Minimally Invasive Neurosurgery Approach Limits Damage in Patients Following Brain Tumor Surgery

Brain tumors situated in areas responsible for speech, vision, and motor function pose unique challenges for neurosurgeons, as damage to adjacent tissue can result in significant impairment of these abilities. These regions, referred to as "eloquent brain areas," necessitate special care and methods to minimize damage and deficits. Now, researchers investigating the efficacy of a minimally invasive approach in reducing vision and hearing loss in patients after brain tumor surgery have found the method to be highly effective.

State-of-the-art technologies enable neurosurgeons to precisely navigate to the tumor. These tools include neuronavigation, functioning as a GPS to guide the surgeon to the tumor by connecting the patient's MRI to the navigation system. Surgeons can then utilize a pen-like instrument to register the brain with the MRI. Cortical mapping, another technique, applies mild electrical stimulation to the brain during surgery to identify specific regions, helping surgeons avoid crucial areas controlling speech, motor function, and vision. Tractography, a third technology, maps the location and direction of white matter in the brain using advanced imaging software. These techniques work collectively to help surgeons excise as much of the tumor as possible while minimizing damage to surrounding tissue.

Even using these new technologies, traditional methods of neurosurgery involve removing large Traditional neurosurgery methods involve removing large portions of the skull and retracting significant sections of the brain to access the tumor. However, excessive retraction can damage neurons and cause tissue death. Researchers at University of Cincinnati (Cincinnati, OH, USA) studied a minimally invasive alternative using a small tube, which requires removing a smaller section of the skull and eliminating the need for brain retraction. With imaging technology pinpointing the tumor's location and indicating the shortest distance to it, the tube can be inserted directly into the tumor site, allowing for its removal.

The research team assessed the outcomes of 72 patients who underwent brain tumor removal in eloquent areas using the tubular approach. As eloquent-area brain tumors are relatively rare, the prospective observational study included various tumor types and regions. The team discovered that nearly 95% of patients had their entire tumors removed using this method. Post-surgery, 9% of patients experienced new or worsened speech or motor function deficits, consistent with expected complication rates for surgeries in these brain areas. Further studies are needed to evaluate the tubular approach's effectiveness for specific tumor types and regions, enabling direct comparisons. As with any surgical technique, neurosurgeons must study and practice the tubular approach before employing it in an operating room, with more data on its effectiveness expected to be published in the future.

“Maybe this approach may be of better benefit for particular tumors, so we may be best to use this only for those tumors instead of all types,” said University of Cincinnati’s Paolo Palmisciano, MD, who was part of the research team.

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