Smith Sabrina, Mediratta Saniya, Knight Jennifer, Patel Brihitejas, Paraskevopoulos Dimitris
Royal Free London NHS Foundation Trust, London, UK.
Department of Neurosurgery, Barts Health NHS Trust, London, UK.
Neurosurg Rev. 2025 Apr 27;48(1):391. doi: 10.1007/s10143-025-03513-1.
The port technique for accessing deep lying brain lesions using tubular retractors is a relatively recent development. The use of tubular retractors in minimally invasive neurosurgery was first introduced in 1988 by Kelly et al. and since then the port technique for surgical access to deep brain anatomy has been developed. In the last three decades, multiple dedicated devices to facilitate the port technique have become available on the market. Currently, few articles compare the advantages and disadvantages, with Echeverry et al. performing the first formal comparison between three such devices: METRx, Vycor VBAsS and BrainPath in 2020. This systematic review aims to identify and summarise all devices for the port technique currently available in order to compare their benefits and limitations. Literature from PubMed, Cochrane Central Register of Controlled Trials and Cochrane database of systematic reviews were screened (last reviewed 5/7/2024) and analysed through a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). The inclusion criteria were peer-reviewed English language journals, excluding reviews, reporting on the use of cranial retractors providing direct access to the brain and have been tested in adult humans. Thirty-three articles were selected for data extraction and analysis. Nine devices were identified including five currently available on the market (Aurora Surgiscope, BrainPath, cerebral corridor creators, METRx, Vycor VBAS) with a sixth (MindsEye) approaching commercialisation. All articles extracted were case series or reports (n = 335), but three clinical trials are currently ongoing (n = 364-639) thus indicating the need for further comparative studies. Risk of Bias was performed using the Oxford Centre for Evidence-Based Medicine tool. Type of lesion, rates of complication and gross total resection were measures used to compare devices. There was no statistically significant difference in complication rates between the nine devices identified. Clinical trial number: not applicable.
使用管状牵开器进入深部脑病变的端口技术是一项相对较新的进展。1988年，凯利等人首次在微创神经外科手术中引入了管状牵开器，自那时起，用于手术进入深部脑解剖结构的端口技术得到了发展。在过去三十年中，市场上出现了多种便于端口技术使用的专用设备。目前，很少有文章比较其优缺点，埃切维里等人在2020年首次对三种此类设备（METRx、Vycor VBAsS和BrainPath）进行了正式比较。本系统评价旨在识别和总结目前可用的所有端口技术设备，以比较它们的优点和局限性。筛选了来自PubMed、Cochrane对照试验中央登记册和Cochrane系统评价数据库的文献（最后一次审查时间为2024年7月5日），并根据系统评价和Meta分析的首选报告项目（PRISMA）指南进行系统评价分析。纳入标准为经过同行评审的英文期刊，不包括综述，报道使用直接进入脑部的颅骨牵开器并已在成年人类中进行测试。选择了33篇文章进行数据提取和分析。确定了9种设备，其中5种目前在市场上可用（Aurora Surgiscope、BrainPath、脑走廊创建器、METRx、Vycor VBAS），第六种（MindsEye）即将商业化。提取的所有文章均为病例系列或报告（n = 335），但目前有三项临床试验正在进行（n = 364 - 639），因此表明需要进一步的比较研究。使用牛津循证医学中心工具进行偏倚风险评估。病变类型、并发症发生率和大体全切除率是用于比较设备的指标。所确定的9种设备之间的并发症发生率没有统计学上的显著差异。临床试验编号：不适用。
