Minimally invasive trans-sulcal parafascicular surgical resection of cerebral tumors: translating anatomy to early clinical experience

Monroy-Sosa, Alejandro; Navarro-Fernández, José Omar; Chakravarthi, Srikant S.; Rodríguez-Orozco, Jossana; Rovin, Richard; Garza, Jaime de la; Kassam, Amin

doi:10.1007/s10143-020-01349-5

Cited by 8 publications

(3 citation statements)

References 26 publications

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“…There are some slight deviations in surgical outcomes between our study and others using the TScal. Some authors report slightly higher GTR rates, less surgical complications, and reduced mortality [ 46 , 51 , 58 , 63 , 64 ]. Influencing factors may include limited sample size of this study, lesion characteristics, and retraction methods.…”

Section: Discussionmentioning

confidence: 99%

Wide Dissection Trans-Sulcal Approach for Resection of Deep Intra-Axial Lesions in Eloquent Brain Areas

et al. 2022

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Introduction: Resection of intra-axial tumors (IaT) in eloquent brain regions risks major postoperative neurological deficits. Awake craniotomy is often used to navigate these areas; however, some patients are ineligible for awake procedures. The trans-sulcal approach (TScal) was introduced to reduce parenchymal trauma during tumor resection. We report our experiences utilizing TScal for resection of deep IaT located in eloquent areas. Materials and Methods: This is a single-center retrospective analysis of patients who underwent IaT resection in eloquent areas via TScal from January 2013 to April 2021. Seventeen cases were reviewed, and relevant data was collected. Fluorescence-guided surgery with 5-aminolevulinic acid (ALA) and intraoperative ultrasound was performed in some cases. Results: Seventeen patients (10 males, 7 females) averaging 61.2 years-old (range, 21–76) were included in this study. Average length of stay was 4.8 days, and only 2 patients (11.8%) required hospital readmission within 30 days. Gross total resection (GTR) was achieved in 15 patients (88.2%), while subtotal resection occurred in 2 patients (11.8%). Eleven patients (64.7%) reported full resolution of symptoms, 4 patients (23.5%) reported deficit improvement, and 2 patients (11.8%) experienced no change from their preoperative deficits. No patient developed new permanent deficits postoperatively. Discussion: GTR, preoperative deficit reduction, and complications were comparable to awake craniotomy and other TScal studies. Ancillary intraoperative techniques, such as brain mapping, 5-ALA and intraoperative ultrasound, are afforded by TScal to improve resection rates and overall outcomes. Conclusions: TScal can be an option for patients with deep lesions in eloquent areas who are not candidates for awake surgeries.

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Section: Discussionmentioning

confidence: 99%

Wide Dissection Trans-Sulcal Approach for Resection of Deep Intra-Axial Lesions in Eloquent Brain Areas

et al. 2022

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“…For deep lesions that would otherwise be inaccessible via conventional craniotomy approaches, parafascicular approaches that provide an alternative method of access were developed and further refined with the introduction of stereotactic tubular retractors, with a recent case series and anatomic description of the technique across multiple tumor types demonstrating a near-total resection (>95% resection) rate of 82%, in line with other tubular retractor literature. 69 Critically, this approach enables minimization of retraction and damage to adjacent cortical and subcortical area while enabling GTR of lesions that may otherwise be inoperable. Emerging technologies for real-time intraoperative histology and assessment of the brain–tumor interface have also been developed; Raman spectroscopy uses the unique spectral patterns of tumor versus normal tissue to characterize surgical specimens in a near real-time, unlabeled, and unprocessed manner.…”

Section: Additional and Emerging Surgical Adjunctsmentioning

confidence: 99%

Surgical Management and Advances in the Treatment of Glioma

Hardigan,

Jackson,

Patel

2023

Semin Neurol

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The care of patients with both high-grade glioma and low-grade glioma necessitates an interdisciplinary collaboration between neurosurgeons, neuro-oncologists, neurologists and other practitioners. In this review, we aim to detail the considerations, approaches and advances in the neurosurgical care of gliomas. We describe the impact of extent-of-resection in high-grade and low-grade glioma, with particular focus on primary and recurrent glioblastoma. We address advances in surgical methods and adjunct technologies such as intraoperative imaging and fluorescence guided surgery that maximize extent-of-resection while minimizing the potential for iatrogenic neurological deficits. Finally, we review surgically-mediated therapies other than resection and discuss the role of neurosurgery in emerging paradigm-shifts in inter-disciplinary glioma management such as serial tissue sampling and “window of opportunity trials”.

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“…The risk of optic radiation injury is high in mesial temporal lobe surgery, even with current conservative resection methods [16,22,27]. Moreover, this risk is also present for certain surgical approaches : the temporal T1-T2 trans-sulcal approach has become a standard approach for resection of intraventricular tumors of the temporal horn [21], and is widely used for resection of glial tumors of the temporal area [23]. Trans-sulcal approach reduces the risk of fascicular injury compared to other approaches, but does not eliminate it, and the knowledge gained from this study about the anatomical variability of the optic radiation and their interhemispheric asymmetry would also be useful for this kind of surgical approach.…”

Section: Application To Neurosurgical Planningmentioning

confidence: 99%

Cross-subject variability of the optic radiation anatomy in a cohort of 1065 healthy subjects

Herlin,

Uszynski,

Chauvel

et al. 2023

Surg Radiol Anat

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Introduction: Optic radiations are tracts of particular interest for neurosurgery, especially for temporal lobe resection, because their lesion is responsible for visual field defects. However, histological and MRI studies found a high inter-subject variability of the optic radiation anatomy, especially for their most rostral extent inside the Meyer's temporal loop. We aimed to better assess inter-subject anatomical variability of the optic radiations, in order to help to reduce the risk of postoperative visual field deficiencies. Methods: Using an advanced analysis pipeline relying on a whole-brain probabilistic tractography and fiber clustering, we processed the diffusion MRI data of the 1065 subjects of the HCP cohort. After registration in a common space, a cross-subject clustering on the whole cohort was performed to reconstruct the reference optic radiation bundle, from which all optic radiations were segmented on an individual scale. Results: We found a median distance between the rostral tip of the temporal pole and the rostral tip of the optic radiation of 29.2 mm (standard deviation: 2.1 mm) for the right side and 28.8 mm (standard deviation: 2.3 mm) for the left side. The difference between both hemispheres was statistically significant (p=1.10 -8 ). Conclusion: We demonstrated inter-individual variability of the anatomy of the optic radiations on a large-scale study, especially their rostral extension. In order to better guide neurosurgical procedures, we built a MNI-based reference atlas of the optic radiations that can be used for fast optic radiation reconstruction from any individual diffusion MRI tractography.

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Minimally invasive trans-sulcal parafascicular surgical resection of cerebral tumors: translating anatomy to early clinical experience

Cited by 8 publications

References 26 publications

Wide Dissection Trans-Sulcal Approach for Resection of Deep Intra-Axial Lesions in Eloquent Brain Areas

Wide Dissection Trans-Sulcal Approach for Resection of Deep Intra-Axial Lesions in Eloquent Brain Areas

Surgical Management and Advances in the Treatment of Glioma

Cross-subject variability of the optic radiation anatomy in a cohort of 1065 healthy subjects

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