Operating deep-seated brain lesions involves substantial challenges during the procedure. Achieving complete resection with minimal complications should be the aim, as it significantly contributes to overall survival rates [1], [2], [3], [4]. Retracting normal brain tissue becomes essential to create a sufficient surgical view for visualizing the lesion and different retractors used throughout history [5]. Nevertheless, a crucial equilibrium exists between heightened visibility and the prospective detriment to the adjacent healthy brain tissue [6], [7]. Establishing a substantial operating window, enabling unobstructed visualization for resection while safeguarding local brain tissue integrity and preserving optimal blood flow is necessary. Tubular retractors evenly distribute pressure around their circumference, theoretically reducing the risk of local trauma, minimizing vascular disruption, and mitigating ischemic events [1].

More recently, tubular retractor systems have emerged as a potentially safer and more effective method for the removal of deep-seated brain lesions. These systems encompass various designs, either newly devised or adapted from existing materials and technologies. Various commercially available tubular retractor systems exhibit unique characteristics in their materials, flexibility, and designs [8], [9], [10]. These systems have been employed in the surgical resection of diverse intracranial tumors such as colloid cysts, deep-seated gliomas, and cavernous hemangiomas [11], [12], [13]. Earlier studies included innovative cylindrical retractors crafted from flexible materials [14], [15]. The essence of these tubular retraction systems lies in their ability to diminish pressure exerted on the retracted tissue by evenly distributing it across the entire cylinder surface. Consequently, this mechanism reduces the likelihood of traumatic complications [16], [17]. Smaller case series may overlook infrequent complications, such as the potential for seizures with a transcortical approach. Consequently, there exists a scarcity of comprehensive data delineating the utilization of tubular retractors across larger and diverse patient cohorts managed by single-surgeon.

This study aims to present outcomes from the largest single-surgeon cohort in the context of tubular retractor-mediated resections of intracranial lesions, encompassing primary and secondary brain tumors, colloid cysts and cavernomas.