Operative Neurosurgery 29:118–124, 2025
This study introduces a minimally invasive, cost-effective technique for resecting deep-seated brain lesions using a 19F peel-away sheath introducer and dynamic retraction. In 13 patients, the method proved safe and effective, achieving high rates of gross total resection with minimal complications and reduced costs.
A novel, cost-effective minimally invasive technique for deep-seated intracranial lesions uses a 19F peel-away sheath introducer and “dynamic” retraction.
• This approach was evaluated in 13 patients with various brain pathologies, including glioblastoma, metastases, cavernous malformations, pilocytic astrocytoma, and colloid cyst.
• Gross total resection was achieved in 11 of 13 cases, with minimal complications and most patients remaining neurologically stable or improved postoperatively.
• The technique involves a small craniotomy, insertion of the 19F introducer using image guidance, and lining the corridor with cottonoid strips after sheath removal for retractorless, dynamic retraction.
• Compared to standard tubular retractor systems, this method reduces cost (introducer: ~$252 vs. commercial systems: $695–$4000) and potentially lessens brain trauma.
• Postoperative imaging showed minimal brain damage, with only one patient exhibiting minor diffusion changes without clinical consequences.
• Limitations include small sample size and retrospective design, but the technique may be especially valuable in resource-limited settings.
• Authors conclude this method is safe, technically feasible, and a viable alternative to more expensive tubular retraction systems for deep brain lesions.
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