1799. Experiential Summary of 286 Cases of Brain Surgery in Older Adults Using A Navigable Tubular Retractor System for the Trans-sulcal Removal of Deep-Seated Brain Tumors & Vascular Hemorrhages, Malformations & Lesions
Authors: Martina Cartwright; Juan Alzate, MD (Scottsdale, AZ)
Older adults have the highest incidence of glioblastoma multiforme (GBM) & glioma. Evidence supports survival & mortality benefits of maximal resection & awake craniotomy in those ≥65 years. Similarly this cohort benefits from rapid evacuation of intracranial vascular events. A-traumatic access & awake surgery are key to functional preservation. We describe a navigable trans-sulcal tubular retractor system (NTRS) engineered to reach deep-seated brain lesions parafascicularly in an older adult cohort.
An observational analysis of adults ≥65 years undergoing mini-craniotomies using BrainPath™ (BP, NICO Inc. Indianapolis, IN) for brain tumors/lesions & intracranial vascular events was performed. The NICO Myriad multifunction tool was used in most cases. Demographic characteristics, tumor/lesion location, pathology, size, surgical mortality were analyzed.
286 patients >65 years underwent BP surgery between December 12, 2012- September 30, 2017; tumor n=170, 84 females & 79 males; vascular n= 116, 42 females, 72 males. Of tumor patients, 18 were ≥80 years, with 5 ≥85 years & an average age of 72.2 years (range 65-92 years). Mean tumor size = 2.8 cm. Confirmed tumor pathologies included: GBM=26; metastatic tumors =14 & glioma=10. Awake surgery & maximal resection were performed when feasible.
Of the vascular cohort, 17 were ≥80 years & 2 ≥85 with a mean age of 72.2 years (age range 65-91 years). The most common vascular issue was Intracranial Hemorrhage (ICH) affecting 96.5% (112/116) with 4 intraventricular hemorrhages; there was 1 cavernous malformation, 1 ateriovenous malformation & 2 “other.” Average vascular size =1.76 cm. No deaths were associated with BP surgery in either group.
Older age should not preclude patients from receiving brain tumor surgery or timely intracranial hemorrhage evacuation. We demonstrate that a NTRS coupled with multifunctional tool provides a-traumatic access & can be performed under awake conditions with a goal of maximal resection/evacuation.