Vol.:(0123456789) 1 3 Journal of Neuro-Oncology https://doi.org/10.1007/s11060-020-03500-0 CLINICAL STUDY Minimally invasive resection of intracranial lesions using tubular retractors: a large, multi‑surgeon, multi‑institutional series Daniel G. Eichberg 1,5  · Long Di 1  · Ashish H. Shah 1  · Evan M. Luther 1  · Christina Jackson 2  · Lina Marenco‑Hillembrand 3  · Kaisorn L. Chaichana 3  · Michael E. Ivan 1,4  · Robert M. Starke 1  · Ricardo J. Komotar 1,4 Received: 25 January 2020 / Accepted: 13 April 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020 Abstract Purpose Lesions located in subcortical areas are difficult to safely access. Tubular retractors have been increasingly used successfully with low complication profile to access lesions by minimizing brain retraction trauma and distributing pressure radially. Both binocular operative microscope and monocular exoscope are utilized for lesion visualization through tubular retractors. We present the largest multi-surgeon, multi-institutional series to determine the efficacy and safety profile of a transcortical-transtubular approach for intracranial lesion resections with both microscopic and exoscopic visualization. Methods We reviewed a multi-surgeon, multi-institutional case series including transcortical-transtubular resection of intracranial lesions using either BrainPath (NICO, Indianapolis, Indiana) or ViewSite Brain Access System (VBAS, Vycor Medical, Boca Raton, Florida) tubular retractors (n = 113). Results One hundred thirteen transtubular resections for intracranial lesions were performed. Patients presented with a diverse number of pathologies including 25 cavernous hemangiomas (21.2%), 15 colloid cysts (13.3%), 26 GBM (23.0%), two meningiomas (1.8%), 27 metastases (23.9%), 9 gliomas (7.9%) and 9 other lesions (7.9%). Mean lesion depth below the cortical surface was 4.4 cm, and mean lesion size was 2.7 cm. A gross total resection was achieved in 81 (71.7%) cases. Permanent complication rate was 4.4%. One patient (0.8%) experienced one early postoperative seizure (< 1 week postop). No patients experienced late seizures (> 1 week follow-up). Mean post-operative hospitalization length was 4.1 days. Conclusion Tubular retractors provide a minimally invasive operative corridor for resection of intracranial lesions. They provide an effective tool in the neurosurgical armamentarium to resect subcortical lesions with a low complication profile. Keywords Tubular retractor · Minimally invasive surgery · Brain tumor · Exoscope · Microsurgery · Neurosurgery Introduction The resection of deep-seated brain lesions presents unique operative challenges to the neurosurgeon. The effect of extent of resection on patient outcome and overall survival has been well documented [1–7]. Gross total resection of other lesions is also required to minimize risk of compli- cations such as endocrine dysfunction, hydrocephalus, and memory impairment. Retraction of normal brain paren- chyma is often necessary to establish an adequate opera- tive window for visualization of the lesion and surround- ing critical vascular structures [8–11]. However, there is a balance between improved visibility and potential damage to surrounding healthy brain tissue. Metal blade retractors have conventionally been used to create surgical corridors for resection of deep-seated lesions, although such retrac- tors may exert focal pressure on the surrounding healthy Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11060-020-03500-0) contains supplementary material, which is available to authorized users. * Daniel G. Eichberg dge18@med.miami.edu 1 Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA 2 Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA 3 Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA 4 Sylvester Comprehensive Cancer Center, Miami, FL, USA 5 University of Miami Hospital, 1321 N.W. 14th Street, West Building, Suite 306, Miami, FL 33125, USA