NDLI: Intraoperative magnetic resonance imaging-guided tractography with integrated monopolar subcortical functional mapping for resection of brain tumors. Clinical article.

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Year: 2011 Volume: 114 Issue: 2

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Intraoperative magnetic resonance imaging-guided tractography with integrated monopolar subcortical functional mapping for resection of brain tumors. Clinical article.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Prabhu, Sujit S. Gasco, Jaime Tummala, Sudhakar Weinberg, Jefrey S. Rao, Ganesh
Description	Country affiliation: United States Author Affiliation: Prabhu SS ( Department of Neurosurgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA. sprabhu@mdanderson.org)
Abstract	OBJECT: The object of this study was to describe the utility and safety of using a single probe for combined intraoperative navigation and subcortical mapping in an intraoperative MR (iMR) imaging environment during brain tumor resection. METHODS: The authors retrospectively reviewed those patients who underwent resection in the iMR imaging environment, as well as functional electrophysiological monitoring with continuous motor evoked potential (MEP) and direct subcortical mapping combined with diffusion tensor imaging tractography. RESULTS As a navigational tool the monopolar probe used was safe and accurate. Positive subcortical fiber MEPs were obtained in 10 (83%) of the 12 cases. In 10 patients in whom subcortical MEPs were recorded, the mean stimulus intensity was 10.4 ± 5.2 mA and the mean distance from the probe tip to the corticospinal tract (CST) was 7.4 ± 4.5 mm. There was a trend toward worsening neurological deficits if the distance to the CST was short, and a small minimum stimulation threshold was recorded indicating close proximity of the CST to the resection margins. Gross-total resection (95%-100% tumor removal) was achieved in 11 cases (92%), whereas 1 patient (8%) had at least a 90% tumor resection. At the end of 3 months, 2 patients (17%) had persistent neurological deficits. CONCLUSIONS: The monopolar probe can be safely implemented in an iMR imaging environment both for navigation and stimulation purposes during the resection of intrinsic brain tumors. In this study there was a trend toward worsening neurological deficits if the distance from the probe to the CST was short (< 5 mm) indicating close proximity of the resection cavity to the CST. This technology can be used in the iMR imaging environment as a surgical adjunct to minimize adverse neurological outcomes.
File Format	HTM / HTML
ISSN	00223085
e-ISSN	19330693
Journal	Journal of Neurosurgery
Issue Number	3
Volume Number	114
Language	English
Publisher	American Association of Neurological Surgeons
Publisher Date	2011-03-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Neurosurgery Brain Neoplasms Surgery Diffusion Tensor Imaging Neurosurgical Procedures Pyramidal Tracts Anatomy & Histology Surgery, Computer-assisted Anesthesia, General Brain Physiology Brain Mapping Cerebral Cortex Electric Stimulation Electrophysiological Phenomena Evoked Potentials, Motor Image Processing, Computer-assisted Nerve Fibers Nervous System Diseases Epidemiology Oligodendroglioma Postoperative Complications
Content Type	Text
Resource Type	Case study Article
Subject	Neurology (clinical) Surgery

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