Verhey Leonard H, Restrepo Orozco Andres, Abouelleil Mohamed, Mazaris Paul, Madura Casey J, Bercu Michael, Singer Justin A
Division of Neurosurgery, Department of Clinical Neurosciences, Spectrum Health, Grand Rapids, Michigan, USA.
Department of Clinical Neurosciences, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA.
Neurosurg Pract. 2024 Sep 26;5(4):e00114. doi: 10.1227/neuprac.0000000000000114. eCollection 2024 Dec.
Hemorrhagic subcortical vascular lesions such as cavernous malformations (CM) and arteriovenous malformations (AVM) can be neurologically devastating. Conventional open surgical resection is often associated with additional morbidity. The BrainPath® (NICO Corp.) transsulcal tubular retractor system offers a less-invasive corridor to deep-seated lesions. Our objective was to describe a single-center experience with the resection of subcortical hemorrhagic vascular lesions in adult and pediatric patients using the BrainPath® system.
The departmental database was queried for patients who underwent resection of a hemorrhagic CM, AVM, or cerebral aneurysm through the BrainPath® tubular retractor system between January 2017 and September 2021. All patients underwent either postoperative MRI (for patients with CM) or digital subtraction angiography (for patients with AVM or aneurysm). Demographic and clinical characteristics, preoperative and postoperative imaging features, operative details, and surgical and clinical outcomes were extracted through a retrospective review of the medical records.
Fourteen patients (mean [SD] age 32.3 [23.9] years; 7 (50%) female) underwent BrainPath®-based resection of a deeply seated CM (n = 7), AVM (n = 6), or ruptured cerebral aneurysm (n = 1). The mean maximal lesion diameter was 21.5 (12.6) mm. The mean operative time was 134 (53) minutes. Residual lesion was present in 2 patients, both of which underwent repeat BrainPath®-assisted surgery for complete resection. All lesions were completely resected or obliterated on postoperative MRI or digital subtraction angiography. At a mean follow-up of 4.1 (1.1) years, the median modified Rankin Scale score was 1 (range 0-6).
In a well-selected cohort, we show the effective use of BrainPath® tubular retractors for resection or obliteration of subcortical hemorrhagic vascular lesions. This report further exemplifies the expanded role of the endoport system beyond that of intracerebral hemorrhage and tumor. Further study will elucidate the impact of this less-invasive brain retraction technique on clinical outcome in patients with vascular lesions.
诸如海绵状血管畸形（CM）和动静脉畸形（AVM）等出血性皮质下血管病变可造成严重神经功能损害。传统的开放手术切除常伴有额外的发病率。BrainPath®（NICO公司）经脑沟管状牵开器系统为深部病变提供了一种侵入性较小的通道。我们的目的是描述在成人和儿童患者中使用BrainPath®系统切除皮质下出血性血管病变的单中心经验。
查询科室数据库，找出2017年1月至2021年9月期间通过BrainPath®管状牵开器系统切除出血性CM、AVM或脑动脉瘤的患者。所有患者术后均接受了MRI检查（CM患者）或数字减影血管造影（AVM或动脉瘤患者）。通过回顾病历提取人口统计学和临床特征、术前和术后影像学特征、手术细节以及手术和临床结果。
14例患者（平均[标准差]年龄32.3[23.9]岁；7例（50%）为女性）接受了基于BrainPath®的深部CM（n = 7）、AVM（n = 6）或破裂脑动脉瘤（n = 1）切除术。病变最大直径平均为21.5（12.6）mm。平均手术时间为134（53）分钟。2例患者存在残留病变，均接受了重复BrainPath®辅助手术以完全切除。术后MRI或数字减影血管造影显示所有病变均完全切除或闭塞。平均随访4.1（1.1）年，改良Rankin量表评分中位数为1（范围0 - 6）。
在精心挑选的队列中，我们展示了BrainPath®管状牵开器在切除或闭塞皮质下出血性血管病变方面的有效应用。本报告进一步例证了端口系统在脑出血和肿瘤之外的扩展作用。进一步研究将阐明这种侵入性较小的脑牵开技术对血管病变患者临床结局的影响。
