Continuous Microdebrider-Based Dynamic Subcortical Motor Mapping: A Technical Advance in Tubular Retractor-Assisted...

Area of Science:

• Neurosurgery
• Minimally Invasive Surgery
• Neurophysiology

Background:

• Transsulcal minimally invasive parafasicular (TsMIP) approaches utilize tubular retractors to reduce brain injury during tumor resection.
• Dynamic neurophysiological mapping is crucial for safely resecting tumors in motor-eloquent areas.

Purpose of the Study:

• To introduce a novel technique integrating TsMIP, tubular retractors, and dynamic subcortical mapping with a single electrified microdebrider.
• To evaluate the efficacy and safety of this combined approach.

Main Methods:

• The NICO Myriad microdebrider was adapted with continuous monopolar stimulation using high-frequency train-of-5 stimulation.
• Continuous subcortical mapping was performed with the adapted device and compared to standard suction stimulation.

Main Results:

• The adapted microdebrider demonstrated no significant difference in stimulation response compared to conventional methods.
• Synchronous tumor resection and subcortical mapping with the NICO Brainpath tubular retractor led to increased maneuverability and faster resection times.
• Improved safety was noted as the stimulating probe is positioned 2 mm proximal to the resection window.

Conclusions:

• The adapted microdebrider is reliable for TsMIP approaches, offering comparable subcortical mapping responses to traditional methods.
• This integrated instrument facilitates safer and more efficient brain tumor resection within tubular retractors.