(AS2) Mizuho Minimally Invasive Brain Tumor Surgery Award (2023 Award Winner): Standardization of Strategies to Perform a Parafascicular Tubular Approach for the Resection of Brain Tumors in Eloquent Areas

Introduction: This study aims to define a methodological strategy for minimally invasive tubular retractors (MITRs) parafascicular transulcal approach (PTA) for the management of brain tumors sited in eloquent brain regions.

Methods: An observational prospective study was designed and conducted from June 2018 to June 2021 to evaluate the benefits of PTA associated with MITRs, tractography, and intraoperative cortical stimulation for resection of brain tumors located in eloquent brain regions. Information regarding white matter tracts was processed, preventing potential damage during the approach and/or resection. Patients were included if they: 1) were ≥18 years old; 2) had a single brain tumor lesion; 3) had a preoperative Karnofsky Performance score >70%; 4) had a preoperative Glasgow Coma Scale (GCS) ≥14 points.

Results: A total of 72 patients were enrolled, with a mean age of 49.6 years and mostly males. Most patients presented with variable motor deficits (41.6%), aphasia (12.5%), paraphasia (11.1%), and/or optic pathway involvement with visual deficits (9.7%). Tumors were most frequently located in the frontal lobe (26.3%), and were mostly high-grade gliomas (34.7%). Scalp incisions measured on average 5.58 cm. A total of 94.4% of patients underwent total macroscopic resection using PTA associated with MITRs. No new postoperative neurological deficits were noted in 90.2% patients.

Conclusion : Our study suggests that tubular minimally invasive approaches allow to perform maximal safe resection of brain tumors in eloquent areas through small surgical corridors. Future comparative studies between traditional and minimally invasive techniques are required to further investigate the potential of these surgical nuances.