Published online Feb 26, 2022. doi: 10.12998/wjcc.v10.i6.1914
Peer-review started: July 28, 2021
First decision: October 26, 2021
Revised: November 4, 2021
Accepted: January 14, 2022
Article in press: January 14, 2022
Published online: February 26, 2022
Processing time: 209 Days and 23.9 Hours
Resection of deep intracranial tumors requires significant brain retraction, which frequently causes brain damage. In particular, tumor in the trigone of the lateral ventricular presents a surgical challenge due to its inaccessible location and intricate adjacent relationships with essential structures such as the optic radiation (OR) fibers. New brain retraction systems have been developed to minimize retraction-associated injury. To date, there is little evidence supporting the superiority of any retraction system in preserving the white matter tract integrity. This report illustrates the initial surgical excision in two patients using a new retraction system termed the cerebral corridor creator (CCC) and demonstrates its advantage in protecting OR fibers.
We report two patients with nonspecific symptoms, who had trigone ventricular lesions that involved the neighboring OR identified on preoperative diffusion tensor imaging (DTI). Both patients underwent successful surgical excision using the CCC. Total tumor removal was achieved without additional neurological deficit. DTI showed that the OR fibers were preserved along the surgical field. Preoperative symptoms were alleviated immediately after surgery. Clinical outcomes were improved according to the Glasgow-Outcome-Scale and Activity-of-Daily-Living Scale assessments.
In the two cases, the CCC was a safe and useful tool for creating access to the deep trigonal area while preserving the white matter tract integrity. The CCC is thus a promising alternative brain retractor.
Core Tip: The cerebral corridor creator (CCC) is a specially designed surgical tool set containing a balloon catheter and a transparent tubular retractor. The balloon is made of natural latex and can gently open up the brain tissue with minimum fluctuations in intracranial pressure and creates a surgical corridor by gradually inflating and deflating, thereby reducing damage to the incised cortical tissue and deep white matter tracts. The transparent tubular retractor provides a clear view of the trigonal area and surrounding brain tissue, helps maintain the corridor, protects brain tissue from surgical instrument, and avoids brain tissue collapse during surgery. The CCC provides an innovative and minimally invasive surgical corridor especially for small to medium and deep-seated brain lesions.