• World Neurosurg · Nov 2020

    Review Meta Analysis

    Minimally Invasive Surgical Outcomes for Deep-Seated Brain Lesions Treated with Different Tubular Retraction Systems: A Systematic Review and Meta-analysis.

    • Lina Marenco-Hillembrand, Calder Prevatt, Paola Suarez-Meade, Henry Ruiz-Garcia, Alfredo Quinones-Hinojosa, and Kaisorn L Chaichana.
    • Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA.
    • World Neurosurg. 2020 Nov 1; 143: 537-545.e3.

    BackgroundMinimally invasive surgery using tubular retractors was developed to minimize injury of surrounding brain during the removal of deep-seated lesions. No evidence supports the superiority of any available tubular retraction system in the treatment of these lesions. We conducted a systematic review and meta-analysis to evaluate outcomes and complications after the resection of deep-seated lesions with tubular retractors and among available systems.MethodsA PRISMA compliant systematic review was conducted on PubMed, Embase, and Scopus to identify studies in which tubular retractors were used to resect deep-seated brain lesions in patients ≥18 years old.ResultsThe search strategy yielded 687 articles. Thirteen articles complying with inclusion criteria and quality assessment were included in the meta-analysis. A total of 309 patients operated on between 2008 and 2018 were evaluated. The most common lesions were gliomas (n = 127), followed by metastases (n = 101) and meningiomas (n = 19). Four different tubular retractors were used: modified retractors (n = 121, 39.1%); METRx (n = 60, 19.4%); BrainPath (n = 92, 29.7%); and ViewSite Brain Access System (n = 36,11.7%). Estimated gross total resection rate was 75% (95% confidence interval, 69%-80%; I2 = 9%), whereas the estimated complication rate was 9% (95% confidence interval: 6%-14%; I2 = 0%). None of the different brain retraction systems was found to be superior regarding extent of resection or complications on multiple comparisons (P > 0.05).ConclusionsTubular retractors represent a promising tool to achieve maximum safe resection of deep-seated brain lesions. However, there does not seem to be a statistically significant difference in extent of resection or complication rates among tubular retraction systems.Copyright © 2020 Elsevier Inc. All rights reserved.

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