Clinical Application of Motor Pathway Mapping Using Diffusion Tensor Imaging Tractography and Intraoperative Direct Subcortical Stimulation in Cerebral Glioma Surgery: A Prospective Cohort Study COMMENT

摘要

In this article, the authors describe their experience dealing with intrinsic brain tumors located close to motor areas. The combination of the pyramidal tract (PT) intraoperative navigation and direct subcortical stimulation (DsCS) has been used in a series of 58 patients with an initial diagnosis of cerebral glioma, with a confirmed final diagnosis of World Health Organization grade II to IV glioma in 51 of them. The authors conclude that the complementary use of PT navigation and DsCS “can yield twice the results with half of the effort, thus increasing the surgeon's confidence and the extent of tumor resection and decreasing subsequent motor deficits.” However, it should be highlighted that these conclusions are subjective and are not supported by the design and results of this study. Actually, the effort and confidence remain subjective patterns, and the study lacks of control groups from which to draw conclusions about the benefits from the extent of resection and the clinical results achieved with the described protocol.