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

Lavrador, José Pedro; Wroe-Wright, Oliver; Marchi, Francesco; Elhag, Ali; O’Keeffe, Andrew; De la Fuente, Pablo; Soumpasis, Christos; Cardia, Andrea; Mirallave-Pescador, Ana; Díaz-Baamonde, Alba; Sadio Mosquera, Jose; Coiteiro, Domingos; Jewell, Sharon; Strong, Anthony J; Gullan, Richard; Ashkan, Keyoumars; Vergani, Francesco; Kailaya Vasan, Ahilan; Bhangoo, Ranjeev

doi:10.3390/cancers17091392

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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

2025

Published in:

Cancers. - 2025, vol. 17, no. 9, p. 1392

Minimal invasive parafascicular surgery

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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