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Effectiveness of navigation-guided cyst aspiration before resection of large cystic brain tumors: a proof of concept for more radical surgery

  • Original Article - Brain Tumors
  • Published:
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Abstract

Background

Resection of tumors close to the corticospinal tract (CST) carries a high risk of damage to the CST. For cystic tumors, aspirating the cyst before resection may reduce the risk of damage to vital structures. This study evaluated the effectiveness of cyst aspiration, by comparing the results before and after aspiration of diffusion tensor image (DTI) tractography.

Methods

This study enrolled 23 patients with large cystic brain tumors (>20 cm3) between 2012 and 2016. All underwent magnetic resonance imaging (MRI), including DTI tractography, followed by navigation-guided aspiration of the cyst and subsequent tumor resection via craniotomy. Distances between the tumor margin and CST before and after cyst aspiration, volume reduction, and postoperative outcomes were assessed.

Results

Median tumor volume decreased from 88 cm3 (range, 25-153) to 29 cm3 (range, 20-80) and distances between tumor margins and the CST increased from 5.7 mm (range, 0.6-22.0) to 14.8 mm (range, 0.6-41.4) after aspiration. Neurological symptoms of patients immediately improved after cyst aspiration. All patients, except for one with a secondary glioblastoma, underwent gross total resection of the tumor. No neurological deterioration was observed after tumor resection.

Conclusions

Navigation-guided cyst aspiration followed by resection is a useful and safe procedure for brain tumors with large cystic components. Cyst aspiration resulted in expansion of the compressed brain tissue between the tumor margins and vital structures, making maximal safe resection possible.

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Authors and Affiliations

  1. Yonsei University Graduate School, Seoul, Republic of Korea

    Tae Hoon Roh

  2. Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea

    Tae Hoon Roh

  3. Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

    Kyoung Su Sung, Seok-Gu Kang, Ju Hyung Moon, Eui Hyun Kim, Sun Ho Kim & Jong Hee Chang

  4. Brain Tumor Center, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Republic of Korea

    Kyoung Su Sung, Seok-Gu Kang, Ju Hyung Moon, Eui Hyun Kim, Sun Ho Kim & Jong Hee Chang

  5. Brain Research Institute, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Republic of Korea

    Seok-Gu Kang, Eui Hyun Kim, Sun Ho Kim & Jong Hee Chang

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  1. Tae Hoon Roh
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  2. Kyoung Su Sung
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  3. Seok-Gu Kang
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  4. Ju Hyung Moon
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  5. Eui Hyun Kim
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  6. Sun Ho Kim
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  7. Jong Hee Chang
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Correspondence to Jong Hee Chang.

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Funding

The Ministry of Education, Science and Technology and the Korea government provided financial support in the form of the Basic Science Research Program through the National Research Foundation of Korea (NRF). The sponsor had no role in the design or conduct of this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Roh, T.H., Sung, K.S., Kang, SG. et al. Effectiveness of navigation-guided cyst aspiration before resection of large cystic brain tumors: a proof of concept for more radical surgery. Acta Neurochir 159, 1947–1954 (2017). https://doi.org/10.1007/s00701-017-3293-y

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  • DOI: https://doi.org/10.1007/s00701-017-3293-y

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