Related Experiment Video
Updated: May 17, 2025
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Longitudinal Intravital Imaging of Brain Tumor Cell Behavior in Response to an Invasive Surgical Biopsy
Published on: May 3, 2019
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Microvascular Cortical Dynamics in Minimal Invasive Deep-Seated Brain Tumour Surgery
José Pedro Lavrador1, Oliver Wroe-Wright1, Francesco Marchi1,2
1Department of Neurosurgery, King's College Hospital Foundation Trust, London SE5 9RS, UK.
Cancers
|May 14, 2025
Summary
Changes in microvascular blood flow during tubular retractor-assisted minimally invasive parafascicular approach (trMIPS) surgery correlate with patient outcomes. Increased speed and cerebral blood flow index after surgery indicate a worse neurological outcome for brain tumor patients.
Area of Science:
- Neurosurgery
- Cerebrovascular dynamics
- Minimally invasive surgical techniques
Background:
- The tubular retractor-assisted minimally invasive parafascicular approach (trMIPS) is a transsulcal technique for accessing deep-seated brain tumors.
- While trMIPS is considered safe, its effects on the microvascular dynamics of the retracted cortex and subsequent clinical implications remain largely unknown.
Purpose of the Study:
- To investigate the impact of trMIPS on the microvascular flow dynamics of the brain cortex.
- To determine the clinical implications of observed changes in microvascular flow on patient neurological outcomes.
Main Methods:
- A single-center prospective study involving 35 patients undergoing trMIPS for deep-seated brain tumors.
- Pre- and post-cannulation indocyanine green (ICG) angiography was performed using a FLOW 800 module.
- Key microvascular metrics assessed included speed, delay, time-to-peak (TtP), and cerebral blood flow index (CBFI).
Main Results:
- Analysis of 144 regions-of-interest (ROIs) revealed that increased speed and CBFI post-cannulation were significantly associated with worse neurological outcomes.
- ROI-based analysis showed a statistically significant correlation between increased speed/CBFI and neurological deterioration (p < 0.0001 for speed, p = 0.0005 for CBFI).
- These findings were consistent in patient-level analyses and after adjusting for confounding factors.
Conclusions:
- Microvascular flow dynamics are significantly impacted by trMIPS.
- An increase in cerebral blood flow speed and index after decannulation is a predictor of poorer neurological outcomes in patients undergoing trMIPS for brain tumors.
