Cylinder tumor surgery in pediatric low-grade gliomas

• Published in: Child's nervous system 2024-10, Vol.40 (10), p.3051-3063
• Main Authors: Jaimovich, Sebastian Gaston, Takeuchi, Kazuhito, Testa, Victoria Tcherbbis, Okumura, Eriko, Jaimovich, Roberto, Cinalli, Giuseppe
• Format: Article
• Language: English
• Subjects: Brain Neoplasms - pathology; Brain Neoplasms - surgery; Child; Child, Preschool; Female; Glioma - pathology; Glioma - surgery; Humans; Male; Medicine; Medicine & Public Health; Minimally Invasive Surgical Procedures - instrumentation; Minimally Invasive Surgical Procedures - methods; Neuroendoscopy - instrumentation; Neuroendoscopy - methods; Neurosciences; Neurosurgery; Neurosurgical Procedures - methods; Review
• ISSN: 0256-7040; 1433-0350; 1433-0350
• DOI: 10.1007/s00381-024-06417-5

Background Periventricular pediatric low-grade gliomas (pLGG) present a surgical challenge due to their deep-seated location, accessibility, and relationship with the subcortical network connections. Minimally invasive parafascicular approaches with tubular brain retractors (port brain surgery) have emerged, in recent years, as an alternative to conventional microsurgical and endoscopic approaches for removal of periventricular tumors. Objectives To describe the minimally invasive approach with tubular brain retractors for periventricular pLGG, its technique, applications, safety, and efficacy. Methods In this article, we describe the port brain surgery techniques for periventricular pLGG as performed in different centers, with different commercialized tubular retractor systems. Illustrative cases followed by a literature review are analyzed, with a detailed description of different approaches or techniques, comparing their advantages and disadvantages with contemporary microsurgical and endoscopic approaches. Conclusions The port brain surgery with micro-exoscopic vision and endoscopic assistance, for the treatment of deep-seated lesions such as periventricular pLGG, is an alternative for achieving a functionally safe—gross total or subtotal—tumor resection, obtaining adequate tissue for pathological examination. This technique could offer a new dimension for a less-invasive, safe, and effective access to deep-seated tumors, offering the possibility to lower morbidity in experienced hands.