P01.023 Intraoperative mapping of long associated tracts in surgery of brain gliomas
| Autor: | A Ogurtsova, D Pitzhelauri, S Goryaynov, N Zakharova, A Batalov, Alexander Potapov, S Buklina, V Jukov |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Brachial Plexus Neuritis
Cancer Research medicine.medical_specialty medicine.diagnostic_test business.industry medicine.medical_treatment Magnetic resonance imaging medicine.disease Preoperative care Premotor cortex Poster Presentations medicine.anatomical_structure Oncology Frontal lobe Glioma medicine Neurology (clinical) Radiology Diffusion Tractography business Craniotomy |
| Popis: | BACKGROUND: Surgery of intracerebral tumors involving long associated tracts is a complicated task. This study is devoted to intraoperative mapping of the upper longitudinal, arcuate and frontal aslant tracts in surgery of brain gliomas. Intraoperative mapping and postoperative speech function was analyzed in patients operated for premotor cortex gliomas of the left frontal lobe involving upper longitudinal, arcuate and frontal aslant tracts by method of awake craniotomy. MATERIAL AND METHODS: A series of 12 clinical observations is reported, enrolling patients with gliomas located in the functionally meaningful left frontal lobe; 11 of them were right-handed. All patients had MRI with a long associated tract reconstruction; the tumor-tract topographic anatomical correlations were established before and after surgery. All 12 operations were performed by awake-asleep-awake protocol. Also, cortical and subcortical stimulation was used in all cases to control the tumor resection size. Speech impairment before, during and after surgery was evaluated by an experienced neuropsychologist. Mean electrical stimulation voltage made up 3 мА (1,9-6,5). RESULTS: 12 patients during surgery revealed associative tracts (11 pts - SLF/AF and 1 pts - FAT); 4 patients (33%) had intraoperative Broca’s area mapping; 3 patients developed speech impairment without electrical stimulation (paraphasia, preservations) during tumor removal; direct electrical stimulation revealed speech impairment in 7 cases (66%). MRI control within the first 48–72 hours was performed in all patients: total tumor resection (over 90% of tumor) was conducted in 7 cases, subtotal - in 2, and partial - in 2 cases. According to MR-tractography findings the removed tumor сavity was tightly adjacent to SLF/AF complex in 7 cases, was located in the vicinity of SLF/AF complex (at some distance) - in 4 cases and was directly adjoined to FAT in 1 cases. Ten of 12 patients developed neurologic aggravation manifesting in different aphatic disturbances. CONCLUSION: The postoperative period after premotor region tumor removal in the speech-dominant hemisphere is likely to be characterized by a high incidence rate of complicated speech disorders as a result of SLF/AF and FAT damage. Intraoperative mapping along the long associated tracts is the required procedure in those cases. Use of preoperative tractography in combination with intraoperative speech recordings (mapping) allows us to reveal associative SLF/AF and FAT complex fibers, thus allowing avoiding of marked conductive aphasia with poor speech recovery after tumor removal. |
| Databáze: | OpenAIRE |
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