Wide Dissection Trans-Sulcal Approach for Resection of Deep Intra-Axial Lesions in Eloquent Brain Areas
<i>Introduction:</i> 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...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-10-01
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| Series: | Current Oncology |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1718-7729/29/10/581 |
| _version_ | 1827650854800326656 |
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| author | Brandon Kaye Raphael Augusto Correa Bastianon Santiago Gerard MacKinnon Rocco Dabecco Bilal Ibrahim Assad Ali Romel Santos Phillip Johansen Surabhi Ranjan Michal Obrzut Hamid Borghei-Razavi Badih Adada |
| author_facet | Brandon Kaye Raphael Augusto Correa Bastianon Santiago Gerard MacKinnon Rocco Dabecco Bilal Ibrahim Assad Ali Romel Santos Phillip Johansen Surabhi Ranjan Michal Obrzut Hamid Borghei-Razavi Badih Adada |
| author_sort | Brandon Kaye |
| collection | DOAJ |
| description | <i>Introduction:</i> 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. <i>Materials and Methods:</i> 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. <i>Results:</i> 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. <i>Conclusions:</i> TScal can be an option for patients with deep lesions in eloquent areas who are not candidates for awake surgeries. |
| first_indexed | 2024-03-09T20:24:49Z |
| format | Article |
| id | doaj.art-f7c550b1a7d042b99a3d098f580eb07a |
| institution | Directory Open Access Journal |
| issn | 1198-0052 1718-7729 |
| language | English |
| last_indexed | 2024-03-09T20:24:49Z |
| publishDate | 2022-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Current Oncology |
| spelling | doaj.art-f7c550b1a7d042b99a3d098f580eb07a2023-11-23T23:40:28ZengMDPI AGCurrent Oncology1198-00521718-77292022-10-0129107396741010.3390/curroncol29100581Wide Dissection Trans-Sulcal Approach for Resection of Deep Intra-Axial Lesions in Eloquent Brain AreasBrandon Kaye0Raphael Augusto Correa Bastianon Santiago1Gerard MacKinnon2Rocco Dabecco3Bilal Ibrahim4Assad Ali5Romel Santos6Phillip Johansen7Surabhi Ranjan8Michal Obrzut9Hamid Borghei-Razavi10Badih Adada11Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, FL 33328, USADepartment of Neurosurgery, Cleveland Clinic Florida, Weston, FL 33331, USADepartment of Neurosurgery, Cleveland Clinic Florida, Weston, FL 33331, USADepartment of Neurosurgery, Cleveland Clinic Florida, Weston, FL 33331, USADepartment of Neurosurgery, Cleveland Clinic Florida, Weston, FL 33331, USADepartment of Neurosurgery, Cleveland Clinic Florida, Weston, FL 33331, USADepartment of Neurosurgery, Cleveland Clinic Florida, Weston, FL 33331, USADepartment of Neurosurgery, Cleveland Clinic Florida, Weston, FL 33331, USADepartment of Neurosurgery, Cleveland Clinic Florida, Weston, FL 33331, USADepartment of Neurosurgery, Cleveland Clinic Florida, Weston, FL 33331, USADepartment of Neurosurgery, Cleveland Clinic Florida, Weston, FL 33331, USADepartment of Neurosurgery, Cleveland Clinic Florida, Weston, FL 33331, USA<i>Introduction:</i> 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. <i>Materials and Methods:</i> 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. <i>Results:</i> 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. <i>Conclusions:</i> TScal can be an option for patients with deep lesions in eloquent areas who are not candidates for awake surgeries.https://www.mdpi.com/1718-7729/29/10/581trans-sulcal approachsurgical outcomeeloquenceglioblastomalanguagebrain metastasis |
| spellingShingle | Brandon Kaye Raphael Augusto Correa Bastianon Santiago Gerard MacKinnon Rocco Dabecco Bilal Ibrahim Assad Ali Romel Santos Phillip Johansen Surabhi Ranjan Michal Obrzut Hamid Borghei-Razavi Badih Adada Wide Dissection Trans-Sulcal Approach for Resection of Deep Intra-Axial Lesions in Eloquent Brain Areas Current Oncology trans-sulcal approach surgical outcome eloquence glioblastoma language brain metastasis |
| title | Wide Dissection Trans-Sulcal Approach for Resection of Deep Intra-Axial Lesions in Eloquent Brain Areas |
| title_full | Wide Dissection Trans-Sulcal Approach for Resection of Deep Intra-Axial Lesions in Eloquent Brain Areas |
| title_fullStr | Wide Dissection Trans-Sulcal Approach for Resection of Deep Intra-Axial Lesions in Eloquent Brain Areas |
| title_full_unstemmed | Wide Dissection Trans-Sulcal Approach for Resection of Deep Intra-Axial Lesions in Eloquent Brain Areas |
| title_short | Wide Dissection Trans-Sulcal Approach for Resection of Deep Intra-Axial Lesions in Eloquent Brain Areas |
| title_sort | wide dissection trans sulcal approach for resection of deep intra axial lesions in eloquent brain areas |
| topic | trans-sulcal approach surgical outcome eloquence glioblastoma language brain metastasis |
| url | https://www.mdpi.com/1718-7729/29/10/581 |
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