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Sinha S, Kalyal N, Gallagher MJ, Richardson D, Kalaitzoglou D, Abougamil A, Silva M, Oviedova A, Patel S, Mirallave-Pescador A, Bleil C, Zebian B, Gullan R, Ashkan K, Vergani F, Bhangoo R, Pedro Lavrador J. Impact of Preoperative Mapping and Intraoperative Neuromonitoring in Minimally Invasive Parafascicular Surgery for Deep-Seated Lesions. World Neurosurg 2024; 181:e1019-e1037. [PMID: 37967744 DOI: 10.1016/j.wneu.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/07/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Transsulcal tubular retractor-assisted minimally invasive parafascicular surgery changes the surgical strategy for deep-seated lesions by promoting a deficit-sparing approach. When integrated with preoperative brain mapping and intraoperative neuromonitoring (IONM), this approach may potentially improve patient outcomes. In this study, we assessed the impact of preoperative brain mapping and IONM in tubular retractor-assisted neuro-oncological surgery. METHODS This retrospective single-center cohort study included patients who underwent transsulcal tubular retractor-assisted minimally invasive parafascicular surgery for resection of deep-seated brain tumors from 2016 to 2022. The cohort was divided into 3 groups: group 1, no preoperative mapping or IONM (17 patients); group 2, IONM only (25 patients); group 3, both preoperative mapping and IONM (38 patients). RESULTS We analyzed 80 patients (33 males and 47 females) with a median age of 46.5 years (range: 1-81 years). There was no significant difference in mean tumor volume (26.2 cm3 [range 1.07-97.4 cm3]; P = 0.740) and mean preoperative depth of the tumor (31 mm [range 3-65 mm], P = 0.449) between the groups. A higher proportion of high-grade gliomas and metastases was present within group 3 (P = 0.003). IONM was related to fewer motor (P = 0.041) and language (P = 0.032) deficits at hospital discharge. Preoperative mapping and IONM were also related to shorter length of stay (P = 0.008). CONCLUSIONS Preoperative and intraoperative brain mapping and monitoring enhance transsulcal tubular retractor-assisted minimally invasive parafascicular surgery in neuro-oncology. Patients had a reduced length of stay and prolonged overall survival. IONM alone reduces postoperative neurological deficit.
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Affiliation(s)
- Siddharth Sinha
- Department of Neurosurgery, King's College Hospital Foundation Trust, London, United Kingdom.
| | - Nida Kalyal
- Department of Neurosurgery, King's College Hospital Foundation Trust, London, United Kingdom
| | - Mathew J Gallagher
- Department of Neurosurgery, King's College Hospital Foundation Trust, London, United Kingdom
| | - Daniel Richardson
- Department of Neurosurgery, King's College Hospital Foundation Trust, London, United Kingdom
| | - Dimitrios Kalaitzoglou
- Department of Neurosurgery, King's College Hospital Foundation Trust, London, United Kingdom
| | - Ahmed Abougamil
- Department of Neurosurgery, King's College Hospital Foundation Trust, London, United Kingdom
| | - Melissa Silva
- Department of Neurosurgery, Intraoperative Neurophysiology, King's College Hospital Foundation Trust, London, United Kingdom
| | - Anna Oviedova
- Department of Neurosurgery, King's College Hospital Foundation Trust, London, United Kingdom
| | - Sabina Patel
- Department of Neurosurgery, King's College Hospital Foundation Trust, London, United Kingdom
| | - Ana Mirallave-Pescador
- Department of Neurosurgery, King's College Hospital Foundation Trust, London, United Kingdom; Departamento de Neurocirurgia, Hospital Garcia de Orta, Almada, Portugal
| | - Cristina Bleil
- Department of Neurosurgery, King's College Hospital Foundation Trust, London, United Kingdom
| | - Bassel Zebian
- Department of Neurosurgery, King's College Hospital Foundation Trust, London, United Kingdom
| | - Richard Gullan
- Department of Neurosurgery, King's College Hospital Foundation Trust, London, United Kingdom
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital Foundation Trust, London, United Kingdom
| | - Francesco Vergani
- Department of Neurosurgery, King's College Hospital Foundation Trust, London, United Kingdom
| | - Ranjeev Bhangoo
- Department of Neurosurgery, King's College Hospital Foundation Trust, London, United Kingdom
| | - José Pedro Lavrador
- Department of Neurosurgery, King's College Hospital Foundation Trust, London, United Kingdom
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