Craniotomy and stereotaxy-guided volumetric resection in patients with refractory epilepsy
DOI:
https://doi.org/10.47924/neurotarget2007365Keywords:
guided/assisted craniotomy, steretactic volumetric resection, intra-surgical awakening, cortical functional mappingAbstract
Introduction: We present the outcomes of a retrospective study on a series of 60 consecutive patients with intraaxial brain damage, who were operated on using multimodal methods, including craniotomy and volumetric resection guided by estereotaxy, cortical functional mapping, and intra-surgical awakening.
Patients and Methods: Between March 1999 and January 2007, 216 patients had been operated on with estereotatic methods, at Hospital Neurológico de la Liga Colombiana contra la Epilepsia, Clínica MediHelp, Clínica Madre Bernarda and Hospital Bocagrande, in Cartagena de Indias, Colombia. Among inclusion criteria intraaxial brain damage located at eloquent, deep and/or epilepsy producers areas were considered as well as the use of stereotatic continuous guide intrasurgical procedure. Presurgical assessments/tests had been undergone in all patients following the institutional protocol. In all cases, a ZD stereotatic equipment/device (Laibenger-Fischer), Stereo Plan 2.0 software and brain TAC/RM with contrast was used. Neurolepto-anesthesia was the anesthetic technique applied. Intra-surgical awakening and cortical functional mapping using Berger and Ojemann´s parameters were used. Craniotomy and resection were carried out by continuous stereotactic assistance/guide.
Outcomes: In total, 216 patients had been operated on with stereotactic methods; 60 of them experienced continuous stereotactic guide/assistance. 34 were males (53%) and 26 females (47%), between 14 and 70 years of age (average: 42). Pathologies found: tu- moral, in 46 cases (76.6%), vascular, in 9 (15 %), other pathologies 8.3%. Complications related to surgery arouse with 10 patients (16.6% of the cases).
Conclusion: The multimodal approach (craniotomy and volumetric resection guided by stereotactic + cortical functional mapping + intra-surgical awakening) allows for total resections or subtotal extensive resections of brain damages located in eloquent, deep and/or epilepsy producer areas, with lower morbimortality rate than in conventional procedures.
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Copyright (c) 2007 Juan Carlos Benedetti
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