Microscopic Resection of Intracranial Lesions with Tubular Retractor of Plastic Syringe: A Single-Center Experience of 157 Cases

Abstract

Objective: Deeply located intracranial lesions such as intraparenchymal and intraventricular lesions are surgically challenging and associated with unavoidable complications such as seizure, surgical bed hematoma, and brain contusion caused by traction. The objective of this study is to evaluate the safety and effectiveness of the microscopic tubular retractor of a plastic syringe for the resection of deeply located brain lesions.

Materials and methods: We retrospectively studied 157 patients with deep-seated intracranial lesions who underwent microscopic resection with the help of a tubular retractor made of a plastic syringe and Teflon introducer between January 2018 and January 2024 in a tertiary hospital. All deep-seated lesions were such as neurocytoma, lymphoma, ependymoma, colloid cysts, metastatic brain tumors, astrocytoma, and meningiomas. We evaluated all patients postoperatively with computed tomography (CT) scan on the first/second day of surgery. The amount of blood loss, the complications, and the mortality rate were recorded.

Results: There were 104 males and 53 females with a mean age of 54.13 (range: 15-80) years. Gross total resection was obtained in 85.35% and subtotal in 14.65% of patients. Complications such as surgical bed hematoma in 5.73%, seizure in 3.18%, weakness in 2.54%, and contusion in 3.82% of patients were noted. The blood loss varied from 30 to 500 mL (average, 100 mL). The mortality rate was observed in 2.54% of all patients. Follow-up ranged from 1 to 25 months (average, 10 months).

Conclusion: Plastic syringe tubular retractor with Teflon introducer system is safe and effective for the treatment of deeply located intracranial lesions in terms of low morbidity and excellent rate of resection.

Keywords: deeply located; intracranial lesions; outcome; plastic syringe; tubular retractor.

Fig. 1

( A ) Teflon dilator; ( B ) 5 and 10 mL size of syringe; and ( C ) plastic syringe with introducer—Teflon trocar.

Fig. 2

Schematic diagram showing illustrations of procedure in use: The small corridor through the brain cortex was made by bipolar forceps ( A ). Teflon introducer being progressively inserted with syringe tube along the path to promote the required space to position the retractor ( B ). Teflon removed after reaching desired location and syringe tubular retractor sutured with dura to prevent the dislodgement of tube during surgery ( C ). Excision of the lesion started with special instruments such as bipolar along with a suction tube ( D ).

Fig. 3

A 16-year-old girl with MRI—sagittal section ( A ) and coronal section ( B )—showing sellar/suprasellar lesion extending to third ventricle with hydrocephalus; syringe tubular retractor with lesion ( C ); postoperative follow-up MRI showing complete resection of lesion with no recurrence at 3 months ( D ) (histopathology report—pilocytic astrocytoma, WHO grade I). MRI, magnetic resonance imaging.

Fig. 4

A 58-year-old woman with imaging (postcontrast MRI) T2 sagittal section ( A ) and axial section ( B ) showing heterogeneous hyperintense large lesion in deep right frontal lobe extending to wall of lateral ventricle and peri-insular cortex with hydrocephalus; syringe retraction with tumor ( C ) ; postoperative CT scan showing near total resection of invasive lesion with cavity filled with air and hematoma ( D ) (histopathology report—high-grade glioma, WHO grade III). CT, computed tomography; MRI, magnetic resonance imaging.

Fig. 5

A 34-year-old woman with imaging (CT of the head), axial section ( A ) and MRI T1, axial section( B ) showing small oval lesion with size of 1.6 × 1.4 × 1.3 cm in roof of third ventricle (in foramen of Monro) with hydrocephalus; excising cyst through syringe retractor ( C ) and postoperative image (CT of the head, axial section) showing complete resection of cyst with resolution in hydrocephalus and tiny pneumocephalus in left frontal horn of third ventricle ( D ) (histopathology report—colloid cyst). CT, computed tomography; MRI, magnetic resonance imaging.

Fig. 6

A 28-year-old woman with imaging (postcontrast MRI T1), sagittal section ( A ), axial section ( B ), and FLAIR ( C ) showing 15.3 × 15.5 × 17.5 mm lesion in anterosuperior aspect of third ventricle; syringe tubular retractor with lesion ( D ); postoperative CT of the head showing gross total resection of lesion with left frontal pneumocephalus and Ommya in situ ( E ); follow-up CT of the head at 6 months showing no hydrocephalus with Ommaya in situ ( F ) (histopathology report—central neurocytoma). CT, computed tomography; FLAIR, fluid-attenuated inversion recovery; MRI, magnetic resonance imaging.