Assessment of safe and gross total resection of intra-axial brain tumors

Abstract

Background Safe and gross total resection (GTR) of intra-axial brain-tumor surgery is associated with improving functional outcomes, reducing symptoms, and decreasing the incidence of postoperative complications. Intraoperative imaging helps in achieving the maximum extent of resection. Intraoperative evaluation of the neurological function provides safe tumor resection in eloquent areas. Aim This study aimed to assess the achievement of GTR of intra-axial brain tumors guided by neuronavigation and intraoperative ultrasound and to evaluate the safety of tumor resection in eloquent areas with the use of intraoperative neurophysiological monitoring or awake craniotomy. Patients and methods This study included 30 patients with intra-axial brain tumors in the period from September 2019 to February 2021. Neuronavigation and intraoperative ultrasound were used for all cases, while intraoperative neurophysiological monitoring or awake craniotomy was used for intra-axial brain tumor in eloquent area. Operative details, outcomes, and final results had been recorded and analyzed. Results The mean age was 42 years (4–75 years). GTR was achieved in 18/30 (60%) of all cases. GTR was achieved in 4/10 (40%) of tumors located in the eloquent area, while GTR increased to 14/20 (70%) in noneloquent areas. The mean Karnofsky performance status for all cases has improved from 80 preoperatively to 86.67 postoperatively. Conclusion Neuronavigation and intraoperative ultrasound provides maximization of the extent of resection of intra-axial brain tumors. Intraoperative neurophysiological monitoring or awake craniotomy provides safe tumor resection in eloquent areas.