Use of a minimally invasive tubular retraction system for deep-seated tumors in pediatric patients: Technical note

Pablo F. Recinos, Shaan M. Raza, George Jallo, Violette Renard Recinos

Research output: Contribution to journalArticle

Abstract

Object. Microsurgical removal is the preferred treatment for most deep-seated, intraaxial tumors in the pediatric population. The feasibility of surgery as an option has improved with advances in surgical technology and technique. Tubular retractors disperse retraction forces over a greater surface area than do conventional retractors, which can lower the risk of ischemic complications. The authors describe their experience utilizing a new tubular retractor system specifically designed for cranial applications in conjunction with frameless neuronavigation. Methods. The Vycor ViewSite retractor was used in 4 pediatric patients (ages 15 months and 9, 10, and 16 years) with deep-seated intraaxial tumors. The lesions included a papillary tumor of the pineal region, a low-grade astrocytoma in the occipital lobe, a dysembryoplastic neuroepithelial tumor arising from the basal ganglia, and an intraventricular low-grade glioma. The extent of white matter damage along the surgical trajectory (based on T2 or FLAIR and diffusion restriction/apparent diffusion coefficient signals) and the extent of resection were assessed on postoperative imaging. Results. Satisfactory resection or biopsy was achieved in all patients. A comparison of pre- and postoperative MR imaging studies revealed evidence of white matter damage along the surgical trajectory in 1 patient. None of the patients demonstrated new neurological deficits postoperatively. Conclusions. Obtaining surgical access to deep-seated, intraaxial tumors is challenging. In this small series of pediatric patients, the combination of the ViewSite tubular retractor and frameless neuronavigation facilitated the surgical approach. The combination of these technologies adds to the armamentarium to safely approach tumors in deep locations.

Original languageEnglish (US)
Pages (from-to)516-521
Number of pages6
JournalJournal of Neurosurgery: Pediatrics
Volume7
Issue number5
DOIs
StatePublished - May 2011

Fingerprint

Pediatrics
Neuronavigation
Neoplasms
Neuroepithelial Neoplasms
Pinealoma
Technology
Occipital Lobe
Astrocytoma
Basal Ganglia
Glioma
Biopsy
Population
White Matter
Therapeutics

Keywords

  • Diffusion tensor imaging
  • Frameless stereotaxy
  • Functional MR imaging
  • Intraventricular glioma
  • Minimally invasive neurosurgery
  • Pediatric brain tumor
  • ViewSite tubular retractor

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Use of a minimally invasive tubular retraction system for deep-seated tumors in pediatric patients : Technical note. / Recinos, Pablo F.; Raza, Shaan M.; Jallo, George; Recinos, Violette Renard.

In: Journal of Neurosurgery: Pediatrics, Vol. 7, No. 5, 05.2011, p. 516-521.

Research output: Contribution to journalArticle

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abstract = "Object. Microsurgical removal is the preferred treatment for most deep-seated, intraaxial tumors in the pediatric population. The feasibility of surgery as an option has improved with advances in surgical technology and technique. Tubular retractors disperse retraction forces over a greater surface area than do conventional retractors, which can lower the risk of ischemic complications. The authors describe their experience utilizing a new tubular retractor system specifically designed for cranial applications in conjunction with frameless neuronavigation. Methods. The Vycor ViewSite retractor was used in 4 pediatric patients (ages 15 months and 9, 10, and 16 years) with deep-seated intraaxial tumors. The lesions included a papillary tumor of the pineal region, a low-grade astrocytoma in the occipital lobe, a dysembryoplastic neuroepithelial tumor arising from the basal ganglia, and an intraventricular low-grade glioma. The extent of white matter damage along the surgical trajectory (based on T2 or FLAIR and diffusion restriction/apparent diffusion coefficient signals) and the extent of resection were assessed on postoperative imaging. Results. Satisfactory resection or biopsy was achieved in all patients. A comparison of pre- and postoperative MR imaging studies revealed evidence of white matter damage along the surgical trajectory in 1 patient. None of the patients demonstrated new neurological deficits postoperatively. Conclusions. Obtaining surgical access to deep-seated, intraaxial tumors is challenging. In this small series of pediatric patients, the combination of the ViewSite tubular retractor and frameless neuronavigation facilitated the surgical approach. The combination of these technologies adds to the armamentarium to safely approach tumors in deep locations.",
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