Eichberg Daniel G, Buttrick Simon, Brusko G Damian, Ivan Michael, Starke Robert M, Komotar Ricardo J
Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
World Neurosurg. 2018 Apr;112:e50-e60. doi: 10.1016/j.wneu.2017.12.023. Epub 2017 Dec 15.
Brain retraction is often required to develop a surgical corridor during the resection of deep-seated intracranial lesions. Traditional blade retractors distribute pressure asymmetrically and may case local tissue damage. Tubular retractors minimize this pitfall by distributing pressure evenly, which has been shown to translate to significant safety and efficacy data. Further qualified reports regarding the use of tubular retractors are of interest.
We performed a retrospective analysis of 1 surgeon's experience with 20 cases of minimally invasive resection with the ViewSite Brain Access System (n = 7) and BrainPath (n = 13) systems. In addition, a comprehensive review of all published cases of tubular retractor systems used for resection of subcortical neoplastic, cystic, infectious, vascular, and hemorrhagic lesions was conducted.
Of the 20 cases analyzed, gross total resection was achieved in 18, with an associated 10% immediate postoperative complication rate and 5% long-term complication rate. A comprehensive review of the literature showed 30 articles describing 536 cases of resection of deep neoplastic or colloid cysts with an overall complication rate of 9.1%.
Tubular retractor systems have a favorable safety profile and are an important tool in the armamentarium of a neurosurgeon for the resection of deep intracranial lesions.
在切除深部颅内病变时，通常需要进行脑牵拉以形成手术通道。传统的刀片式牵开器压力分布不对称，可能导致局部组织损伤。管状牵开器通过均匀分布压力将这种风险降至最低，这已被证明能转化为显著的安全性和有效性数据。关于使用管状牵开器的进一步合格报告备受关注。
我们对一位外科医生使用ViewSite脑通路系统（n = 7）和BrainPath系统（n = 13）进行20例微创切除手术的经验进行了回顾性分析。此外，还对所有已发表的使用管状牵开器系统切除皮质下肿瘤性、囊性、感染性、血管性和出血性病变的病例进行了全面综述。
在分析的20例病例中，18例实现了肿瘤全切除，术后即刻并发症发生率为10%，长期并发症发生率为5%。对文献的全面综述显示，有30篇文章描述了536例深部肿瘤或胶体囊肿切除病例，总体并发症发生率为9.1%。
管状牵开器系统具有良好的安全性，是神经外科医生切除深部颅内病变的重要工具。
