Intraoperative DTI and brain mapping for surgery of neoplasm of the motor cortex and the corticospinal tract: our protocol and series in BrainSUITE

摘要

We report our preliminary series of patients treated for lesions involving the motor cortex and the corticospinal tract in BrainSuite, with intraoperative MRI, tractography and “neuronavigated” electrophysiological cortical and subcortical mapping. An exact localization of the cortical and subcortical functional areas is mandatory for executing surgery of intra-parenchymal neoplasm involving the motor cortex and the corticospinal tract. Nowadays modern technology offers a variety of tools to reduce as much as possible postoperative deficits during surgery of cerebral eloquent areas. From December 2008 and June 2010, 18 patients underwent functional surgery, for neoplasm involving the motor cortex and/or the subcortical pathway, in BrainSuite. Our preliminary series include 14 gliomas and 4 metastases; Table 1 summarizes all of the data. We included in this series patients with complete removal of lesions of eloquent areas with an average distance from the corticospinal tract of 4 mm. Six neoplasms were considered in contact and/or involving the motor cortex, while in 18 cases (100%) the tumour involved eloquent areas concerning the corticospinal tract. All of the patients underwent complete removal of the lesion as subsequently demonstrated by intraoperative postsurgical MRI. Our series highlights the good integration and the high compatibility between BrainSUITE with 1.5 T intraoperative magnetic field and neurophysiological monitoring. We strongly believe that intraoperative MRI with DTI allows us to treat complex surgery tumours that without its auxilium we would not be able to deal with. Table 1 Summary of intraoperative data Case Name Age Sex Histology Surgical risk Resection Distance from tract Distance of MEP (mm) Immediate outcome Quality of life Recovery 1 A. M. 68 M Low grade Tract Complete In contact 0 Improved Excellent Immediate 2 B. S. 39 F Metastasis Tract Complete 7 mm 7 Unchanged Excellent Immediate 3 C. M. 77 M Glioma Tract Complete In contact 0 Improved Excellent Immediate 4 D. C. 67 M Glioma Tract Complete In contact 0 Unchanged Excellent Immediate 5 D. M. N. 42 M Metastasis Tract/cortex Complete In contact 5 Improved Excellent Immediate 6 F. V. 66 F Glioma Tract Complete 15 mm 15 Unchanged Excellent Immediate 7 P. A. 37 M Oligodendroglioma Tract/cortex Complete In contact 2 Mild paresis Excellent 3 months 8 S. M. 65 F Low grade Tract/cortex Complete In contact 0 Unchanged Excellent Immediate 9 M. L. 66 F Glioma Tract Complete 4 mm 4 Improved Excellent Immediate 10 R. G. 40 F Glioma Tract Complete 12 mm 12 Improved Excellent Immediate 11 Q. A. 26 M Glioma Tract Complete 6 mm 6 Improved Excellent Immediate 12 A. G. 68 F Glioma Tract Complete 8 mm 8 Improved Excellent Immediate 13 P. C. 50 F Glioma Tract Complete In contact 2 Improved Excellent Immediate 14 P. I. 50 M Metastasis Tract/cortex Complete In contact 0 Unchanged Excellent Immediate 15 C. A. 75 F Glioma Tract Complete In contact 2 Improved Optimum Immediate 16 C. L. 76 M Glioma Tract Complete In contact 0 Unchanged Optimum Immediate 17 R. A. 54 F Glioma Tract/cortex Complete In contact 0 Improved Excellent Immediate 18 D. N. 43 M Metastasis Tract/cortex Complete In contact 0 Monoparesis Excellent 1 month