SURG-15. MINIMALLY INVASIVE PREFRONTAL APPROACH FOR GLIOMAS: TECHNICAL DESCRIPTION AND ASSOCIATED COMPLICATIONS

Abstract INTRODUCTION Classical prefrontal approaches exposed the lateral surface of the frontal lobe. Minimally invasive (MI) approaches achieved to reduce soft tissue damage and craniotomy size without affecting tumor resection grade. This is associated with shorter hospital stays and faster return to preoperative daily activities. OBJECTIVE To describe the MI prefrontal glioma resection technique developed in our department and to analyze our surgical results. METHODS We performed a retrospective review of patients who underwent prefrontal lobe glioma (WHO grade II-IV) resection using an MI approach in 2016-2021 at the University of Miami Hospital. Re-surgery, biopsy-only patients, multicentric tumors, and patients with less than four months of follow-up were excluded. Demographic and clinical data were collected. A 4-5 cm linear incision is done, starting at 1 cm lateral to the sagittal suture and extending towards the superior temporal line. An ellipsoidal-shaped mini-craniotomy is performed. RESULTS Thirty-four patients were included. The mean age was 50.2 years old, with 20 male subjects. Twenty-two patients had high-grade gliomas (HGG) and 12 patients had low-grade gliomas (LGG). On average, patients were discharged 1.97 days after surgery. The mean craniotomy area was 15,5 cm2 (7-43 cm2). The mean tumor volume was 64,5 cm2 ( 9 -165.8 cm2). Two wound infections and one case of aseptic meningitis were observed in patients with craniotomies > 15 cm2, while the group with craniotomies < 15 cm2 had no perioperative complications. In the HGG group, a supramaximal resection (SMR) was achieved in 8 patients, 9 HGG patients had gross total resection (GTR) or near-total resection (NTR), and 5 patients had subtotal resection (STR). In the LGG, GTR was achieved in 10 patients and STR in 2 patients. CONCLUSION MI prefrontal approach for frontal gliomas is safe and feasible with minor complications, short hospital stay, and without sacrificing tumor resection volume.