Pre- and Intraoperative Mapping for Tumors in the Primary Motor Cortex: Decision-Making Process in Surgical Resection.
| Autor: | Lavrador JP; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom., Ghimire P; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom., Brogna C; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom., Furlanetti L; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom., Patel S; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom., Gullan R; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom., Ashkan K; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom., Bhangoo R; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom., Vergani F; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom. |
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| Jazyk: | angličtina |
| Zdroj: | Journal of neurological surgery. Part A, Central European neurosurgery [J Neurol Surg A Cent Eur Neurosurg] 2021 Jul; Vol. 82 (4), pp. 333-343. Date of Electronic Publication: 2020 May 21. |
| DOI: | 10.1055/s-0040-1709729 |
| Abstrakt: | Background: Lesions within the primary motor cortex (M1) and the corticospinal tract (CST) represent a significant surgical challenge with a delicate functional trade-off that should be integrated in the overall patient-centered treatment plan. Methods: Patients with lesions within the M1 and CST with preoperative cortical and subcortical mapping (navigated transcranial magnetic stimulation [nTMS] and tractography), intraoperative mapping, and intraoperative provisional histologic information (smear with and without 5-aminolevulinic acid [5-ALA]) were included. This independently acquired information was integrated in a decision-making process model to determine the intraoperative extent of resection. Results: A total of 10 patients (6 patients with metastatic precentral tumor; 1 patient with grade III and 2 patients with grade IV gliomas; 1 patient with precentral cavernoma) were included in the study. Most of the patients (60%) had a preoperative motor deficit. The nTMS documented M1 invasion in all cases, and in eight patients, the lesions were embedded within the CST. Overall, 70% of patients underwent gross total resection; 20% of patients underwent near-total resection of the lesions. In only one patient was no surgical resection possible after both preoperative and intraoperative mapping. Overall, 70% of patients remained stable postoperatively, and previous motor weakness improved in 20%. Conclusion: The independently acquired anatomical (anatomical MRI) and functional (nTMS and tractography) tests in patients with CST lesions provide a useful guide for resection. The inclusion of histologic information (smear with or without 5-ALA) further allows the surgical team to balance the potential functional risks within the global treatment plan. Therefore, the patient is kept at the center of the informed decision-making process. Competing Interests: None declared. (Thieme. All rights reserved.) |
| Databáze: | MEDLINE |
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