Article
Intersulcal corridors for removal of deep seated brain tumors in eloquent areas
Nutzung intersulcaler Korridore für die Entfernung tiefsitzender Hirntumore in eloquenten Arealen
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Published: | April 11, 2007 |
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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.