Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
World Neurosurg. 2023 Aug;176:162-167. doi: 10.1016/j.wneu.2023.05.036. Epub 2023 May 17.
Recent advances in intraoperative neuronavigation and cranial access devices have facilitated an increasing interest in the use of minimally invasive techniques (minimally invasive surgery) to safely treat subcortical lesions via a parafascicular approach. Newly developed expandable retractors, such as the MindsEye system further optimize such approaches. In this technical report, we describe the nuances in minimally invasive surgery parenchymal hematoma evacuation using the MindsEye device.
After placement of the device, the inner stylet and inner obturator are removed, and the expandable sheath is left in place and secured into place with a Greenberg refractor. The sheath easily dilates to the surgeonss preference with a dial, and the walls of the sheath are composed of a thin, clear, membrane to allow easy visualization of the lesion. We additionally retrospectively reviewed clinical characteristics and outcomes across three patients treated at our facility with spontaneous multicompartment intracranial hematoma using the MindsEye system.
We provide a video case demonstrating the use of the MindsEye retractor in a transfrontal parenchymal hematoma evacuation. Successful evacuation with achieved in less than 90 minutes with near total clot removal and resolution of mass effect for all reviewed cases with no patients experiencing procedure-related postoperative decline.
Minimally invasive catheter-based and parafascicular approaches using tubular retractors are increasingly recognized as a viable option in the treatment of subcortical lesions. The MindsEye is the first expandable brain access port designed for removal of deep intracranial lesions. We believe it represents a recent addition in the armament of cranial surgeons.
术中神经导航和颅部进入装置的最新进展，促使人们越来越感兴趣地采用微创技术（微创手术），通过旁正中入路安全地治疗皮质下病变。新开发的可扩张牵开器，如 MindsEye 系统，进一步优化了这些方法。在本技术报告中，我们描述了使用 MindsEye 装置进行微创血肿清除术的细微差别。
放置装置后，取出内芯和内堵塞器，将可扩张鞘留在原位，并使用 Greenberg 折射器将其固定到位。鞘可通过刻度轻松扩张至外科医生的偏好，鞘壁由薄而透明的膜组成，便于观察病变。我们还回顾性地分析了在我们机构使用 MindsEye 系统治疗自发性多腔颅内血肿的 3 例患者的临床特征和结果。
我们提供了一个视频病例，演示了在经额部脑实质血肿清除术中使用 MindsEye 牵开器。所有接受治疗的患者均在 90 分钟内成功清除血肿，接近完全清除血栓，占位效应明显减轻，无患者出现与手术相关的术后恶化。
基于导管的微创和管状牵开器的旁正中入路，被越来越多地认为是治疗皮质下病变的可行选择。MindsEye 是第一个用于清除深部颅内病变的可扩张脑入路端口。我们认为它是神经外科医生的最新工具。
