Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, FL 33328, USA.
Department of Neurosurgery, Cleveland Clinic Florida, Weston, FL 33331, USA.
Curr Oncol. 2022 Oct 4;29(10):7396-7410. doi: 10.3390/curroncol29100581.
Resection of intra-axial tumors (IaT) in eloquent brain regions risks major postoperative neurological deficits. Awake craniotomy is often used to navigate these areas; however, some patients are ineligible for awake procedures. The trans-sulcal approach (TScal) was introduced to reduce parenchymal trauma during tumor resection. We report our experiences utilizing TScal for resection of deep IaT located in eloquent areas. This is a single-center retrospective analysis of patients who underwent IaT resection in eloquent areas via TScal from January 2013 to April 2021. Seventeen cases were reviewed, and relevant data was collected. Fluorescence-guided surgery with 5-aminolevulinic acid (ALA) and intraoperative ultrasound was performed in some cases. Seventeen patients (10 males, 7 females) averaging 61.2 years-old (range, 21-76) were included in this study. Average length of stay was 4.8 days, and only 2 patients (11.8%) required hospital readmission within 30 days. Gross total resection (GTR) was achieved in 15 patients (88.2%), while subtotal resection occurred in 2 patients (11.8%). Eleven patients (64.7%) reported full resolution of symptoms, 4 patients (23.5%) reported deficit improvement, and 2 patients (11.8%) experienced no change from their preoperative deficits. No patient developed new permanent deficits postoperatively. Discussion: GTR, preoperative deficit reduction, and complications were comparable to awake craniotomy and other TScal studies. Ancillary intraoperative techniques, such as brain mapping, 5-ALA and intraoperative ultrasound, are afforded by TScal to improve resection rates and overall outcomes. TScal can be an option for patients with deep lesions in eloquent areas who are not candidates for awake surgeries.
在功能区切除脑内肿瘤（IaT）存在术后发生严重神经功能缺损的风险。通常采用唤醒开颅术来导航这些区域；然而，有些患者不适合进行唤醒手术。经侧裂入路（TScal）的引入是为了减少肿瘤切除过程中的实质创伤。我们报告了我们利用 TScal 切除位于功能区深部 IaT 的经验。 这是一项回顾性单中心研究，纳入了 2013 年 1 月至 2021 年 4 月期间通过 TScal 行功能区深部 IaT 切除术的患者。回顾性分析了 17 例患者的临床资料。部分患者采用了 5-氨基酮戊酸（ALA）荧光引导手术和术中超声。 研究纳入了 17 例患者（男 10 例，女 7 例），平均年龄为 61.2 岁（范围：21-76 岁）。平均住院时间为 4.8 天，仅 2 例（11.8%）患者在术后 30 天内需要再次住院。15 例（88.2%）患者达到了大体全切除（GTR），2 例（11.8%）患者行次全切除，2 例（11.8%）患者行部分切除。11 例（64.7%）患者症状完全缓解，4 例（23.5%）患者症状改善，2 例（11.8%）患者术前神经功能缺损无变化。术后无患者发生新的永久性神经功能缺损。讨论：GTR、术前神经功能缺损的改善和并发症与唤醒开颅术和其他 TScal 研究相当。TScal 还可辅助应用术中脑功能定位、5-ALA 和术中超声等辅助技术，提高切除率和总体预后。 对于不适合唤醒手术的功能区深部病变患者，TScal 是一种选择。
