gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Intersulcal corridors for removal of deep seated brain tumors in eloquent areas

Nutzung intersulcaler Korridore für die Entfernung tiefsitzender Hirntumore in eloquenten Arealen

Meeting Abstract

  • corresponding author L. Stieglitz - International Neuroscience Institute Hannover
  • A. Akbarian - International Neuroscience Institute Hannover
  • M. Samii - International Neuroscience Institute Hannover
  • R. Fahlbusch - International Neuroscience Institute Hannover
  • A. Samii - International Neuroscience Institute Hannover

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocSA.09.03

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter:

Veröffentlicht: 11. April 2007

© 2007 Stieglitz et al.
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Objective: Brain sulci are used as successful approaches to deeper seated brain lesions in non eloquent areas. Does a neuronavigation system, offering new ways for functional imaging, also allow an easy, safe and accurate approach to deep seated tumors in eloquent areas?

Methods: 20 of 95 patients, who have been operated using the BrainLab Vector Vision neuronavigation system between February and October 2006, had deep seated lesions. The pre- and postoperative neurological status, completeness of tumor resection and location of the tumor were documented. Tumor removal was performed with functional navigation including diffusion tensor imaging (DTI, DTI-software iPlan provided by BrainLab) by means of a 3T MRI (3T Siemens MAGNETOM). Two of the patients were operated under awake conditions.

Results: With the exception of one cavernoma, one arachnoid and one epidermoid cyst all patients presented brain tumors: 15 gliomas and 2 metastases. 10 tumors were located adjacent and/or within the pre- (7 patients) or postcentral gyrus (2 patients) and adjacent to the Wernicke or Broca area (2 patients). In case of a close relationship between the tumors and the eloquent cortex, functional navigation made it possible to define a safe corridor through which the surgical approach could be performed. While functional MRI gave a good impression of the location of eloquent areas in the central region, it was of far less use in locating the Broca area. In 12 of the 20 cases a total removal was possible. In 8 cases the tumor could not be resected completely without risking new neurological deficits. 7 patients had no neurological deficit pre- and postoperatively. Among 13 patients with preoperative deficits,one deteriorated after subtotal and one after total removal. Altogether 2 of 20 patients had new neurological deficits. We found that the viscoelasticity of the brain allows an intrasulcal approach of about 1 cm to be enlarged in a way that cortical and subcortical structures will not be damaged.

Conclusions: In many cases functional neuronavigation enables the surgeon to find a safe corridor to approach even deep seated brain lesions, risking new neurological deficits iat a low, acceptable percentage.