Standardization of Strategies to Perform a Parafascicular Tubular Approach for the Resection of Brain Tumors in Eloquent Areas.

Autor: Abdala-Vargas NJ; Neurosurgery Department, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital Infantil Universitario de San José, Cra. 19 #8A-32, Bogotá 111221, Colombia., Umana GE; Department of Neurosurgery, Trauma and Gamma-Knife Center Cannizzaro Hospital, 95126 Catania, Italy., Patiño-Gomez JG; Neurosurgery Department, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital Infantil Universitario de San José, Cra. 19 #8A-32, Bogotá 111221, Colombia., Ordoñez-Rubiano E; Neurosurgery Department, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital Infantil Universitario de San José, Cra. 19 #8A-32, Bogotá 111221, Colombia., Cifuentes-Lobelo HA; Neurosurgery Department, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital Infantil Universitario de San José, Cra. 19 #8A-32, Bogotá 111221, Colombia., Palmisciano P; Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH 45220, USA., Ferini G; Department of Radiation Oncology, REM Radioterapia s.r.l., 95029 Vaigrande, Italy., Viola A; Department of Radiation Oncology, REM Radioterapia s.r.l., 95029 Vaigrande, Italy., Zagardo V; Department of Radiation Oncology, REM Radioterapia s.r.l., 95029 Vaigrande, Italy., Casanova-Martínez D; San Felipe Campus, Medical Faculty, University of Valparaíso, Valparaíso 2170000, Chile., Tomasi OS; Department of Neurosurgery, Christian-Doppler-Klinik, Paracelsus Private Medical University, 5020 Salzburg, Austria., Campero A; Department of Neurological Surgery, Padilla Hospital, Tucumán T4000, Argentina., Baldoncini M; Department of Neurological Surgery, San Fernando Hospital, Buenos Aires B1646, Argentina.
Jazyk: angličtina
Zdroj: Brain sciences [Brain Sci] 2023 Mar 15; Vol. 13 (3). Date of Electronic Publication: 2023 Mar 15.
DOI: 10.3390/brainsci13030498
Abstrakt: Objective: The aim of this work is to define a methodological strategy for the minimally invasive tubular retractor (MITR) parafascicular transulcal approach (PTA) for the management of brain tumors sited in eloquent areas.
Methods: An observational prospective study was designed to evaluate the benefits of PTA associated with MITRs, tractography and intraoperative cortical stimulation. They study was conducted from June 2018 to June 2021. Information regarding white matter tracts was processed, preventing a potential damage during the approach and/or resection. All patients older than 18 years who had a single brain tumor lesion were included in the study. Patients with a preoperative Karnofsky Performance Scale (KPS) score greater than 70% and a Glasgow Coma Scale (GCS) score > 14 points were included.
Results: 72 patients were included in the study, the mean age was 49.6, the most affected gender was male, 12.5% presented aphasia, 11.1% presented paraphasia, 41.6% had motor deficit, 9.7% had an affection in the optic pathway, the most frequently affected region was the frontal lobe (26.3%), the most frequent lesions were high-grade gliomas (34.7%) and the measurement of the incisions was on average 5.58 cm. Of the patients, 94.4% underwent a total macroscopic resection and 90.2% did not present new postoperative neurological deficits. In all cases, a PTA was used.
Conclusion: Tubular minimally invasive approaches (MIAs) allow one to perform maximal safe resection of brain tumors in eloquent areas, through small surgical corridors. Future comparative studies between traditional and minimally invasive techniques are required to further investigate the potential of these surgical nuances.
Databáze: MEDLINE
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