Exoscope aided trans-sulcal minimally invasive parafascicular resection of a paediatric brainstem pilocytic astrocytoma using a tubular retractor system

• Published in: British journal of neurosurgery Vol. 38; no. 3; p. 746
• Main Authors: Sweeney, Kieron J, Amoo, Michael, Kilbride, Ronan, Jallo, George I, Javadpour, Mohsen
• Format: Journal Article
• Language: English
• Published: England 01.06.2024
• Subjects: Astrocytoma - diagnostic imaging; Astrocytoma - surgery; Brain Stem Neoplasms - diagnostic imaging; Brain Stem Neoplasms - surgery; Child; Female; Humans; Male; Minimally Invasive Surgical Procedures - instrumentation; Minimally Invasive Surgical Procedures - methods; Neuronavigation - instrumentation; Neuronavigation - methods; Neurosurgical Procedures - instrumentation; Neurosurgical Procedures - methods; Treatment Outcome; Orbeye; minimally invasive neurosurgery; para-fascicular surgery; pilocytic astrocytoma; exoscope; brainstem; BrainPath; Tubular retractor; paediatric
• ISSN: 1360-046X
• DOI: 10.1080/02688697.2021.1967880

The surgical management of brainstem glioma is challenging and has significant morbidity. Advances in surgical armamentarium has presented the opportunity to tackle these lesions. We present the case of a paediatric patient with a 2.3cm midbrain pilocytic astrocytoma. With the aid of tractography, neuro-navigation, 3-dimensional exoscope and a tubular retractor, near total resection of the tumour was achieved through a trans-sulcal para-fascicular approach without permanent injury to the corticospinal tract. To our knowledge this is the first report of a brainstem tumour resected using this approach and demonstrates what can be achieved with synergistic utility of evolving technologies in neurosurgery.