Minimally invasive keyhole temporal lobectomy approach for supramaximal glioma resection: A safety and feasibility study. (February 2020)

• Record Type: Journal Article
• Authors: Figueroa, Javier; Morell, Alexis; Bowory, Veronica; Shah, Ashish H.; Eichberg, Daniel; Buttrick, Simon S.; Richardson, Angela; Sarkiss, Christopher; Ivan, Michael E.; Komotar, Ricardo J.
• Is Part Of: Journal of clinical neuroscience. Volume 72(2020)
• Page Start: 57
• Page End: 62
• Publication Date: 2020-02
• Subjects: GBM glioblastoma -- HGG high grade glioma -- KPS Karnofsky performance score -- LITT laser interstitial thermal therapy -- NLR neutrophil-to-lymphocyte ratio -- NPV negative predictive value -- OS overall survival -- PFS progression free survival -- PPV positive predictive value -- ROC receiver operator characteristics; Craniotomy -- Keyhole -- Lobectomy -- Glioma -- Extent-of-resection; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2020.01.031
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Here we describe a keyhole approach for temporal lobectomies in glioma patients. SMR achieved in 15 patients, GTR in 32 patients, and NTR in 10 patients. Safe and effective method to achieve SMR or GTR with minimal morbidity. Wound healing and cosmetic benefits are appealing in modern neurosurgery. Instrumental tool for neurosurgeons transitioning to less invasive techniques. Abstract: With a recent trend towards supra-maximal resection for gliomas and minimally invasive techniques, keyhole temporal lobectomies may serve an important role in neurosurgical oncology. Due to their location and proximity to eloquent brain, temporal lobe gliomas offer unique challenges that may limit the extent of resection. Here we describe a modified technique using mini-craniotomies through a keyhole approach for temporal lobectomies in glioma patients. We retrospectively reviewed data from consecutive patients who underwent temporal lobectomies for resection of gliomas from 2012 to 2018. Demographic data, extent of tumor resection, pre and post-op KPS, short term and long term complications, as well as other relevant data were collected. We identified 57 patients who underwent keyhole-mini craniotomy for temporal lobectomies for glioma. Surgical procedures were performed in 12 patients for low-grade glioma (LGG) and 45 patients for high-grade glioma (HGG). Awake craniotomies were performed in 15 of the cases, and 13 cases were for tumor recurrence. Supra-maximal resection (SMR) was achieved in 15 patients, while gross total resection (GTR) and near total resection (NTR) achieved in 32 patients and 10 patients, respectively. Average pre- and post-op KPS were equivalent, and post-operative complications requiring surgical intervention were experienced in 4 patients. Here we show that our modified keyhole craniotomy is both safe and effective in achieving SMR or GTR in glioma patients, with minimal morbidity. This minimally-invasive temporal lobectomy may be an instrumental tool for neurosurgical oncologists transitioning to less invasive techniques.