1143. Minimally Invasive Transtubular Approach for Resection of Deep-seated Cavernomas

Authors: Daniel Eichberg, MD; Long Di, BS; Michael Ivan, MD; Ricardo Komotar, MD; Robert Starke, MD (Miami, FL)

Introduction: Cavernomas located in subcortical or eloquent locations are difficult lesions to access safely. Numerous surgical strategies are available requiring various amounts of brain retraction with associated potential for local injury and surgical morbidity. Tubular retractors, which distribute retraction pressure radially, have been increasingly employed successfully. These retractors may be beneficial in deeply seated cavernoma resection. We aimed toretrospectively review a single institution’s case series to determine the safety profile and efficacy of transcortical-transtubular cavernoma resections. Additionally, we will describe our transtubular operative technique. Methods: We retrospectively reviewed a single institution’s transcortical-transtubular cavernoma resections using either BrainPath (NICO, Indianapolis, Indiana) or ViewSite Brain Access System (Vycor Medical, Boca Raton, Florida) tubular retractors performed from 2013-2018 (n = 20). Results: Gross total resection was achieved in all patients. When a developmental venous anomaly (DVA) was present, avoidance of DVA resection was achieved in all cases (n=4). Average postoperative clinical follow up was 20.4 weeks. Early neurologic deficit rate was 10% (n = 2), but permanent neurologic deficit rate was 0%. One patient (5%) experienced early postoperative seizures (<1 week postop). No patients experienced late seizures (>1 week follow up). Conclusion: Tubular retractors provide a low profile, minimally invasive operative corridor for resection of deeply-seated cavernomas. There were no permanent neurologic complications in our series of twenty cases, and long term seizure control was achieved in all patients. DVA resection was avoided in all cases in which a DVA was present. Thus, tubular retractors appear to be a safe and efficacious tool for resection of subcortical cavernomas.