Surgical resection of malignant brain tumors with stereotaxic guidance
DOI:
https://doi.org/10.47924/neurotarget2007363Keywords:
stereotaxis, gliomas, surgical technique, neuronavigationAbstract
The authors reports a Phase I clinic study of a surgical technique for resecting glial tumors located in or near cerebral motor structures (motor cortical area or internal capsule). Gliomas resection in this location always carries a significant risk of injury of motor function. To reduce this kind of risk, it has been advocated the use of computer-assisted stereotactic volumetric approach (neuronavigation), intraoperative ultrasonography, intraoperative magnetic resonance (MR) or intraoperative cortical recording. However, this technological devices are costly or requires special expertise to be applied adequately and massively. In order to find a simpler manner to resect imagenologically defined tumors, the author performed guided resection of tumors by stereotactically placing cotton marks embebbed in trypan blue. The first mark is placed at the volumetric center of the tumor and/or at its bottom; other 3 to 4 marks are placed at the borders, adjacent to the motor structure to be spared. Once the marks are placed, craniotomy is performed followed by a corticotomy as conventionally. The approach is continued by following the cord of the mark placed in the center or at the bottom. Once the tumor is reached, resection is done as usual, stopping every time an edge/border mark is encountered. Edges where no mark has been placed, the end of the resection will depend upon surgeon’s own criterion. This series include 12 cases operated on for gliomas of variable grade, located adjacent to the motor area or to the internal capsule. Motor function and life quality were clinically assesed, using the motor scale (muscle strentgth grade) and quality of life using the Karnofsky’s scale, respectively. Anatomically, tumor resection was assesed comparing pre and post operative MR. Gross-total resection was accomplished in all cases. In 2 out of a total of 12 patients motor function worsened temporarily, and 4 patients diminished grading in the Karnofsky’s scale (including 2 first patients). The authors conclude that this modality for stereotactic navigation is feasible to be continued at a Phase II study, in view that, in this series, surgical resection was totally achieved without major morbidity.
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References
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Copyright (c) 2007 Sergio A. Sacchettoni
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