Navegación Quirúrgica Transcraneal y Transnasal Integrada para Tumores de Base de Cráneo: Preservación de la Función Visual, Auditiva y Cognitiva mediante Neuromodulación Postoperatoria Inmediata

Jonathan Alejandro  Jaramillo Valarezo; Josue David  Jaramillo Valarezo; Alexa Carolina Villalba Sánchez; Génesis Elizabeth Sánchez Aponte; Nicolás Sebastian Andrade Montufar

doi:10.70577/asce.v5i3.1018

Authors

Jonathan Alejandro Jaramillo Valarezo Hospital León Becerra https://orcid.org/0000-0003-1632-7350
Josue David Jaramillo Valarezo Centro de Salud ocupacional IESS https://orcid.org/0009-0002-6403-1992
Alexa Carolina Villalba Sánchez Investigador independiente https://orcid.org/0009-0002-3532-8279
Génesis Elizabeth Sánchez Aponte Investigador independiente https://orcid.org/0009-0008-6074-8033
Nicolás Sebastian Andrade Montufar Investigador independiente https://orcid.org/0009-0001-1541-974X

DOI:

https://doi.org/10.70577/asce.v5i3.1018

Keywords:

Skull base neoplasms; Surgical navigation; Neuromodulation; Transcranial direct current stimulation; Visual function; Cognitive function

Abstract

Skull base tumors (SBTs) pose a surgical challenge due to proximity to critical neural structures. Integrated surgical navigation (transcranial and transnasal) combined with immediate postoperative neuromodulation (IPN) may improve outcomes. Objective: To assess, through a systematic review and computational model, the feasibility and potential effects of a multimodal navigation plus IPN (tDCS + cognitive training) approach. A PRISMA 2020 systematic review was conducted (PubMed, EMBASE, Cochrane, Scopus; 2015-2025). In addition, an in silico simulation of tDCS over the dorsolateral prefrontal cortex (DLPFC) and visual cortex was developed using a finite element head model (SimNIBS 4.0). The review (18 studies, n=1,204 patients) showed reduced operative time (SMD=-0.58; 95%CI:-0.81 to -0.35), lower risk of neurological complications (OR=0.42; 95%CI:0.28-0.63), and better visual (OR=0.35) and auditory (OR=0.48) preservation. Predictive simulation indicated that anodal tDCS over the DLPFC (2 mA, 20 min) increases cortical excitability by 28.4% (95%CI:22.1-34.7%), and stimulation over the visual cortex improves optic pathway activity by 31.2% (95%CI:24.5-37.9%). The systematized evidence and computational models support the safety and potential benefit of the multimodal approach. Preclinical studies and clinical trials are required to confirm these findings.

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