New microsurgical technique for intraparenchymal lesions of the brain: transcylinder approach

Abstract

Although various minimally invasive approaches, including endoscopic, stereotaxic, and ultrasound-guided surgery, have been introduced to minimize damage to healthy brain tissue, the microsurgical technique has retained a significant role in contemporary neurosurgery. A new microsurgical approach to intraparenchymal brain lesions, namely, the transcylinder approach, was developed to realize both minimal surgical access and sufficient microsurgical technique. A 0.1-mm transparent polyester film was used to create a cylindrical surgical route. The film was rolled into a thin stick and used to penetrate the brain, and a computer-aided navigation system was used from inside the stick to access the lesion accurately. After the stick gained access to the lesion, it was dilated to 2 cm, and this diameter was maintained during surgery. The transcylinder approach was used in 11 cases, including intraparenchymal tumours and haematomas, and the usual microsurgical procedure was performed without difficulty. The film avoided unnecessary enlargement of the surgical field and minimized injury to the brain. Intra-operative ultrasonography also can be used to identify the lesion through the cylinder because the polyester film does not reflect the ultrasound beam. The surgical route was observed to recover to almost the same size as the initial cortical incision after removal of the cylinder. The transcylinder approach could be advantageous for removing tumours or haematomas in the intraventricular or intraparenchymal regions. By avoiding unnecessary retraction, it significantly reduces the risk of injury to surrounding brain tissue while facilitating precise microsurgical technique. The accuracy of this minimally invasive technique can be enhanced when used in conjunction with frameless stereotaxy and intra-operative ultrasound guidance.