Modified tubular retractor for deep brain tumour resection: enhanced surgical outcomes in resource-constrained settings

Clinical Snapshot

Key Findings

• P Value: p = 0.035 for retractor type association

• Effect Size: OR 2.59 for retractor type as predictor of residual tumour

• Primary Outcome: Gross total resection achieved in 91.4% (modified retractor) vs 78.9% (Leyla) vs 28.9% (conventional tubular)

• Nnt Or Sensitivity: Number needed to treat: 8 patients (91.4% vs 78.9% success rate compared to Leyla retraction)

• Confidence Interval: Not reported in abstract

Clinical Application

High feasibility given focus on low-cost modifications to existing tubular retractor systems Relevant to Australian neurosurgical practice, especially in regional centres with limited advanced imaging resources. May complement existing techniques covered under Medicare Benefits Schedule items for craniotomy procedures Neurosurgical patients with deep-seated brain tumours ≥3cm requiring resection, particularly in resource-limited settings

Abstract

Tubular retractors permit minimally invasive access to deep-seated intracranial tumours; however, limitations in visualisation and manoeuvrability reduce their suitability for lesions ≥ 3 cm, particularly in resource-limited centres. We evaluated a modified, low-cost tubular retractor incorporating enhanced visualisation and ergonomic features, comparing its performance with Leyla spatula-based retraction and traditional syringe-derived tubular systems. A prospective comparative cohort of 105 patients with deep brain tumours ≥ 3 cm was analysed. Patients underwent Leyla retraction (Group 1, n = 38), conventional tubular systems (Group 2, n = 32), or a modified tubular retractor (Group 3, n = 35). Outcomes included intraoperative visualisation, retractor stability, manoeuvrability, extent of resection, complications, and three-month Glasgow Outcome Scores. Owing to non-normal distribution, continuous variables were analysed using non-parametric tests and binary logistic regression. The modified tubular retractor demonstrated greater stability, broader visualisation, and enhanced instrument handling compared with conventional tubular systems. Gross total resection was achieved in 91.4% with the modified device, 78.9% with Leyla-based retraction, and 28.9% with traditional tubular systems. Logistic modelling identified retractor type (OR 2.59, p = 0.035), intraoperative visualisation (OR 2.01, p = 0.036), and histopathology (OR 1.41, p = 0.036) as independent predictors of residual tumour. The modified retractor group exhibited fewer complications, shorter ICU stays, and superior functional outcomes (GOS ≥ 4 in 91%). The modified tubular retractor demonstrated favourable operative handling and outcome trends for deep-seated tumours ≥ 3 cm, with improved visualisation, stability, and ergonomic access compared with conventional systems. However, limitations related to non-randomised design, learning-curve effects, advanced mapping, fluorescence integration, and supramaximal resection warrant cautious interpretation pending multicentre long-term validation.

References

1. 1.Jha, V. C., Jain, R., Sinha, V. S., Kumar, N., & Jha, S. (2026). Modified tubular retractor for deep brain tumour resection: enhanced surgical outcomes in resource-constrained settings. Neurosurgical Review. https://doi.org/10.1007/s11060-020-03652-z