Immediate outcomes of using tubular retractors in surgery of deep brain lesions

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Background. Resection of deep-seated space-occupying brain lesions is traditionally associated with a triad of problems: retraction injury, limited radicality, and risks of augmentation of neurologic symptoms. Port-assisted or tubular surgery has been recently gaining popularity as its goal is to minimize these risks. Therefore, it is necessary to evaluate its effectiveness and compare it to the traditional interventions. Aim. To perform comparative analysis of the immediate outcomes of traditional and port-assisted surgery of deep-seated space-occupying brain lesions. Materials and methods. The results of resection of deep-seated space-occupying brain lesions in 61 patients (31 men and 30 women) including 36 patients with diffuse glial tumors and 25 patients with nodular lesions were retrospectively analyzed. Among them, 35 patients were operated on using the traditional technique with spatulas (1st group), 26 patients – using tubular retractors, port-assistance (2nd group). Evaluation and comparison of radicality and neurologic outcomes in these patient groups, as well as differentiation of possible factors of unfavorable outcomes were performed. Results. Radicality of glial tumor resection per the total / subtotal / partial grading in the 1st group was 0, 50 and 50 %; in the 2nd group, 21.4; 35.7 and 42.9 %. Total resection of nodular lesions in the 1st group was achieved in 76.9 % of cases; in the 2nd group, in 91.7 %. Clinical deterioration was observed in 13 (37.1 %) patients of the 1st group and 4 (15.4 %) patients of the 2nd group, but it was mostly transient. Compared to traditional surgery, the use of tubular retractors allowed to achieve significantly smaller trephination size (13.2 ± 4.6 cm2 versus 22.7 ± 7.8 cm2) and decrease postoperative in-hospital period (3 [3; 5] days versus 12 [6; 16] days). Conclusion. The use of port-assistance in surgery of deep-seated space-occupying brain lesions is preferential to traditional surgery in terms of higher radicality for similar size and histology of lesions and lower rate of neurologic complications without imposition of additional constraints.