Microvascular cortical dynamics in minimal invasive deep-seated brain tumour surgery
Additional information
Authors
Lavrador J. P.,
Wroe-Wright O.,
Marchi F.,
Elhag A.,
O’Keeffe A.,
De la Fuente P.,
Soumpasis C.,
Cardia A.,
Mirallave-Pescador A.,
Díaz-Baamonde A.,
Sadio Mosquera J.,
Coiteiro D.,
Jewell S.,
Strong A. J.,
Gullan R.,
Ashkan K.,
Vergani F.,
Kailaya Vasan A.,
Bhangoo R.
Type
Journal Article
Year
2025
Language
English
Abstract
Background: The tubular retractor-assisted minimally invasive parafascicular approach (trMIPS) is a transsulcal approach to deep-seated brain tumours. It is a safe surgical approach but its impact on the microvascular dynamics of the retracted cortex and its clinical implications are unknown. Methods: This was a single-centre prospective study including patients with deep-seated brain tumours operated on with a trMIPS (BrainPath Nico System©). All patients underwent pre- and post-cannulation indocyanine green study using a FLOW 800 module in a KINEVO Zeiss© microscope. Speed, delay, time-to-peak (TtP) rise-in-time and cerebral blood flow index (CBFI) metrics were assessed. Results: Thirty-five patients were included, with 144 regions-of-interest (ROIs) selected. The majority of patients were diagnosed with glioblastoma (51.43%), and 37.14% of patients had a preoperative focal neurological deficit (FND) at presentation. A ROI-based analysis concluded that an increase in speed and CBFI was related with a worse neurological outcome when comparing the pre- and post-brain cannulation assessments (speed: deterioration = 43.12 ± 80.60% versus stable = −14.51 ± 57.80% versus improvement = 6.93 ± 31.33%, p < 0.0001; CBFI: deterioration = 50.40 ± 88.17% versus stable = −2.70 ± 67.54% versus improvement = −38.98 ± 26.17%, p = 0.0005). These findings were reproducible in a combined-ROI per patient analysis and confirmed after adjustment for confounding. Conclusion: Microvascular flow dynamics impact trMIPS outcomes as an increase in the speed and CBFI after decannulation was related with worse neurological outcome.
Keywords
Transsulcal approach, Minimal invasive parafascicular surgery, Neuro-oncology, Tubular retractor, Microvascularization, Deep-seated lesions
Journal
Cancers
Volume
17
Number ( Month )
9
Pages (or article number)
1392
Diffusion
License
CC BY
Visibility
Public
Status open access
Gold
