Eichberg Daniel G, Di Long, Shah Ashish H, Ivan Michael E, Komotar Ricardo J, Starke Robert M
Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, Florida.
Morsani College of Medicine, University of South Florida, Tampa, Florida.
Oper Neurosurg (Hagerstown). 2020 Jun 1;18(6):629-639. doi: 10.1093/ons/opz184.
Cavernomas located in subcortical or eloquent locations are difficult lesions to access safely. Tubular retractors, which distribute retraction pressure radially, have been increasingly employed successfully. These retractors may be beneficial in subcortical cavernoma resection.
To review a single institution's case series to determine the safety profile and efficacy of transcortical-transtubular cavernoma resections and to describe our transtubular operative technique.
We reviewed a single institution's transcortical-transtubular cavernoma resections using either BrainPath (NICO, Indianapolis, Indiana) or ViewSite Brain Access System (Vycor Medical, Boca Raton, Florida) tubular retractors performed from 2013 to 2018 (n = 20).
Gross total resection was achieved in all patients. When a developmental venous anomaly (DVA) was present, avoidance of DVA resection was achieved in all cases (n = 4). All patients had a supratentorial cavernoma with mean depth below cortical surface of 44.1 mm. Average postoperative clinical follow-up was 20.4 wk. Early neurologic deficit rate was 10% (n = 2); permanent neurologic deficit rate was 0%. One patient (5%) experienced early postoperative seizures (< 1 wk postop). No patients experienced late seizures (> 1 wk follow-up). Engel class 1 seizure control at final clinical follow-up was achieved in 87.5% of patients presenting with preoperative epilepsy.
Tubular retractors provide a low-profile, minimally invasive operative corridor for resection of subcortical cavernomas. There were no permanent neurologic complications in our series of 20 cases, and long-term seizure control was achieved in all patients. Thus, tubular retractors appear to be a safe and efficacious tool for resection of subcortical cavernomas.
位于皮质下或功能区的海绵状血管瘤是难以安全切除的病变。径向分布牵开压力的管状牵开器已越来越成功地得到应用。这些牵开器可能有助于皮质下海绵状血管瘤的切除。
回顾单中心病例系列，以确定经皮质-经管状海绵状血管瘤切除术的安全性和有效性，并描述我们的经管状手术技术。
我们回顾了单中心在2013年至2018年期间使用BrainPath（NICO公司，印第安纳波利斯，印第安纳州）或ViewSite Brain Access System（Vycor Medical公司，博卡拉顿，佛罗里达州）管状牵开器进行的经皮质-经管状海绵状血管瘤切除术（n = 20）。
所有患者均实现了肿瘤全切。当存在发育性静脉异常（DVA）时，所有病例（n = 4）均避免了DVA切除。所有患者均患有幕上海绵状血管瘤，平均位于皮质表面以下44.1 mm。术后平均临床随访时间为20.4周。早期神经功能缺损率为10%（n = 2）；永久性神经功能缺损率为0%。1例患者（5%）术后早期出现癫痫发作（术后<1周）。无患者出现晚期癫痫发作（随访>1周）。术前有癫痫的患者在最后一次临床随访时，87.5%达到Engel 1级癫痫控制。
管状牵开器为皮质下海绵状血管瘤的切除提供了一个低轮廓、微创的手术通道。在我们的20例系列病例中没有永久性神经并发症，所有患者均实现了长期癫痫控制。因此，管状牵开器似乎是切除皮质下海绵状血管瘤的一种安全有效的工具。
