Minim Invasive Neurosurg 2010; 53(5/06): 229-235
DOI: 10.1055/s-0030-1268478
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

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

M. N. Carvi y Nievas1 , S. Toktamis2
  • 1Neurosurgical Clinic, Städtischen Klinik Frankfurt am Main Höchst, Academic Hospital of the Johann-Wolfgang-Goethe-University, Frankfurt, Germany
  • 2Helios Klinikum Krefeld, Academic Hospital of the Heinrich Heine-University, Düsseldorf, Germany
Further Information

Publication History

Publication Date:
07 February 2011 (online)

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.

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Correspondence

PD Dr. med. M. N. Carvi y Nievas

Städtischen Kliniken Frankfurt

am Main – Höchst

Akademisches Lehrkrankenhaus

der Johann-Wolfgang-Goethe-

Universität Frankfurt am Main

Gotenstraße 6-8

65939 Frankfurt am Main

– Höchst

Germany

Phone: +49/69/3106 2107

Fax: +49/69/3106 2628

Email: MCNievas@t-online.de