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  • The Safety and Efficacy of Diffusion Tensor Imaging (DTI)- Guided Transulcal Radial Tubular Corridors to subcortical neoplasms: A Multicenter Study

    Final Number:

    Mohamed Labib MD; Ronald L. Young MD; Richard A. Rovin MD; John Diaz Day MD; Javed Khader Eliyas MD; Julian E. Bailes MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Subcortical injury resulting from the surgical management of deep lesions can be devastating. The present study evaluates the safety and efficacy of a novel DTI-guided, exoscopic-assisted, radial tubular transulcal access approach to subcortical neoplastic lesions.

    Methods: Four neurosurgeons from 4 different centers were trained through a CME course to use a standardized technique incorporating 5 cores competencies: image interpretation and trajectory planning, 2) dynamic navigation, 3) atraumatic access system, 4) Extracorporeal optics, and 5) automated atraumatic resection. Demographical, clinical, and radiological, data of patients operated on over a two-year- period were collected and analyzed retrospectively.

    Results: We identified 108 patients (49 males, 59 females) with a mean age of 57.2 years (SD, 14.1). Fifty six percent of the lesions were left sided. The most common sites of presentation were frontal (34 %), temporal (19%), and parietal (17%) lobes. Eleven percent of the lesions involved the cerebellum. There were 5 intra-ventricular lesions. The maximum diameter of the lesions were: < 1.5 cm, 1.5-3.0 cm, and > 3.0 cm in 10.2%, 47.2%, and 42.6 % of the patients, respectively. Twenty one percent of the cases were done under "awake" anesthesia.The ratio of primary to secondary tumors was 1:1. Seventy four percent of the primary lesions were High Grade Gliomas (HGG). The mean degree of resection was 81% (Median 90%, SD 24.4) for HGG, 99% (Median 100%, SD 2.24) for Low Grade Gliomas (LGG), and 95% (Median 100%, SD 15.9%) for metastasis. Forty nine percent of patients had neurological improvement post-operatively. The rates of new, transient and permanent neurological deficits were 7.4% and 4.7 %, respectively.There were 2 post-operative hematomas; both patients improved subsequently.The 30-day- mortality rate was 2.8%.

    Conclusions: The minimally invasive subcortical parafascicular approach described above is both safe and effective for managing a wide range of brain tumors.

    Patient Care: Subcortical injury is devastating to our patients and the goal is to minimize it by using this approach. Providing Safety and Efficacy data for this minimally invasive approach, however, is essential as it is gaining popularity in North America but without any large trials evaluating yet.

    Learning Objectives: 1) Understand the 5 core competencies essential to minimize injury to white matter tracts during surgery. 2) Realize the importance of DTI in brain tumor surgery. 3) identify the value of tans-sulcul approaches to deep lesions


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