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Diffusion changes in minimally invasive parafascicular approach for deep-seated tumours: impact on clinical outcomes
Mariam Awan1, Aya Elshalakany2, Dimitrios Kalaitzoglou2
1Department of Neurosurgery, King's College Hospital Foundation Trust, London, UK. m.awan1@nhs.net.
Abstract:
Minimally invasive parafascicular surgery (MIPS) with the use of tubular retractors achieve a safe resection in deep seated tumours. Diffusion changes noted on postoperative imaging; the significance and clinical correlation of this remains poorly understood. Single centre retrospective cohort study of neuro-oncology patients undergoing MIPS. The impact of surgical approach-transsulcal (TS) versus transgyral (TG) - and respective entry points in clinical and imaging outcomes was assessed. 82 patients (35 male; 47 female, average age 43.94 ± 22.85 years) were included. 84% presented with neurological deficit and glioblastoma was the commonest diagnosis (38.24%). Surgical approach was not relevant for the number of patients that showed postoperative peritubular injury (TS: 20 (37.74%) versus TG: 8 (27.59%), p = 0.354) or its volume (TS: 0.95 ± 1.82 cc versus TG: 0.43 ± 1.32 cc, p = 0.1435). When adjusted for preoperative volume and depth of tumour, TS approach was associated with less diffusion restriction (p = 0.030). Temporal lobe access points had the highest volume of diffusion restriction (temporal lobe-2.50 ± 3.54 cc versus frontal lobe - 1.15 ± 1.53 versus parietal lobe-0.51 ± 0.91 cc, p = 0.0096), particularly in the TS approach (p = 0.0152). Superior motor outcomes were demonstrated in the TS versus the TG approach (postoperative improvement: TS: 14.63% versus TG: 6.9%, p = 0.015), especially for parietal approaches (p = 0.039). TS approach was related with a significantly decreased length of stay (TS-11.67 ± 14.19 days versus TG - 23.97 ± 18.01 days, p = 0.001). Transsulcal approach demonstrated a better motor outcome profile, particularly in parietal lobe, and shorter length of stay. The superior temporal sulcus was more susceptible to ischaemic changes. Therefore, transgyral route can be considered in temporal lobe MIPS.
Insights
Minimally invasive parafascicular surgery (MIPS) using the transsulcal (TS) approach shows better motor outcomes and shorter hospital stays compared to the transgyral (TG) approach. However, the superior temporal sulcus is more prone to ischemia, suggesting TG may be preferable for temporal lobe MIPS.
Area of Science:
- Neurosurgery
- Oncology
- Radiology
Background:
- Minimally invasive parafascicular surgery (MIPS) enables safe resection of deep-seated tumors.
- Postoperative diffusion changes after MIPS require further understanding of their clinical significance.
- The impact of surgical approach (transsulcal vs. transgyral) on outcomes is not fully elucidated.
Purpose of the Study:
- To assess the impact of surgical approach (transsulcal vs. transgyral) and entry points on clinical and imaging outcomes in MIPS.
- To investigate the correlation between surgical trajectory and postoperative diffusion changes.
- To compare motor outcomes and length of stay between transsulcal and transgyral approaches.
Main Methods:
- Single-center retrospective cohort study of 82 neuro-oncology patients undergoing MIPS.
- Comparison of transsulcal (TS) and transgyral (TG) surgical approaches.
- Analysis of postoperative imaging for diffusion changes and correlation with clinical outcomes, including motor function and length of stay.
Main Results:
- No significant difference in the incidence or volume of peritubular injury between TS and TG approaches.
- The TS approach was associated with less diffusion restriction when adjusted for tumor characteristics (p=0.030).
- Temporal lobe access showed the highest diffusion restriction, particularly with the TS approach (p=0.0152).
- Superior motor outcomes (14.63% improvement) and shorter length of stay (11.67 days) were observed with the TS approach compared to TG (6.9% improvement, 23.97 days).
- Parietal lobe approaches, especially TS, demonstrated better motor outcomes (p=0.039).
Conclusions:
- The transsulcal (TS) approach in MIPS is associated with improved motor outcomes and reduced length of hospital stay.
- The superior temporal sulcus is more susceptible to ischemic changes, suggesting the transgyral (TG) route may be a safer option for temporal lobe MIPS.
- Surgical approach selection should consider tumor location to optimize patient outcomes and minimize diffusion restriction.
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