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55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

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The value of intraoperative direct stimulation during surgery in and around the 4th ventricle

Meeting Abstract

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Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocJM II.06

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2004/04dgnc0006.shtml

Published: April 23, 2004

© 2004 Strauß.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective

Neurophysiological techniques, including electrical brainstem mapping are considered mandatory during brainstem surgery with the goal of reducing postoperative neurological deficits. The technique has proven safe and efficient for defining surgical corridors into the brainstem above and below the facial colliculus in intraaxial lesions and for radical resection of tumors involving the 4th ventricle. A prospective study including both monitored and unmonitored cases was designed in order to evaluate the value of neurophysiological monitoring during surgery of brainstem lesions.

Methods

Pre- and postoperative cranial nerve deficits of those nerves accessible for electrical localisation (VI, VII, IX/X, XII) were evaluated in a consecutive series of 29 patients with intrinsic and infiltrative lesions, who underwent surgery with electrical identification and compared to a matched group of 29 patients undergoing surgery without identification between 1991 and 1999. Histological diagnosis included ependymoma (n=24), glioma (n=20) and medulloblastoma (n=14), equally distributed in both groups.

Results

The preoperative total number of cranial nerve deficits was comparable in both groups (28 in the monitored group versus 27 in the matched group). Based on postoperative control, a total of 20 cranial nerve deficits in the monitored group (26 in the control group) were documented, showing a better tendency for recovery of cranial nerve deficits, when intraoperative localisation was used. Extent of surgical removal in the subgroups of ependymomas and medulloblastomas revealed better results in the monitored cases.

Conclusions

The analysis reveals improvement of surgical results for brainstem lesions by intraoperative electrical localisation of nuclei and fibers within the floor of the 4th ventricle.