A new way for reaching deep-seated lesions within the brain has been developed by neurosurgeon, Kaisor Chaichana at Johns Hopkins University. Trying to avoid the damage that can result from a traditional open craniotomy, Chaichana describes that approach in this way: “It usually requires a big incision, a big opening in the skull, a big opening in the dura,” he says. “As we dissect downward, we’re compromising the white matter the whole time.” He goes on to say that this results in substantial blood loss, long hospital stays and recovery times and an increased risk of damage to brain structures, possibly causing neurological deficits.
With that in mind, Chaichana has recently incorporated into his procedures a minimally invasive tubular retractor to help with these issues. This tubular diameter is slightly less than a nickel with this retractor allowing for a less invasive surgery by using an obturator with an atraumatic tip to push away white matter instead of cutting it.
Typically, when using this device, Chaichana and his colleagues will use MRI with diffusion tensor imaging that has pre-gathered data before the surgery to guide an interoperative navigation system. Using data points to locate the lesion, surgeons make an opening the size of silver dollar through the scalp, skull and dura. Then they insert the tubular retractor between white matter tracts directly over the tumor.
With the obdurator in place, surgeons remove an inner metal insert, leaving behind a clear inner sheath, the exoscope hovers over the surgical field and the tools to go within the device. With this protocol, Chaichana and his colleague can resect entire tumors with minimal disruption to the brain structure surrounding it.
To read more about this procedure, its value and results, click here.