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Marchi_2025_MDPI_cancers_Microvascular cortical dynamics
Journal article

Microvascular cortical dynamics in minimal invasive deep-seated brain tumour surgery

  • Lavrador, José Pedro Department of Neurosurgery, King’s College Hospital Foundation Trust, London, United Kingdom
  • Wroe-Wright, Oliver Department of Neurosurgery, King’s College Hospital Foundation Trust, London, United Kingdom
  • Marchi, Francesco ORCID Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland – Department of Neurosurgery, King’s College Hospital Foundation Trust, London, United Kingdom – Department of Neurosurgery, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
  • Elhag, Ali Department of Neurosurgery, King’s College Hospital Foundation Trust, London, United Kingdom
  • O’Keeffe, Andrew Department of Neurosurgery, King’s College Hospital Foundation Trust, London, United Kingdom
  • De la Fuente, Pablo Department of Neurosurgery, Araba University Hospital, Vitoria, Spain
  • Soumpasis, Christos Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
  • Cardia, Andrea ORCID Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland – Department of Neurosurgery, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
  • Mirallave-Pescador, Ana Department of Neurosurgery, King’s College Hospital Foundation Trust, London, United Kingdom – Department of Neurophysiology, King’s College Hospital Foundation Trust, London, United Kingdom
  • Díaz-Baamonde, Alba Department of Neurosurgery, King’s College Hospital Foundation Trust, London, United Kingdom – Department of Neurophysiology, King’s College Hospital Foundation Trust, London, United Kingdom
  • Sadio Mosquera, Jose Department of Neurosurgery, King’s College Hospital Foundation Trust, London, United Kingdom – Department of Neurophysiology, King’s College Hospital Foundation Trust, London, United Kingdom
  • Coiteiro, Domingos Unidade de Saude Local, Hospital Santa Maria, Lisboa, Portugal
  • Jewell, Sharon Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College University, London, United Kingdom
  • Strong, Anthony J Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College University, London, United Kingdom
  • Gullan, Richard Department of Neurosurgery, King’s College Hospital Foundation Trust, London, United Kingdom
  • Ashkan, Keyoumars Department of Neurosurgery, King’s College Hospital Foundation Trust, London, United Kingdom
  • Vergani, Francesco Department of Neurosurgery, King’s College Hospital Foundation Trust, London, United Kingdom
  • Kailaya Vasan, Ahilan Department of Neurosurgery, King’s College Hospital Foundation Trust, London, United Kingdom
  • Bhangoo, Ranjeev Department of Neurosurgery, King’s College Hospital Foundation Trust, London, United Kingdom
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  • 2025
Published in:
  • Cancers. - 2025, vol. 17, no. 9, p. 1392
Transsulcal approach
Minimal invasive parafascicular surgery
Neuro-oncology
Tubular retractor
Microvascularization
Deep-seated lesions
English Background: The tubular retractor-assisted minimally invasive parafascicular approach (trMIPS) is a transsulcal approach to deep-seated brain tumours. It is a safe surgical approach but its impact on the microvascular dynamics of the retracted cortex and its clinical implications are unknown. Methods: This was a single-centre prospective study including patients with deep-seated brain tumours operated on with a trMIPS (BrainPath Nico System©). All patients underwent pre- and post-cannulation indocyanine green study using a FLOW 800 module in a KINEVO Zeiss© microscope. Speed, delay, time-to-peak (TtP) rise-in-time and cerebral blood flow index (CBFI) metrics were assessed. Results: Thirty-five patients were included, with 144 regions-of-interest (ROIs) selected. The majority of patients were diagnosed with glioblastoma (51.43%), and 37.14% of patients had a preoperative focal neurological deficit (FND) at presentation. A ROI-based analysis concluded that an increase in speed and CBFI was related with a worse neurological outcome when comparing the pre- and post-brain cannulation assessments (speed: deterioration = 43.12 ± 80.60% versus stable = −14.51 ± 57.80% versus improvement = 6.93 ± 31.33%, p < 0.0001; CBFI: deterioration = 50.40 ± 88.17% versus stable = −2.70 ± 67.54% versus improvement = −38.98 ± 26.17%, p = 0.0005). These findings were reproducible in a combined-ROI per patient analysis and confirmed after adjustment for confounding. Conclusion: Microvascular flow dynamics impact trMIPS outcomes as an increase in the speed and CBFI after decannulation was related with worse neurological outcome.
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  • English
Classification
Medicine
License
CC BY
Open access status
gold
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https://n2t.net/ark:/12658/srd1332214
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