Minimally invasive keyhole approach for supramaximal frontal glioma resections : technical note
OBJECTIVE: The authors aimed to review the frontal lobe's surgical anatomy, describe their keyhole frontal lobectomy technique, and analyze the surgical results.
METHODS: Patients with newly diagnosed frontal gliomas treated using a keyhole approach with supramaximal resection (SMR) from 2016 to 2022 were retrospectively reviewed. Surgeries were performed on patients asleep and awake. A human donor head was dissected to demonstrate the surgical anatomy. Kaplan-Meier curves were used for survival analysis.
RESULTS: Of the 790 craniotomies performed during the study period, those in 47 patients met our inclusion criteria. The minimally invasive approach involved four steps: 1) debulking the frontal pole; 2) subpial dissection identifying the sphenoid ridge, olfactory nerve, and optic nerve; 3) medial dissection to expose the falx cerebri and interhemispheric structures; and 4) posterior dissection guided by motor mapping, avoiding crossing the inferior plane defined by the corpus callosum. A fifth step could be added for nondominant lesions by resecting the inferior frontal gyrus. Perioperative complications were recorded in 5 cases (10.6%). The average hospital length of stay was 3.3 days. High-grade gliomas had a median progression-free survival of 14.8 months and overall survival of 23.9 months.
CONCLUSIONS: Keyhole approaches enabled successful SMR of frontal gliomas without added risks. Robust anatomical knowledge and meticulous surgical technique are paramount for obtaining successful resections.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:140 |
|---|---|
| Enthalten in: |
Journal of neurosurgery - 140(2024), 4 vom: 01. Apr., Seite 949-957 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Merenzon, Martín A [VerfasserIn] |
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| Links: |
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| Themen: |
Brain tumor |
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| Anmerkungen: |
Date Completed 04.04.2024 Date Revised 04.04.2024 published: Electronic-Print Citation Status MEDLINE |
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| doi: |
10.3171/2023.7.JNS231363 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM370542541 |
|---|
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| 100 | 1 | |a Merenzon, Martín A |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Minimally invasive keyhole approach for supramaximal frontal glioma resections |b technical note |
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| 500 | |a Date Revised 04.04.2024 | ||
| 500 | |a published: Electronic-Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a OBJECTIVE: The authors aimed to review the frontal lobe's surgical anatomy, describe their keyhole frontal lobectomy technique, and analyze the surgical results | ||
| 520 | |a METHODS: Patients with newly diagnosed frontal gliomas treated using a keyhole approach with supramaximal resection (SMR) from 2016 to 2022 were retrospectively reviewed. Surgeries were performed on patients asleep and awake. A human donor head was dissected to demonstrate the surgical anatomy. Kaplan-Meier curves were used for survival analysis | ||
| 520 | |a RESULTS: Of the 790 craniotomies performed during the study period, those in 47 patients met our inclusion criteria. The minimally invasive approach involved four steps: 1) debulking the frontal pole; 2) subpial dissection identifying the sphenoid ridge, olfactory nerve, and optic nerve; 3) medial dissection to expose the falx cerebri and interhemispheric structures; and 4) posterior dissection guided by motor mapping, avoiding crossing the inferior plane defined by the corpus callosum. A fifth step could be added for nondominant lesions by resecting the inferior frontal gyrus. Perioperative complications were recorded in 5 cases (10.6%). The average hospital length of stay was 3.3 days. High-grade gliomas had a median progression-free survival of 14.8 months and overall survival of 23.9 months | ||
| 520 | |a CONCLUSIONS: Keyhole approaches enabled successful SMR of frontal gliomas without added risks. Robust anatomical knowledge and meticulous surgical technique are paramount for obtaining successful resections | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a brain tumor | |
| 650 | 4 | |a glioblastoma | |
| 650 | 4 | |a glioma | |
| 650 | 4 | |a minimally invasive | |
| 650 | 4 | |a neuroanatomy | |
| 650 | 4 | |a oncology | |
| 650 | 4 | |a outcome | |
| 650 | 4 | |a surgical technique | |
| 700 | 1 | |a Mendez Valdez, Mynor J |e verfasserin |4 aut | |
| 700 | 1 | |a Chandar, Jay |e verfasserin |4 aut | |
| 700 | 1 | |a Lu, Victor M |e verfasserin |4 aut | |
| 700 | 1 | |a Marco Del Pont, Francisco |e verfasserin |4 aut | |
| 700 | 1 | |a Morell, Alexis A |e verfasserin |4 aut | |
| 700 | 1 | |a Eichberg, Daniel G |e verfasserin |4 aut | |
| 700 | 1 | |a Daggubati, Lekhaj |e verfasserin |4 aut | |
| 700 | 1 | |a Benjamin, Carolina G |e verfasserin |4 aut | |
| 700 | 1 | |a Shah, Ashish H |e verfasserin |4 aut | |
| 700 | 1 | |a Ivan, Michael E |e verfasserin |4 aut | |
| 700 | 1 | |a Komotar, Ricardo J |e verfasserin |4 aut | |
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