gms | German Medical Science

62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

07. - 11. Mai 2011, Hamburg

Postoperative ischemic changes following glioma resection and their correlation with intraoperative motor evoked potentials

Meeting Abstract

  • J. Gempt - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München
  • S. Krieg - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München
  • N. Buchmann - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München
  • Y.M. Ryang - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München
  • B. Meyer - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München
  • A. Förschler - Abteilung für Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, München
  • F. Ringel - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.08.05

DOI: 10.3205/11dgnc053, URN: urn:nbn:de:0183-11dgnc0535

Veröffentlicht: 28. April 2011

© 2011 Gempt et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: The aim of surgical glioma treatment is the complete resection of tumor tissue with preservation of neurological function. New postoperative neurological deficits or their aggravation are either generated by direct surgical structural damage of cortical or subcortical structures or by cortical or subcortical ischemic lesions. We aimed to assess the incidence of infarctions following the resection of newly diagnosed and recurrent gliomas and their traceability by monitoring of intraoperative motor evoked potentials (MEP) as well as their influence on neurological function.

Methods: Patients who underwent glioma resection for newly diagnosed or recurrent glioma and who received early postoperative MR imaging with DWI and ADC maps as well as intraoperative MEP monitoring between June 2008 and August 2010 were included in the study. Postoperative areas of restricted diffusion were classified as arterial territorial infarction, venous infarction or terminal branch infarction, respectively. Tumor entity, location and neurological function as well as alterations in motor evoked potentials were recorded.

Results: 33 operations on 32 patients for glioma resection were conducted. Mean patient age was 56 yrs (range 23 to 79 yrs, 23 male, 9 female). We conducted 26 resections of high-grade gliomas (WHO IV°: n = 22; WHO III°: n = 4) and 7 resections of low-grade gliomas. 11 of 28 patients (41%) with newly diagnosed gliomas and 4 of 5 patients (80%) undergoing resection for recurrent gliomas displayed new postoperative ischemic lesions. 2 venous infarctions, 6 arterial territorial infarctions, and 7 terminal branch infarctions were recorded. 8 of the 15 (53%) patients with ischemic lesions displayed alterations of MEPs during tumor resection, 1 of 17 patients (6%) without ischemic lesion displayed an alteration in motor evoked potentials. 7 of the 9 (78%) patients with alterations of intraoperative MEPs had a transient or permanent impairment of motor function.

Conclusions: Alteration of MEPs during tumor resection and postoperative impairment of motor function is more frequent in patients with new postoperative ischemic lesions. Rather than a cortical or subcortical structural damage of eloquent brain tissue alone, peri-/postoperative new ischemic lesions play an important role in the development of new postoperative neurological deficits.