Port-assisted surgery of deep space-occupying lesions: methodology and results

INTRODUCTION . Traction injury is one of the main causes of unfavorable outcomes in the removal of deep-seated brain lesions. Port-assisted surgery has been developed to minimize traction impact. Despite its growing popularity, this technique has specific technical features and limitations that are insufficiently observed in the literature. Based on our experience, we present key aspects of tubular retractor application, their advantages, and the outcomes of surgeries performed for various types of deep-seated brain lesions. AIM . To demonstrate the methodology of port-assisted surgery, its limitations, and effectiveness in the removal of deep-seated brain tumors. MATERIALS AND METHODS. Port-assisted surgeries were performed on 26 patients with deep-seated lesions: 14 with diffuse gliomas and 12 with nodular tumors. The median tumor depth was 21 [15; 27] mm, and the median volume was 18.5 [5.9; 53.5] cm3. Port placement and trajectory planning were based on preoperative MR tractography and the relationship between the lesion and the internal capsule. RESULTS . The choice of port size should account for the total length of the surgical corridor, from the skin surface to the medial edge of the tumor. This determines the area of craniotomy, dura opening, and the need for combining port-assisted surgery with conventional spatulas. EOR of surgeries using tubular retractors was 98.2 % [87.5; 100 %] for all tumors, being lower for gliomas (88.9 % [57.2; 96.0 %]) and higher for nodular tumors (100.0 % [100.0; 100.0 %]), with median volumes of 36.1 [19.8; 57.1] cm3 and 5.7 [2.8; 18.8] cm3, respectively. The median Karnofsky Performance Status score remained unchanged at 80 [70; 90]. Deterioration was observed in 4 (15.4 %) patients, but only in 1 (3.8 %) case it was persistent. No complications associated with port-assisted surgery were observed. CONCLUSION . The high radicality and favorable functional outcomes of tubular surgery for deep-seated brain tumors support its recommendation for broader clinical use.