The Use of Vycor Tubular Retractors in the Management of Deep Brain Lesions: A Review of Current Studies

Author Type(s)

Resident/Fellow

Document Type

Article

Publication Date

January 2020

DOI

10.1016/j.wneu.2019.08.217

Journal Title

World Neurosurgery

Abstract

BACKGROUND: Traditional manual retraction to access deep-seated brain lesions has been associated with complications related to vascular compromise of cerebral tissue. Various techniques have been developed over time to minimize injury, such as self-sustaining retractors, neuronavigation, and endoscopic approaches. Recently, tubular retractors such as the ViewSite Brain Access System (VBAS; Vycor Medical Inc.) have been developed to reduce mechanical damage from retraction by dispersing the force of the retractor radially over the parenchyma, thus we sought to review the current literature to accurately assess the indications, benefits, and complications associated with use of VBAS retractors. METHODS: A literature search for English articles published between 2005 and 2019 was performed using the MEDLINE database archive with the search terminology "Vycor OR ViewSite OR Brain-Access-System NOT glass". The Vycor VBAS website was also examined. Only articles detailing neurosurgical procedures using the VBAS tubular retractor system alone, or in combination with other retractors were included. Post-operative morbidity and mortality were analyzed to estimate complications linked to using the retractor. RESULTS: Twelve publications (n=106 patients) met the inclusion criteria. The VYCOR retractor was used for tumor resections, hematoma evacuations, cyst removal, foreign body extractions, and lesion resection in toxoplasmosis and multiple sclerosis. These cases were subdivided into groups based on lesion location, size, and resection volume for further analysis. Gross-total resection was achieved in 63% of tumor excisions and subtotal resection in 37%. Hematoma evacuation was successful in all cases. There were 3 short-term postoperative complications linked to the retractor with an overall complication rate of 2.8%. CONCLUSIONS: This report is the first formal assessment of the VBAS, highlighting technical considerations of the retractor from the surgeon's perspective, patient outcomes, and complications. VYCOR retractor is a safe, efficacious tubular retraction system that can be used for tumor biopsy and resection, colloid cyst removal, hematoma evacuation, and removal of foreign bodies. However, further randomized controlled trials are indicated to accurately assess complication rates and outcomes.

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