Minimally invasive approach to a deep-seated motor eloquent brain tumour: a technical note

Lavrador, José Pedro; Oviedova, Anna; Pereira, Noemia; Patel, Sabina; Rajwani, Kapil; Sekhon, Priya; Gullan, Richard; Ashkan, Keyoumars; Vergani, Francesco; Bhangoo, Ranjeev

doi:10.1093/jscr/rjab611

Cited by 7 publications

(2 citation statements)

References 15 publications

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“…AC provides many advantages compared with surgery under general anesthesia (GA) by enabling real-time cortical and subcortical brain mapping under local anesthesia. 4,22-28 In the awake-awake-awake approach, the patient is sedated at light, moderate, or deep levels with spontaneous ventilation during craniotomy and closure. 6,29,30 Although in the asleep-awake-asleep approach, the patient is under GA with a laryngeal mask airway/endotracheal intubation during craniotomy and closure and awakened and extubated during the mapping and resection step in.…”

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confidence: 99%

Stress, Anxiety, and Depression Associated With Awake Craniotomy: A Systematic Review

et al. 2022

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BACKGROUND: Awake craniotomy (AC) enables real-time monitoring of cortical and subcortical functions when lesions are in eloquent brain areas. AC patients are exposed to various preoperative, intraoperative, and postoperative stressors, which might affect their mental health. OBJECTIVE: To conduct a systematic review to better understand stress, anxiety, and depression in AC patients. METHODS: PubMed, Scopus, and Web of Science databases were searched from January 1, 2000, to April 20, 2022, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. RESULTS: Four hundred forty-seven records were identified that fit our inclusion and exclusion criteria for screening. Overall, 24 articles consisting of 1450 patients from 13 countries were included. Sixteen studies (66.7%) were prospective, whereas 8 articles (33.3%) were retrospective. Studies evaluated stress, anxiety, and depression during different phases of AC. Twenty-two studies (91.7%) were conducted on adults, and 2 studies were on pediatrics (8.3 %). Glioma was the most common AC treatment with 615 patients (42.4%). Awake-awakeawake and asleep-awake-asleep were the most common protocols, each used in 4 studies, respectively (16.7%). Anxiety was the most common psychological outcome evaluated in 19 studies (79.2%). The visual analog scale and self-developed questionnaire by the authors (each n = 5, 20.8%) were the most frequently tools used. Twenty-three studies (95.8%) concluded that AC does not increase stress, anxiety, and/or depression in AC patients. One study (4.2%) identified younger age associated with panic attack. CONCLUSION: In experienced hands, AC does not cause an increase in stress, anxiety, and depression; however, the psychiatric impact of AC should not be underestimated.

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confidence: 99%

Stress, Anxiety, and Depression Associated With Awake Craniotomy: A Systematic Review

et al. 2022

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“…The role of preoperative tractography is 2-fold: it firstly has a crucial role in surgical planning (internal corridor, avoid critical subcortical tracts) and secondly with patient counselling, particularly about the extent of resection and the risk for post-operative functional deficit [ 5 ]. Preoperative mapping can then be combined with tumour modelling to define the tsMIPS trajectory [ 6 ]. Trajectory visualization is critical in understanding and predicting the different modalities of mapping and monitoring we will use at different stages of surgery.…”

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confidence: 99%

Awake minimally invasive parafascicular approach to a language eloquent brain tumour—surgical video

Sangha,

Rajwani,

Price

et al. 2023

Journal of Surgical Case Reports

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Deep-seated brain tumours are surgically challenging to access. When planning approaches to these lesions, it is important to take into account eloquent cortical areas, grey matter nuclei, and subcortical white matter tracts. Traditionally, access to deep-seated lesions would require brain retraction; however, this is associated with secondary brain damage, which may impair neurological function. A trans-sulcal minimally invasive parafascicular approach allows gentle splitting of brain fibres and is thought to splay rather than sever white matter tracts. This is particularly important when approaching medially located, language-eloquent tumours, which lack brain surface expression. This video describes a minimally invasive approach to a deep-seated, language-eloquent brain tumour. We utilized preoperative cortical and subcortical planning to define a safe surgical corridor. We then demonstrate using intraoperative neuro-monitoring and mapping of the motor and language functions to define the boundaries of surgical resection. We find trans-sulcal minimally invasive parafascicular approach to be a safe and effective technique when approaching language-eloquent lesions medial to the main language subcortical networks.

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Fluorescence-Guided Surgery in Patients with Tumors Near Motor Areas of the Brain

Kosyrkova,

Goryaynov,

Batalov

et al. 2024

Neurosci Behav Physi

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Minimally invasive approach to a deep-seated motor eloquent brain tumour: a technical note

Cited by 7 publications

References 15 publications

Stress, Anxiety, and Depression Associated With Awake Craniotomy: A Systematic Review

Stress, Anxiety, and Depression Associated With Awake Craniotomy: A Systematic Review

Awake minimally invasive parafascicular approach to a language eloquent brain tumour—surgical video

Fluorescence-Guided Surgery in Patients with Tumors Near Motor Areas of the Brain

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