NT-14EARLY EXPERIENCE WITH TRANS-SULCAL PARAFASCICULAR EXOSCOPIC RESECTION OF SUPRATENTORIAL BRAIN TUMORS

BACKGROUND: Resection of subcortical lesions is limited by concern for procedure-related injury to critical structures. Such a concern may impede the ability to resect completely and such an injury may affect post-operative recovery significantly. The parafascicular approach involves planned navigation of working channel parallel to critical fascicles when accessing subcortical lesions. This reduces shear injury to major white matter tracts and is achieved by inserting a tapered dilating access device (Neuroport) through a sulcus. Use of an exoscope increases illumination and clarity in optics that go hand in hand with the tenants of this approach. Here we present our early experience with this technique. METHODS: We reviewed our first 10 supratentorial brain tumors that were resected using the 6-pillar approach of parafascicular minimally invasive exoscopic resection. The eligible patients underwent further data analysis focusing on pathology and outcome from this approach. RESULTS: Ten patients with a mean age of 63 years underwent resection of both primary and metastatic lesions. There were no adverse events related to port placement or approach. Eight had primary neoplasm of which 6 were WHO grade IV. Two other lesions were metastatic in nature. Two patients died but both succumbed to their neoplasm and not surgery or its complications. One developed supplementary motor area syndrome following resection of rapidly growing left frontal Glioblastoma. Tumor resection was gross total in all cases. Hospital stay averaged 2.5 days. CONCLUSIONS: Trans-sulcal parafascicular navigated exoscopic resection is rapidly becoming an established way of managing subcortical brain tumors and other lesions, especially intra-cerebral hematomas. Our early results are better than conventional open surgical resection, with inaccessible lesions becoming accessible and shorter hospital stays. With this minimally invasive (minimally disruptive) approach, we see decrease in injury to both vital cortex and significant large white matter tracts thus preserving maximum neurological function.