Minimally Invasive Technique Reduces Secondary Brain Collapse Following a Frontal Interhemispheric Approach to Midline Tumors with Accentuated Brain Shift Phenomena

Abstract

Background: The aim of this study was to assess the influence of minimal invasive techniques (MIT) on secondary brain collapse (BC) following a frontal inter-hemispheric approach to midline tumors with accentuated preoperative brain shift phenomena.

Methods: We reviewed the results obtained in our department during the last 10 years in 24 treated patients with such tumors. Some of these patients underwent traditional surgical approaches using brain retractors (BR) and more recently alternative MIT including the creation of a narrow surgical corridor without brain retractors and the reinforcement and reinsertion from bridging veins. The patient's postoperative condition (consciousness recovery, respirator dependence, ICU-patient's stay and outcome) as well as the volume of the postoperative skull/brain space as a measurable indicator of BC and the ventricular index were assessed in all cases. All data were compared using the Chi square test, the 2-tailed Pearson correlation and t-test.

Results: 24 patients (11 operated with BR and 13 with MIT) were analyzed. The comparison between both techniques revealed a significant reduction of the postoperatively assessed skull/brain space (P<0.001), time for consciousness recovery (P<0.05), respirator dependence (P<0.001) and intensive care unit stay (P<0.005) for patients treated with MIT. A significant correlation was observed between radiological and clinical data (respirator dependence, consciousness recovery and ICU stay) from P<0.01, P<0.05 and P<0.01 respectively.

Conclusions: In our study MIT allow the patients to recover consciousness in a shorter period of time, reducing the needs for prolonged mechanical ventilation and ICU stay. In these patients, such clinical advantages are related with a radiologically assessed postoperative reduced brain collapse.

Key words

brain collapse - frontal interhemispheric approach - surgical technique

References

• 1 Aryan HE, Ozgur BM, Jandial R. et al . Complications of interhemispheric transcallosal approach in children: review of 15 years experience.  Clin Neurol Neurosurg. 2006;  108 790-793
• 2 Kubota M, Saeki N, Yamaura A. et al . Influences of venous involvement on postoperative brain damage following the anterior interhemispheric approach.  Acta Neurochir. 2001;  143 321-325
• 3 Nakamura M, Roser F, Struck M. et al . Tuberculum sellae meningiomas: clinical outcome considering different surgical approaches.  Neurosurgery. 2006;  59 1019-1028
• 4 Kravtchouk AD, Likhterman LB, Potapov AA. et al . Postoperative complications of chronic subdural hematomas: prevention and treatment.  Neurosurg Clin N Am. 2000;  11 547-552
• 5 Carvi y Nievas MN. Volume assessment of large intracranial meningiomas. Considerations about microsurgical strategy and their clinical management.  Neurol Res. 2007;  29 787-797
• 6 Babu R, Barton A, Kasoff SS. Resection of olfactory groove meningiomas: technical note revisited.  Surg Neurol. 1995;  44 567-572
• 7 Colli BO, Carlotti Jr CG, Assirati Jr JA. et al . Olfactory groove meningiomas: surgical technique and follow-up review.  Arq Neuropsiquiatr. 2007;  65 795-799
• 8 Hentschel SJ, DeMonte F. Olfactory groove meningiomas.  Neurosurg Focus. 1993;  14 1-6
• 9 de Divitiis E, Esposito F, Cappabianca P. et al . Tuberculum sellae meningiomas: high route or low route? A series of 51 consecutive cases.  Neurosurgery. 2008;  62 556-563
• 10 Friedrich P, Schulz MR, Wuthe U. et al . Postoperative complications in space occupying processes of the base of the skull.  Zentralbl Neurochir. 1986;  47 105-110
• 11 Nakase H, Shin Y, Nakagawa I. et al . Clinical features of postoperative cerebral venous infarction.  Acta Neurochir. 2005;  147 621-626
• 12 Kurokawa Y, Uede T, Honda O. et al . Technical tactics to preserve cortical venous drainage in interhemispheric approach for anterior communicating artery aneurysms.  No Shinkei Geka. 1994;  22 29-34
• 13 Morimoto T, Yamada T, Ishida Y. et al . Monitoring of venous blood flow velocity during interhemispheric approach for deep seated lesions.  Acta Neurochir. 1995;  137 44-47
• 14 Tsutsumi K, Shiokawa Y, Sakai T. et al . Venous infarction following the interhemispheric approach in patients with acute subarachnoid hemorrhage.  J Neurosurg. 1991;  74 715-719
• 15 Nabavi A, Black PM, Gering DT. et al . Serial intraoperative magnetic resonance imaging of brain shift.  Neurosurgery. 2001;  48 787-797
• 16 Kasowski HJ, Nahed BV, Piepmeier JM. Transcallosal transchoroidal approach to tumors of the third ventricle.  Neurosurgery. 2005;  57 361-366
• 17 Vinchon M, Dhellemmes P. Third ventricle tumors in children.  Neurochirurgie. 2000;  46 323-334
• 18 Zuccaro G, Sosa F, Cuccia V. et al . Lateral ventricle tumors in children: a series of 54 cases.  Childs Nerv Syst. 1999;  15 774-785
• 19 Rivera VM. Modafinil for the treatment of diminished responsiveness in a patient recovering from brain surgery.  Brain Inj. 2005;  19 725-727
• 20 Lam CH, Dubuisson D. Treatment of hemispheric collapse and herniation beneath the falx in a case of shunted hydrocephalus.  Surg Neurol. 1990;  33 202-205
• 21 Spektor S, Valarezo J, Fliss DM. et al . Olfactory groove meningiomas from neurosurgical and ear, nose, and throat perspectives: approaches, techniques, and outcomes.  Neurosurgery. 2005;  57 268-280
• 22 Carbon RT, Baar S, Kriegelstein S. et al . Evaluating the in vitro adhesive strength of biomaterials.  Biosimulator for selective leak closure Biomaterials. 2003;  24 1469-1475
• 23 Schiele U, Kuntz G, Riegler A. Haemostatic preparations on the basis of collagen alone and as fixed combination with fibrin glue.  Clin Mater. 1992;  89 169-177

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