical, Boca Raton, FL, USA) for resection of a deep parietal periventricular high-grade glioma as well as another glioma and a cavernoma with no related morbidity. The approach utilized a navigational tracker mounted on a microscope, which was set to the desired trajectory and depth. It allowed gentle continuous insertion of the VBAS directly to a deep lesion under continuous microscopic visualization, increasing safety by obviating the need to look up from the microscope and thus avoiding loss of trajectory. This technique has broad value for the resection of a variety of deep brain lesions.
Highlights
Surgical access to deep targets is a common challenge in neurosurgery
The surgical management of deep brain tumors is often challenging due to the limitations of stereotactic needle biopsies and the morbidity associated with transcortical approaches
We present a novel microscopic navigational technique utilizing the Viewsite Brain Access System (VBAS) (Vycor Medical, Boca Raton, FL, USA) for resection of a deep parietal periventricular high-grade glioma as well as another glioma and a cavernoma with no related morbidity
Summary
Surgical access to deep targets is a common challenge in neurosurgery. Stereotactic needle biopsies often provide insufficient tissue or result in a sampling bias, potentially leading to a misdiagnosis, especially in the case of smaller lesions [1,2]. In order to better target deep brain lesions, we combined the VBAS, neuronavigation, and microsurgery in a manner that allowed for an accurate approach along with minimal disturbance of normal parenchyma under constant microscopic visualization. By maintaining the distal most portion of the VBAS retractor at the maximal focus point of the microscope, the surgeon was able to track the depth of the retractor as it related to the stereotactic navigation We show the set up of the operative field. The Leica microscope with the attached Stryker Cranial Navigation System were registered to the position, with a plan for a supracerebellar approach At this point, a trajectory was planned and the microscope was fixed in place with the crosshairs of the microscope fixed to target the lesion.
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