Mini-Tubular Access Surgery: A Single Surgeon's 12 Years in the Corridors of the Neuroaxis

BACKGROUND:  Tubular approach surgery now includes complex spinal and cranial procedures. Aided by modified instrumentation and frameless stereotaxy, minimal access surgery is being offered for a growing array of neurosurgical conditions. METHODS:  This article explores the flexibility and adaptability of the tubular retractor system for multiple indications by highlighting the 12-year experience of the primary surgeon using a tubular retractor system reported for the entire neuroaxis including intracranial, foramen magnum, and the craniocaudal extent of the spine for intra- and extradural pathologies. For this article we have not analyzed our experience with degenerative spinal disease. Patient characteristics, pathology, resection results, length of hospital stay, and complications are discussed. RESULTS:  From August 2005 through March 2017, 538 patients underwent neurosurgical procedures with mini-tubular access. Of these, the 127 patients who underwent mini-tubular access operations for nontraditional indications are discussed here. There were 65 women and 61 men with an average age of 53.5 years. The cases by anatomical location are as follows: 27 cranial cases, 11 foramen magnum decompressions, and 89 for spinal indications. The cranial pathologies included primary and metastatic tumors. The spinal pathologies included intra- and extradural spinal tumors, spina bifida occulta, syringomyelia, and other cystic lesions in the spine. In the vast majority of the patients where gross total resection was the goal, it was achieved. The mean length of stay was 2.94 days. CONCLUSIONS:  This report demonstrates that mini-tubular access surgery can be adapted to pathologies in the entire neuroaxis with outcomes that are comparable with open techniques. Limited tissue dissection, smaller incisions, and limited bone resection make the mini-tubular access approach a desirable option when feasible. Greater experience with all of these techniques is needed before the definitive status of these procedures in the neurosurgical armamentarium can be demonstrated.