title: Minimally invasive technique reduces secondary brain collapse following a frontal interhemispheric approach to midline tumors with accentuated brain shift phenomena.
abstract: BACKGROUND
  The aim of this study was to assess the influence of minimal invasive techniques (MIT) on secondary brain collapse (BC) following a frontal inter-hemispheric approach to midline tumors with accentuated preoperative brain shift phenomena.
  
  
  METHODS
  We reviewed the results obtained in our department during the last 10 years in 24 treated patients with such tumors. Some of these patients underwent traditional surgical approaches using brain retractors (BR) and more recently alternative MIT including the creation of a narrow surgical corridor without brain retractors and the reinforcement and reinsertion from bridging veins. The patient's postoperative condition (consciousness recovery, respirator dependence, ICU-patient's stay and outcome) as well as the volume of the postoperative skull/brain space as a measurable indicator of BC and the ventricular index were assessed in all cases. All data were compared using the Chi square test, the 2-tailed Pearson correlation and t-test.
  
  
  RESULTS
  24 patients (11 operated with BR and 13 with MIT) were analyzed. The comparison between both techniques revealed a significant reduction of the postoperatively assessed skull/brain space (P<0.001), time for consciousness recovery (P<0.05), respirator dependence (P<0.001) and intensive care unit stay (P<0.005) for patients treated with MIT. A significant correlation was observed between radiological and clinical data (respirator dependence, consciousness recovery and ICU stay) from P<0.01, P<0.05 and P<0.01 respectively.
  
  
  CONCLUSIONS
  In our study MIT allow the patients to recover consciousness in a shorter period of time, reducing the needs for prolonged mechanical ventilation and ICU stay. In these patients, such clinical advantages are related with a radiologically assessed postoperative reduced brain collapse.
authors.affiliation: Neurosurgical Clinic, Städtischen Klinik Frankfurt am Main Höchst, Academic Hospital of the Johann-Wolfgang-Goethe-University, Frankfurt, Germany. MCNievas@t-online.de
authors.forename: M N
authors.initials: MN
authors.lastname: Carvi y Nievas
authors.forename: S
authors.initials: S
authors.lastname: Toktamis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome