Utility of Tubular Retractors Augmented with Intraoperative Ultrasound in the Resection of Deep-seated Brain Lesions: Technical Note.

Samer G Zammar,Jared Cappelli,Brad E Zacharia

doi:10.7759/cureus.4272

Samer G Zammar, Jared Cappelli + Show 1 more

Open Access

https://doi.org/10.7759/cureus.4272

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Journal: Cureus	Publication Date: Mar 19, 2019
Citations: 11	License type: cc-by

Affiliation: Penn State Milton S. Hershey Medical Center

Abstract

Traditional brain retraction has been associated with significant damage to the healthy brain tissue particularly when attempting to expose a deep-seated lesion of the brain. Tubular retractors tend to provide a surgical corridor to treat these lesions while minimizing the extent of retraction on the brain. Intraoperative ultrasound can be used as a handy adjunct in maximizing the safe resection primarily by identifying the entry point, visualizing the lesion, and providing real-time feedback on the extent of resection. The authors provide a technical note with case illustrations on the use of tubular retractors augmented with intraoperative ultrasound to ensure a maximal safe resection of deep-seated brain lesions.

Highlights

Minimal access neurosurgery is becoming increasingly common
Ultrasound is a fast, inexpensive, real-time tool that has a long history in neurosurgery, but has yet to be fully incorporated into tube-based neurosurgery [1, 2]
We report our experience with the use of ultrasound in tubular surgery and provide technical details regarding augmentation of standard tubular-based surgery techniques with a modified ultrasound probe integrated with the NICO Brainpath

Summary

Introduction

The use of tubular retractors has recently gained traction as an option to decrease morbidity during surgical resection of deep-seated brain lesions As these approaches become more physically constrained, accurate intraoperative localization and navigation become increasingly critical. How to cite this article Zammar S G, Cappelli J, Zacharia B E (March 19, 2019) Utility of Tubular Retractors Augmented with Intraoperative Ultrasound in the Resection of Deep-seated Brain Lesions: Technical Note. Due to its deep location and symptomatic presentation, the decision was made to use the BrainPath augmented with ultrasound via a right frontal parafascicular approach to resect the lesion. The pathology was consistent with metastatic adenocarcinoma of the lung and the patient was discharged home on post-operative day 2 with plans for adjuvant gamma knife radiosurgery

Discussion

Conclusions

Disclosures