RESUMO
OBJECTIVE: The aim of this work is to define a methodological strategy for the minimally invasive tubular retractor (MITR) parafascicular transulcal approach (PTA) for the management of brain tumors sited in eloquent areas. METHODS: An observational prospective study was designed to evaluate the benefits of PTA associated with MITRs, tractography and intraoperative cortical stimulation. They study was conducted from June 2018 to June 2021. Information regarding white matter tracts was processed, preventing a potential damage during the approach and/or resection. All patients older than 18 years who had a single brain tumor lesion were included in the study. Patients with a preoperative Karnofsky Performance Scale (KPS) score greater than 70% and a Glasgow Coma Scale (GCS) score > 14 points were included. RESULTS: 72 patients were included in the study, the mean age was 49.6, the most affected gender was male, 12.5% presented aphasia, 11.1% presented paraphasia, 41.6% had motor deficit, 9.7% had an affection in the optic pathway, the most frequently affected region was the frontal lobe (26.3%), the most frequent lesions were high-grade gliomas (34.7%) and the measurement of the incisions was on average 5.58 cm. Of the patients, 94.4% underwent a total macroscopic resection and 90.2% did not present new postoperative neurological deficits. In all cases, a PTA was used. CONCLUSION: Tubular minimally invasive approaches (MIAs) allow one to perform maximal safe resection of brain tumors in eloquent areas, through small surgical corridors. Future comparative studies between traditional and minimally invasive techniques are required to further investigate the potential of these surgical nuances.
RESUMO
Anatomical variations of the fingers extensor tendons are not uncommon and have been described by several authors. Participation of intertendinous band of fascia in this kind of variation can change muscle functionality. However, this element is scarcely described in the literature. In this case report, we describe the finding of an accessory tendon located between the extensor digitorum communis muscle tendon, destined for the index finger, and the extensor pollicis longus tendon. In an anatomical analysis, we observed a connection between the radial portion of the accessory tendon and the ulnar portion of the extensor pollicis longus tendon by intertendinous fascia. This finding corresponds anatomically to the supernumerary muscle denominated extensor indicis radialis, but due to the fascial connections observed with the extensor pollicis longus, this muscle would behave functionally as a supernumerary muscle denominated extensor pollicis et indicis communis. This report suggests that participation of fascia in muscular variation in this anatomical segment is essential to establish the correct morpho-functional denomination of muscular variants.