Clinical impact of integrated functional neuronavigation and subcortical electrical stimulation to preserve motor function during resection of brain tumors

Abstract

Intraoperative functional neuronavigation and subcortical electrical stimulation are complementary techniques that may facilitate the preservation of pyramidal tracts around 1 cm of resected tumors.

The role of functional magnetic resonance imaging in brain surgery

“…We believe that this increases the efficiency and safety of our procedure. 57 Note that we use fMR imaging protocols that have been validated with ESM at our own institutions. We are currently assessing the exact accuracy of DT imaging fiber tracks compared with subcortical neurosurgical stimulation in awake patients for use in the neuronavigation system during surgery.…”

Diffusion tensor imaging tractography and intraoperative neurophysiological monitoring in surgery of intracranial tumors located near the pyramidal tract

“…При маленькой силе тока (1-3 мА) при прямой субкортикальной ЭС только у 23 из 67 пациентов не отмечалось перма-нентных неврологических нарушений в послеопе-рационном периоде, что связано с большим объ-емом резекции у данной категории пациентов [39]. Как известно, сила тока имеет прямую взаимозави-симость с расстоянием, на которое он распростра-няется, с примерным соотношением 1 мм -1 мА («золотое правило» нейрофизиологии) [23,[40][41][42].…”

Transcranial Motor Evoked Potentials

“…Thus MEP monitoring has been embraced by spine and neurological surgeons as a method to help prevent surgical intervention from exceeding safe limits where risk and severity of the potential surgical injury exceeds the functional gain [ 3 ] . Since MEP monitoring, particularly in spinal surgery, has a better correlation with good postoperative motor outcome than the use of SEPs, many experts advocate MEP monitoring for all surgeries (1) surgical correction of axial skeletal deformity [4][5][6][7] , (2) intramedullary spinal cord tumors [8][9][10][11] , (3) intracranial tumors [12][13][14] , and (4) CNS vascular lesions [15][16][17] . Uses of MEPs continue to expand.…”