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. 2022 Oct;164(10):2587-2594.
doi: 10.1007/s00701-022-05273-z. Epub 2022 Jun 22.

Efficacy and safety of the endoscopic "wet-field" technique for removal of supratentorial cavernous malformations

Kazuhito Takeuchi  1 , Yuichi Nagata  2 , Kuniaki Tanahashi  2 , Yoshio Araki  2 , Akihiro Mizuno  2 , Hiroo Sasaki  2 , Hideyuki Harada  2 , Keishi Ito  2 , Ryuta Saito  2
Affiliations

Efficacy and safety of the endoscopic "wet-field" technique for removal of supratentorial cavernous malformations

Kazuhito Takeuchi et al. Acta Neurochir (Wien). 2022 Oct.

Abstract

Objective: Cerebral cavernous malformations (CMs) presenting with focal neurological symptoms or mass effects require surgical removal. In recent years, cylindrical retractors have been widely utilized for the removal of deep-seated lesions during both microscopic and endoscopic surgery. In the present study, we evaluated the efficacy and safety of endoscopic transcylinder removal of CMs using a novel wet-field technique.

Methods: We included 13 patients with supratentorial CMs who had undergone endoscopic transcylinder surgery between April 2013 and March 2022. One patient experienced recurrence of the CM and underwent a second endoscopic transcylinder surgery. Therefore, we retrospectively evaluated 14 procedures. The surgical field was continuously irrigated with artificial cerebrospinal fluid to maintain expansion and visualization of the tumor bed. We termed this method as the "wet-field technique." Patient characteristics, symptoms, and pre- and postoperative magnetic resonance imaging results were obtained from medical records.

Results: The average maximum CM diameter was 35.3 mm (range: 10-65 mm). Cylinder diameters were 6 mm in eight procedures, 10 mm in four procedures, and 17 mm in one procedure. Wet-field technique was applied in all cases. The endoscope provided a bright field of view even under water. Continuous water irrigation made it easier to observe the entire tumor bed which naturally expanded by water pressure. Gross total resection was achieved in 13 procedures, while subtotal resection was achieved in one procedure. No surgical complications were observed.

Conclusions: The endoscopic transcylinder removal using wet-field technique is safe and effective for the removal of symptomatic intracranial supratentorial CMs.

Keywords: Cavernous angioma; Endoscopy; Navigation system; Port surgery.

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References

    1. Almenawer SA, Crevier L, Murty N, Kassam A, Reddy K (2013) Minimal access to deep intracranial lesions using a serial dilatation technique: case-series and review of brain tubular retractor systems. Neurosurg Rev 36:321–330. https://doi.org/10.1007/s10143-012-0442-x - DOI - PubMed
    1. Almubarak AO, Alobaid A, Qoqandi O, Bafaquh M (2018) Minimally invasive brain port approach for accessing deep-seated lesions using simple syringe. World Neurosurg 117:54–61. https://doi.org/10.1016/j.wneu.2018.05.236 - DOI - PubMed
    1. Akers A, Al-Shahi Salman R, Awad IA et al (2017) Synopsis of guidelines for the clinical management of cerebral cavernous malformations: consensus recommendations based on systematic literature review by the Angioma Alliance Scientific Advisory Board Clinical Experts Panel. Neurosurgery 80:665–680. https://doi.org/10.1093/neuros/nyx091 - DOI - PubMed - PMC
    1. Barrow DL, Schuette AJ (2011) Cavernous malformations: a paradigm for progress. Clin Neurosurg 58:27–41 - DOI
    1. Barzaghi LR, Capitanio JF, Giudice L, Panni P, Acerno S, Mortini P (2018) Usefulness of ultrasound-guided microsurgery in cavernous angioma removal. World Neurosurg 116:e414–e420. https://doi.org/10.1016/j.wneu.2018.04.217 - DOI - PubMed

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