Advice

Summary

Summary

  • The technology described in this briefing is the ViewSite Brain Access System (VBAS). It is used to access and visualise the surgical field during brain surgery.

  • The innovative aspects are that it is made from transparent plastic to help visualise the surrounding tissue. It has an elliptical shape which is designed to distribute brain tissue evenly and help minimise surgical brain injury. It comes in different sizes to meet surgical needs and is compatible with most surgical arms.

  • The intended place in therapy would be as an alternative to conventional self-retaining spatula-based brain retractor systems or other tubular retractors used during minimally invasive brain surgery for deep brain lesions.

  • The main points from the evidence summarised in this briefing are from 6 studies including 1 systematic review and meta-analysis, 2 systematic reviews, 2 retrospective observational studies and 1 prospective observational study. The evidence includes a total of 224 patients undergoing brain surgery (aged between 15 months and 86 years). They show that VBAS appears to be safe and efficacious for managing deep brain lesions.

  • Key uncertainties around the evidence or technology are that the primary evidence base consists mainly of single-centre retrospective observational studies with small sample sizes. There are no head-to-head comparative studies with self-retaining spatula-based brain retractor systems or other tubular retractors, no evidence from an NHS setting and there is limited evidence in children.

  • Experts advised that the technology is relatively established but not yet widely used across the NHS. Experts agreed that the technology has the potential to reduce brain injury from retraction. This can lead to earlier recovery and reduced complications when used for deep-seated brain lesions by surgeons experienced in the use of the retractor. No major issues or barriers to adoption were noted by the experts.

  • The cost of VBAS is £410 per unit for a single-use sterile packed system (excluding VAT). The costs of reusable self-retaining spatula-based brain retractors are between £8,000 and £14,000.