Brain tumors located in regions that control speech, vision and motor function present additional challenges to neurosurgeons, as damaging the surrounding tissue can cause severe loss of those abilities. Because of this, these regions are known as "eloquent brain areas" and require special attention and approaches to limit damage and deficits.
The University of Cincinnati's Paolo Palmisciano, MD, was part of a research team that examined how well a minimally invasive approach worked to limit vision and hearing loss in patients following brain tumor surgery.
The research was published in the journal Brain Sciences, and the research team will receive the Mizuho Minimally Invasive Brain Tumor Surgery Award at the American Association of Neurological Surgeons (AANS) annual scientific meeting April 21-24 in Los Angeles.
The research team analyzed the results of 72 patients who had surgery to remove brain tumors in eloquent areas using the tubular approach from 2018-2021 at the Hospital Infantil Universitario de San Jose in Bogota, Colombia. Because brain tumors in eloquent areas are relatively rare, the prospective observational study was not limited to a specific brain tumor type or region.
"The goal was to see if we can have a lower incidence of complications in this and also to discuss the technique," said Palmisciano, who contributed to the multicenter analysis of the data.
The research team found that almost 95% of patients in the study had their entire tumors removed using the tubular approach.
"As you can imagine, that's a huge achievement," Palmisciano said. "Instead of doing a big opening, we're just using this small tube."
Following surgery, 9% of patients had new or worse speech or motor function deficits, which is within the expected complication rate for surgery to remove tumors in these areas of the brain. Palmisciano said a direct comparison to complication rates for more traditional approaches cannot be made with this data since the study included multiple different tumor types.
Going forward, Palmisciano said future studies should look at the effectiveness of the tubular approach for specific tumor types and in more specific regions of the brain to allow for direct comparison.
"Maybe this approach may be of better benefit for particular tumors, so we may be best to use this only for those tumors instead of all types," he said.
Like with any surgical technique, Palmisciano noted neurosurgeons will not be able to just flip a switch one day and implement tubular approaches if they have not used them before. As more data on its effectiveness is published, it will be important for each surgeon who wants to use a tubular approach to study and practice the technique before using it in an operating room.
Palmisciano will present the award-winning research on behalf of the research team at AANS on April 24 at 2:45 p.m. during the Rapid Fire Research Forum.
"I feel very grateful to be able to be part of this multi-institutional project, and not for the award itself, but because I think working with different neurosurgeons and experts around the world is always a huge honor for me to learn," he said. "Neurosurgery is a small field, so having this network helps everyone to move forward in their career."
Palmisciano will begin a neurosurgery residency at the University of California, Davis in June and said he plans to continue his clinical and academic research in the area of brain tumors.
"I share this award with all the authors, and it embodies both my interest in neuroanatomy and my interest in brain tumors," he said. "I would consider it as the first real step into academic neurosurgery."
Other research co-authors and award winners include Nadin J. Abdala-Vargas, Javier G. Patiño-Gomez, Edgar Ordoñez-Rubiano and Hernando A. Cifuentes-Lobelo of the Hospital Infantil Universitario de San Jose in Bogota, Colombia; Giuseppe E. Umana of the Cannizzaro Hospital in Catania, Italy; Gianluca Ferini, Anna Viola and Valentina Zagardo of REM Radioterapia in Vaigrande, Italy; Daniel Casanova-Martinez of the University of Valparaíso in Valparaíso, Chile; Ottavio S. Tomasi of the Paracelsus Private Medical University in Salzburg, Austria; Alvaro Campero of Padilla Hospital in Tucumán, Argentina; and Matias Baldoncini of San Fernando Hospital in Buenos Aires, Argentina.
Featured photo at top of a MRI brain scan used for tractography techniques. Photo/Wenht/iStock.
