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.
背景：管状牵开器辅助的微创旁裂入路（trMIPS）是一种经脑沟入路用于治疗深部脑肿瘤的手术方法。该入路安全性良好，但其对牵拉皮质微血管动力学的影响及其临床意义尚不明确。 方法：本研究为单中心前瞻性研究，纳入接受trMIPS（BrainPath Nico System©）手术的深部脑肿瘤患者。所有患者均在KINEVO Zeiss©显微镜下使用FLOW 800模块，于置管前及拔管后进行吲哚菁绿造影研究。评估指标包括血流速度、延迟时间、达峰时间、上升时间及脑血流指数。 结果：共纳入35例患者，选取144个感兴趣区。多数患者诊断为胶质母细胞瘤（51.43%），37.14%的患者术前存在局灶性神经功能缺损。基于感兴趣区的分析显示，比较置管前与拔管后评估数据时，血流速度和脑血流指数的增加与较差的神经功能结局相关（速度：恶化组=43.12±80.60% vs 稳定组=-14.51±57.80% vs 改善组=6.93±31.33%，p<0.0001；脑血流指数：恶化组=50.40±88.17% vs 稳定组=-2.70±67.54% vs 改善组=-38.98±26.17%，p=0.0005）。这些发现在患者层面的合并感兴趣区分析中具有可重复性，并在校正混杂因素后得到确认。 结论：微血管血流动力学影响trMIPS手术结局，拔管后血流速度和脑血流指数的增加与较差的神经功能结局相关。
Microvascular Cortical Dynamics in Minimal Invasive Deep-Seated Brain Tumour Surgery
肿瘤(癌症)患者之家