PMID- 37503951
OWN - NLM
STAT- MEDLINE
DCOM- 20240103
LR  - 20240106
IS  - 1933-0693 (Electronic)
IS  - 0022-3085 (Linking)
VI  - 140
IP  - 1
DP  - 2024 Jan 1
TI  - Microsurgical management of midbrain gliomas: surgical results and long-term 
      outcome in a large, single-surgeon, consecutive series.
PG  - 104-115
LID - 10.3171/2023.5.JNS222219 [doi]
AB  - OBJECTIVE: The authors report on a large, consecutive, single-surgeon series of 
      patients undergoing microsurgical removal of midbrain gliomas. Emphasis is put on 
      surgical indications, technique, and results as well as long-term oncological 
      follow-up. METHODS: A retrospective analysis was performed of prospectively 
      collected data from a consecutive series of patients undergoing microneurosurgery 
      for midbrain gliomas from March 2006 through June 2022 at the authors' 
      institution. According to the growth pattern and location of the lesion in the 
      midbrain (tegmentum, central mesencephalic structures, and tectum), one of the 
      following approaches was chosen: transsylvian (TS), extreme anterior 
      interhemispheric transcallosal (eAIT), posterior interhemispheric transtentorial 
      subsplenial (PITS), paramedian supracerebellar transtentorial (PST), perimedian 
      supracerebellar (PeS), perimedian contralateral supracerebellar (PeCS), and 
      transuvulotonsillar fissure (TUTF). Clinical and radiological data were gathered 
      according to a standard protocol and reported according to common descriptive 
      statistics. The main outcomes were rate of gross-total resection; extent of 
      resection; occurrence of any complications; variation in Karnofsky Performance 
      Status score at discharge, 3 months, and last follow-up; progression-free 
      survival (PFS); and overall survival (OS). RESULTS: Fifty-four patients (28 of 
      them pediatric) met the inclusion criteria (6 with high-grade and 48 with 
      low-grade gliomas [LGGs]). Twenty-two tumors were in the tegmentum, 7 in the 
      central mesencephalic structures, and 25 in the tectum. In no instance did the 
      glioma originate in the cerebral peduncle. TS was performed in 2 patients, eAIT 
      in 6, PITS in 23, PST in 16, PeS in 4, PeCS in 1, and TUTF in 2 patients. 
      Gross-total resection was achieved in 39 patients (72%). The average extent of 
      resection was 98.0% (median 100%, range 82%-100%). There were no deaths due to 
      surgery. Nine patients experienced transient and 2 patients experienced permanent 
      new neurological deficits. At a mean follow-up of 72 months (median 62, range 
      3-193 months), 49 of the 54 patients were still alive. All patients with LGGs 
      (48/54) were alive with no decrease in their KPS score, whereas 42 showed 
      improvement compared with their preoperative status. CONCLUSIONS: 
      Microneurosurgical removal of midbrain gliomas is feasible with good surgical 
      results and long-term clinical outcomes, particularly in patients with LGGs. As 
      such, microneurosurgery should be considered as the first therapeutic option. 
      Adequate microsurgical technique and anesthesiological management, along with an 
      accurate preoperative understanding of the tumor's exact topographic origin and 
      growth pattern, is crucial for a good surgical outcome.
FAU - Serra, Carlo
AU  - Serra C
AD  - Departments of1Neurosurgery.
AD  - 3Department of Neurosurgery, Clinical Neuroscience Centre, University Hospital 
      Zurich, University of Zurich, Switzerland.
FAU - Ture, Hatice
AU  - Ture H
AD  - 2Anesthesiology.
FAU - Firat, Zeynep
AU  - Firat Z
AD  - 4Radiology, and.
FAU - Staartjes, Victor E
AU  - Staartjes VE
AD  - 3Department of Neurosurgery, Clinical Neuroscience Centre, University Hospital 
      Zurich, University of Zurich, Switzerland.
FAU - Yaltirik, Cumhur Kaan
AU  - Yaltirik CK
AD  - Departments of1Neurosurgery.
FAU - Ekinci, Gazanfer
AU  - Ekinci G
AD  - 4Radiology, and.
FAU - Sav, Aydin
AU  - Sav A
AD  - 5Pathology, Yeditepe University School of Medicine, Istanbul, Turkey; and.
FAU - Ture, Ugur
AU  - Ture U
AD  - Departments of1Neurosurgery.
LA  - eng
PT  - Journal Article
DEP - 20230721
PL  - United States
TA  - J Neurosurg
JT  - Journal of neurosurgery
JID - 0253357
SB  - IM
MH  - Humans
MH  - Child
MH  - *Brain Neoplasms/pathology
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Neurosurgical Procedures/methods
MH  - *Glioma/pathology
MH  - *Surgeons
MH  - Mesencephalon/surgery
OTO - NOTNLM
OT  - brainstem
OT  - glioma
OT  - mesencephalon
OT  - microneurosurgery
OT  - midbrain
OT  - tumor
EDAT- 2023/07/28 13:11
MHDA- 2024/01/03 09:43
CRDT- 2023/07/28 08:03
PHST- 2022/09/26 00:00 [received]
PHST- 2023/05/22 00:00 [accepted]
PHST- 2024/01/03 09:43 [medline]
PHST- 2023/07/28 13:11 [pubmed]
PHST- 2023/07/28 08:03 [entrez]
AID - 10.3171/2023.5.JNS222219 [doi]
PST - epublish
SO  - J Neurosurg. 2023 Jul 21;140(1):104-115. doi: 10.3171/2023.5.JNS222219. Print 
      2024 Jan 1.