Liu XW, Lu WR, Zhang TY, Hou XS, Fa ZQ, Zhang SZ. Cerebral corridor creator for resection of trigone ventricular tumors: Two case reports. World J Clin Cases 2022; 10(6): 1914-1921 [PMID: 35317166 DOI: 10.12998/wjcc.v10.i6.1914]
Corresponding Author of This Article
Shi-Zhong Zhang, MD, Chief Doctor, Department of Functional Neurosurgery, The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Zhujiang Hospital, Southern Medical University, No. 253 Gongye Street, Haizhu District, Guangzhou 510282, Guangdong Province, China. zhangshizhong@smu.edu.cn
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Xing-Wu Liu, Xu-Sheng Hou, Zhi-Qiang Fa, Shi-Zhong Zhang, Department of Functional Neurosurgery, The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, China
Wei-Rong Lu, Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, China
Tian-Yi Zhang, General Hospital of Xinjiang Military Region, Shihezi University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
Author contributions: Liu XW, Fa ZQ and Zhang SZ designed the study, wrote the manuscript and drew the diagrams; Lu WR contributed to the software and project administration; Zhang TY and Hou XS performed the data analysis and interpretation; and Fa ZQ performed the literature search and edited the manuscript; all authors issued final approval for the version to be submitted.
Informed consent statement: This study (No. 2020-KY-093-01) was approved by the Ethical Committee of the Zhujiang Hospital of Southern Medical University. Informed written consent was obtained from the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shi-Zhong Zhang, MD, Chief Doctor, Department of Functional Neurosurgery, The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Zhujiang Hospital, Southern Medical University, No. 253 Gongye Street, Haizhu District, Guangzhou 510282, Guangdong Province, China. zhangshizhong@smu.edu.cn
Received: July 28, 2021 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
Abstract
BACKGROUND
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.
CASE SUMMARY
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.
CONCLUSION
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.
