Minimally Invasive Brain Port Approach for Accessing Deep-Seated Lesions Using Simple Syringe

World Neurosurg. (2018) 117:54-61

Retraction-related injury is a recognized complication in neurosurgery. Use of tubular retractors that distribute the pressure on brain tissue was introduced to minimize brain injury. We developed a modified technique using a simple plastic syringe with a Foley catheter to achieve atraumatic cannulation in accessing deep lesions.
METHODS: A retrospective pilot study was conducted to assess safety of the syringe transtubular technique for accessing deep lesions as a cost-effective substitute for commercial brain port methods and to identify retractionrelated injury using diffusion-weighted magnetic resonance imaging postoperatively. Nine patients were operated on using the syringe technique. Lesions selected were intraparenchymal, deeply located in the supratentorial compartment. Lesions were located in the insula (n [ 2), thalamus or basal ganglia (n [ 5), subcortical frontoparietal (n [ 1) lobe, and right temporal lobe (n [ 1). Patients with hematomas, intraventricular lesions, superficially located lesions; pediatric patients less than 12 years old; and patients undergoing redo surgeries were excluded.
RESULTS: Surgical goals were achieved in 8 patients. Three patients had transient deficits; one patient had significant morbidity, which was diagnosed postoperatively as toxoplasmosis. Diffusion restriction was noted in all patients at the surgical cavity but not in the cannulation path.
CONCLUSIONS: Transtubular approaches have a good safety profile and can help achieve surgical goals. Larger studies are needed to compare this approach with other methods, including its effect on hospital stay and survival. The syringe technique is an alternative safe method that can be used in certain neurosurgical centers where commercial tube systems are unavailable.