Intraoperative brain mapping during awake surgery in symptomatic supratentorial cavernomas
| Autor: | Pilar López-Ruiz, Ricardo Prat-Acín, Raul Espert-Tortajada, Inma Galeano-Senabre, Daniel García-Sánchez, Angel Ayuso-Sacido |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Neurological morbidity Complete resection Brain mapping Young Adult 03 medical and health sciences 0302 clinical medicine Monitoring Intraoperative Humans Medicine Neuropsychological assessment Wakefulness Awake surgery Brain Mapping medicine.diagnostic_test Brain Neoplasms business.industry Neuropsychology Middle Aged Surgery Hemangioma Cavernous Hemiparesis Brain stimulation Female Neurology (clinical) medicine.symptom business 030217 neurology & neurosurgery |
| Zdroj: | Neurocirugia (English Edition). |
| ISSN: | 2529-8496 |
| Popis: | Background Complete resection of symptomatic supratentorial cavernoma (SCA) and removal of the surrounding gliotic area is recommended to minimize the risk of persistent seizures or (re)bleeding. Surgery of SCA located in an eloquent area, can carry out severe postoperative neurological morbidity. We report a study aimed to assess feasibility, extent of resection and outcome after surgical removal of CA by cortico-subcortical intraoperative brain stimulation (ioBS) in the awake patient. Methods Six patients diagnosed of symptomatic SCA located on an eloquent area and operated on while awake under local anaesthesia ioBS, were included. Preoperative planning included neuropsychologic assessment of language-related functions, sociocognitive functions and executive functions. Intraoperatively, we recorded the results achieved in the planned neuropsychological tasks when stimulation was applied (cortical and subcortical). Postoperative control 3D MRI was scheduled at 1 month after surgery to calculate extent of resection. Neuropsychological assessment at 6 months after surgery was performed in all cases. Results Six patients (5 females, 1 male) aged 24–48 years were included in our study. Locations of the lesions were right insular (n = 1), left insular (n = 1), left temporo-insular (n = 1), left temporal (n = 2) and left frontal (n = 1). In all patients, positive findings were obtained during ioBS. In 5 patients, complete surgical resection was achieved. Two patients had postoperative transient neurological deficits, one case of hemiparesis, one case of dysnomia, both cleared over a 6-month period. Clinical follow-up revealed that all patients experienced complete recovery from preoperative symptoms within a year and five patients with seizures showed marked improvement and eventually quit antiepileptic drugs. Neuropsychological assessment at 6 months provided normal results compared to preoperative baseline in all domains. Conclusions Our study suggests that ioBS in the awake surgery of symptomatic SCA located in eloquent areas, allows to increase the rate of complete resection, minimizing postoperative neurological and neuropsychological deficit, and improving postoperative seizures control. |
| Databáze: | OpenAIRE |
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