Minimally Invasive Surgical Outcomes for Deep-Seated Brain Lesions Treated with Different Tubular Retraction Systems: A Systematic Review and Meta-analysis

Abstract Background Minimally invasive surgery using tubular retractors was developed to minimize injury of surrounding brain during the removal of deep-seated lesions. To date, no evidence supports the superiority of any available tubular retraction system in the treatment of these lesions. We conducted a systematic review and meta-analysis to evaluate outcomes and complications following the resection of deep-seated lesions with tubular retractors and between available systems. Methods A PRISMA compliant systematic review was conducted on PubMed, Embase, and Scopus to identify articles where tubular retractors were used to resect deep-seated brain lesions in subjects ≥ 18 years old. Results The search strategy yielded 687 articles. Thirteen articles complying with inclusion criteria and quality assessment were included in the meta-analysis. A total of 309 patients operated between 2008 to 2018 were evaluated. The most common lesions were gliomas (n=127), followed by metastases (n=101) and meningiomas (n=19). Four different tubular retractors were employed: modified retractors (n=121, 39.1%); METRx (n=60, 19.4%); BrainPath (n= 92, 29.7%); and ViewSite Brain Access System (n=36,11.7%). Estimated gross total resection rate was 75% (95% CI: 69-80%, I2: 9%), whereas the estimated complication rate was 9% (95% CI: 6-14%, I2: 0%). None of the different brain retraction systems were found to be superior with regard to EOR or complications upon multiple comparisons (p >0.05). Conclusions Tubular retractors represent a promising tool to achieve maximum safe resection of deep-seated brain lesions. However, there does not seem to be a statistically significant difference in EOR or complication rates between tubular retraction systems.