Minimally Invasive Surgical Outcomes for Deep-Seated Brain Lesions Treated with Different Tubular Retraction Systems: A Systematic Review and Meta-Analysis

Abstract

Minimally invasive surgery using tubular retractors was developed to minimize injury of surrounding brain during the removal of deep-seated lesions. No evidence supports the superiority of any available tubular retraction system in the treatment of these lesions. We conducted a systematic review and meta-analysis to evaluate outcomes and complications after the resection of deep-seated lesions with tubular retractors and among available systems. A PRISMA compliant systematic review was conducted on PubMed, Embase, and Scopus to identify studies in which tubular retractors were used to resect deep-seated brain lesions in patients ≥18 years old. The search strategy yielded 687 articles. Thirteen articles complying with inclusion criteria and quality assessment were included in the meta-analysis. A total of 309 patients operated on between 2008 and 2018 were evaluated. The most common lesions were gliomas (n= 127), followed by metastases (n= 101) and meningiomas (n= 19). Four different tubular retractors were used: modified retractors (n= 121, 39.1%); METRx (n= 60, 19.4%); BrainPath (n= 92, 29.7%); and ViewSite Brain Access System (n= 36,11.7%). Estimated gross total resection rate was 75% (95% confidence interval, 69%-80%; I2= 9%), whereas the estimated complication rate was 9% (95% confidence interval: 6%-14%; I2= 0%). None of the different brain retraction systems was found to be superior regarding extent of resection or complications on multiple comparisons (P > 0.05). Tubular retractors represent a promising tool to achieve maximum safe resection of deep-seated brain lesions. However, there does not seem to be a statistically significant difference in extent of resection or complication rates among tubular retraction systems.