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Minimally Invasive Neurosurgery Approach Could Assist Maximal, Safe Brain Tumor Resection
Researchers have found a new minimally invasive approach (MIA) that could help to achieve maximal safe resection of brain tumors in eloquent areas and limit vision and hearing loss following surgery, according to a prospective observational study recently published in Brain Sciences.
“We suggest considering adding MIA in routine surgical planning to perform safe tubular [parafascicular transulcal approach (PTA)] for eloquent area tumors, which, added to the implementation of technologies such as intraoperative cortical and subcortical mapping, as well as tractography reconstruction,” researchers wrote, “may improve maximal safe resection, preserving neurological function.”
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Researchers examined patients with single brain tumor lesions in eloquent areas from June 2018 to June 2021. The patients had a preoperative Karnofsky Performance Scale (KPS) score greater than 70% and a Glasgow Coma Scale (GSC) score greater than 14 points. The study assessed muscle strength and visual acuity in each patient, and tumor locations were recorded in the cerebral regions. Diagnostic imaging was achieved with diffusion tensor imaging, and information regarding white matter tracts was processed to prevent potential damage during approach and/or resection. Researchers performed intraoperative cortical and subcortical mapping and designed a standardized 8-step strategy for an MIA. The extent of resection was classified as total, near-total, and partial based on the degree of macroscopic resection.
A total of 72 patients who underwent brain study were included in the study, along with an examination of preoperative and postoperative clinical characteristics. The mean age of the patients was 49.6 years, and males were more commonly affected than females, the study found. The frontal lobe was the most common location of the tumor lesion, and high-grade gliomas (HGGs) was the most frequently occurring tumor type. The average incision size was 5.58 cm, and the most commonly used minimally invasive tubular retractors (MITRs) had dimensions of 17 mm wide, 11 mm high, and 5 cm long.
The study found that when the area of the tumor was up to 5 times greater than the area of exposure of the MITRs, the tumor resection was greater than 90%. Using neuronavigation, intraoperative monitoring, and rigid support for the MITRs could avoid unintended movement that could change the resection trajectory, study authors suggest.
“Despite that the results presented in our study support the use of MIA, it is necessary to continue developing strategies to evaluate other aspects, allowing one to solve the questions of the critics of this tool,” researchers concluded. “We are convinced that MIAs offer the possibility of mutating some practices, in specific cases, which ends up influencing the clinical and surgical results of patients, as has already happened in other surgical specialties.”
Researchers noted that the observational design of the study and the heterogeneity of the patient population may have limited results.
