The Use of BrainPath Tubular Retractors in the Management of Deep Brain Lesions: A Review of Current Studies

Abstract

Background: Traditional retraction to access deep intraparenchymal brain lesions results in vascular disruption. Tubular retractors such as the BrainPath tubular retractor system were developed to reduce retractor-related force injuries via radial dispersion of force. Our study seeks to assess the indications, benefits, and complications associated with BrainPath retractors.

Methods: A literature search of PubMed MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Cochrane Database of Systematic Reviews was performed. The search terminology used was "BrainPath OR Brain-Path." The BrainPath Web site was also examined. Postoperative morbidity and mortality were analyzed to estimate complications linked to using the retractor.

Results: Twenty-nine articles (n = 289 patients) met the inclusion criteria. BrainPath was used primarily for tumor resections and hematoma evacuations. These cases were subdivided into groups based on lesion location, size, and resection volume for further analysis. Gross total resection was achieved in 79% of tumor excisions and subtotal resection in 21%. Hematoma evacuation >90% of original hematoma volume was achieved in 65.1% of cases, 75%-90% of original volume in 21.7%, and <75% in the remaining 13.2%. The complication rate attributed to retractor use was 8.3%.

Conclusions: This report is the first formal assessment of the BrainPath tubular retraction system, highlighting technical considerations of the retractor from the surgeon's perspective, patient outcomes, and complications. The retractor is a safe, efficacious system that can be used for tumor resection or biopsy and hematoma evacuation. However, further randomized controlled trials are indicated to accurately assess complication rates and outcomes.

Keywords: BrainPath; Intracranial; Retraction injury; Tubular retractor.