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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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Neuronavigation and resection of lesions located in eloquent brain areas under local anesthesia and neuropsychological-neurophysiological monitoring

Navigationsgestützte Resektion eloquent lokalisierter Läsionen in Lokalanästhesie mit neuropsychologischem und neurophysiologischem Monitoring

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  • corresponding author Marcus Otto Pinsker - Neurochirurgische Klinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel
  • A. Nabavi - Neurochirurgische Klinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel
  • B. Gottwald - Neurochirurgische Klinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel
  • H. M. Mehdorn - Neurochirurgische Klinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel

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. DocMO.06.05

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2004/04dgnc0066.shtml

Published: April 23, 2004

© 2004 Pinsker et al.
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

To determine the safety and maximal extension of tumor resection achievable with a combination of awake craniotomy under local anesthesia, neuronavigation, and continuous neuropsychological and neurophysiological monitoring in patients with lesions within the eloquent brain.

Methods

We have performed 55 resections with neuronavigation on 52 patients from January 1998 to December 2002. Mean age was 49 years, male-to-female ratio was 37 to 15. Lesions were classified as followed: 24 astrocytoma (n=1 WHO grade 1, n=6 WHO grade 2, n=17 WHO grade 3), 22 glioblastoma, 3 oligodendroglioma (n=3 WHO grade 2), 3 oligo-astrocytoma (n=1 WHO grade2, n=2 WHO grade 3), 1 cavernoma and 2 metastasis. All patients underwent a continuous examination by a neuropsychologist and repetitive cortical stimulations during the resection, and a 3-month postoperative neurologic examination to determine functional outcome.

Results

Tumor resection was stopped when a macroscopic total cytoreduction was achieved, or at the onset of neurologic dysfunction. Nineteen patients developed intraoperative deficits, which resolved completely during the operation in 5 patients, and improved during the stay in hospital in another 6 patients. A complete resection was achieved in 40 patients (72%), a partial resection in 28%. There was no operative mortality.

Conclusions

The combination of neuronavigation with cortical stimulation and repetitive neurologic and language examinations allows more radical resection of tumors in eloquent brain areas, otherwise considered as inexcisable.