Microsurgery 'burr hole' for intracranial tumors and mesial temporal lobe epilepsy

Abstract

In recent years, neurosurgery has been characterized by a clear tendency towards the development of minimally invasive and less traumatic surgical approaches. To minimize the degree of injury to the brain tissue, we have proposed burr hole-based microsurgical approaches. In the period between February 2016 and February 2019, more than 500 microsurgical interventions were performed through a 14 mm burr hole using a technique that we called burr-hole microneurosurgery; to date, 200 of these have been analyzed. The age of patients varied from 16 to 79 years (median, 38 years). Female patients predominated - 1.6:1. Surgery for intracranial lesions with various locations was performed in 176 cases; in the remaining 24 cases, patients with hippocampal sclerosis underwent selective amygdalohippocampectomy. Various surgical approaches were used: transcortical approach in 81 (40.5%) cases; retro-sigmoid approach in 38 (19%); sub-temporal approach in 32 (16%); infratentorial supracerebellar approach in 25 (12.5%); interhemispheric approach in 17 (8.5%); telovelar approach in 5 (2.5%); trans-eyebrow approach in 2 cases. The resection degree was evaluated in 167 patients with planned maximum tumor resection. Resection was total and almost total in 145 (87%) patients, subtotal in 15 (9%), and partial in 7 (4%). The surgery duration varied from 35 to 300 min (mean, 80 min). The extubation time after surgery ranged from 5 min to 5 days (mean, 70 min). In 195 (97.5%) cases, patients were verticalized within the first 3 days after surgery. The proposed burr hole technique enables successful surgery in patients with various intracranial pathologies, using a smaller trepanation window compared to that in keyhole surgery. The proposed burr hole technique minimizes injury to the brain substance, significantly reduces patient's exposure to anesthesia, and decreases the entire duration of surgery.