Abstract:
OBJECT:Nowadays the role of microsurgical management of intrinsic brain tumors is to maximize the volumetric resection of the tumoral tissue, minimizing the postoperative morbidity. The purpose of this paper was to study the benefits of an original protocol developed for the microsurgical treatment of tumors located in eloquent motor areas where the navigation and electrical stimulation of motor subcortical pathways have been implemented. METHODS:A total of 17 patients who underwent resection of cortical or subcortical tumors in motor areas have been included in the series. The preoperative planning for multimodal navigation was done by integrating anatomical studies, motor functional MR (fMR) imaging, and subcortical pathway volumes generated by diffusion tensor (DT) imaging. Intraoperative neuromonitoring included motor mapping by direct cortical stimulation (CS) and subcortical stimulation (sCS), and localization of the central sulcus by using cortical multipolar electrodes and the N20 wave inversion technique. The location of all cortically and subcortically stimulated points with positive motor response was stored in the navigator and correlated with the cortical and subcortical motor functional structures defined preoperatively. RESULTS:The mean tumoral volumetric resection was 89.1 +/- 14.2% of the preoperative volume, with a total resection (> or = 100%) in 8 patients. Preoperatively a total of 58.8% of the patients had some kind of motor neurological deficit, increasing 24 hours after surgery to 70.6% and decreasing to 47.1% at 1 month later. There was a great correlation between anatomical and functional data, both cortically and subcortically. A total of 52 cortical points submitted to CS had positive motor response, with a positive correlation of 83.7%. Also, a total of 55 subcortical points had positive motor response; in these cases the mean distance from the stimulated point to the subcortical tract was 7.3 +/- 3.1 mm. CONCLUSIONS:The integration of anatomical and functional studies allows a safe functional resection of the brain tumors located in eloquent areas. Multimodal navigation allows integration and correlation among preoperative and intraoperative anatomical and functional data. Cortical motor functional areas are anatomically and functionally located preoperatively thanks to MR and fMR imaging and subcortical motor pathways with DT imaging and tractography. Intraoperative confirmation is done with CS and N20 inversion wave for cortical structures and with sCS for subcortical pathways. With this protocol the authors achieved a good volumetric resection in cortical and subcortical tumors located in eloquent motor areas, with an increase in the incidence of neurological deficits in the immediate postoperative period that significantly decreased 1 month later. Ongoing studies must define the safe limits for functional resection, taking into account the intraoperative brain shift. Finally, it must be demonstrated whether this protocol has any long-term benefit for patients by prolonging the disease-free interval, the time to recurrence, or the survival time.
journal_name
Neurosurg Focusjournal_title
Neurosurgical focusauthors
González-Darder JM,González-López P,Talamantes F,Quilis V,Cortés V,García-March G,Roldán Pdoi
10.3171/2009.11.FOCUS09234subject
Has Abstractpub_date
2010-02-01 00:00:00pages
E5issue
2issn
1092-0684journal_volume
28pub_type
杂志文章abstract:OBJECT:Clinical and radiographic results were assessed to determine the clinical outcomes and fusion rate in eight consecutive patients selected for minimally invasive transforaminal lumbar interbody fusion (TLIF) in which a percutaneous pedicle screw system was used unilaterally. METHODS:Eight patients underwent one-...
journal_title:Neurosurgical focus
pub_type: 临床试验,杂志文章
doi:
更新日期:2006-03-15 00:00:00
abstract::OBJECTIVE Sagittal malalignment decreases patients' quality of life and may require surgical correction to achieve realignment goals. High-risk posterior-based osteotomy techniques are the current standard treatment for addressing sagittal malalignment. More recently, anterior lumbar interbody fusion, anterior column ...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2017.8.FOCUS17423
更新日期:2017-12-01 00:00:00
abstract::OBJECT There are a variety of surgical positions that provide optimal exposure of the dorsal lumbar spine. These include the prone, kneeling, knee-chest, knee-elbow, and lateral decubitus positions. All are positions that facilitate exposure of the spine. Each position, however, is associated with an array of unique c...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2015.7.FOCUS15268
更新日期:2015-10-01 00:00:00
abstract::Cauda equina syndrome is a well-documented complication of uneventful lumbar microdiscectomy. In the vast majority of cases, no radiological explanation can be obtained. In this paper, the authors report two cases of postoperative cauda equina syndrome in patients undergoing single-level de novo lumbar microdiscectomy...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.2005.19.2.12
更新日期:2005-08-15 00:00:00
abstract::OBJECTIVE The objective of this study was to identify clinically relevant predictors of progression-free survival and functional outcomes in patients who underwent surgery for intramedullary spinal cord tumors (ISCTs). METHODS An institutional spinal tumor registry and billing records were reviewed to identify adult p...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2016.5.FOCUS16147
更新日期:2016-08-01 00:00:00
abstract::Flow diversion has become a well-accepted option for the treatment of cerebral aneurysms. Given the significant treatment effect of flow diverters, numerous options have emerged since the initial Pipeline embolization device studies. In this review, the authors describe the available flow diverters, both endoluminal a...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2017.3.FOCUS16427
更新日期:2017-06-01 00:00:00
abstract::Choroid plexus tumors consist of papillomas and carcinomas. A variety of germline and somatic genetic changes have been demonstrated for each of these subtypes. In this paper, the authors summarize the current knowledge of the genetic bases of these tumors. ...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2006.20.1.11
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2014.V3.FOCUS14155
更新日期:2014-09-01 00:00:00
abstract:OBJECTIVE:Nonfunctioning pituitary adenomas present without biochemical or clinical signs of hormone excess and are the second most common type of pituitary adenomas. The 2017 WHO classification scheme of pituitary adenomas differentiates null-cell adenomas (NCAs) and silent gonadotroph adenomas (SGAs). The present stu...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2020.3.FOCUS20114
更新日期:2020-06-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2011.3.FOCUS117
更新日期:2011-05-01 00:00:00
abstract::Several cases of congenital or acquired temporal encephaloceles have been reported in the literature as the causative mechanism of simple and/or complex partial seizures. In this report the authors describe a rare case of spontaneous parietal encephalocele presenting with simple partial seizures and progressively incr...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2005.19.3.11
更新日期:2005-09-15 00:00:00
abstract:OBJECT:The goal of this paper is to elucidate the clinical presentation of tethered cord syndrome (TCS) following repair of a myelomeningocele. METHODS:Approximately 10 to 30% of children will develop TCS following repair of a myelomeningocele. Because essentially all children with repaired myelomeningocele will have ...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2004.16.2.8
更新日期:2004-02-15 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.2007.22.3.8
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journal_title:Neurosurgical focus
pub_type: 传,历史文章,杂志文章
doi:10.3171/2017.6.FOCUS17265
更新日期:2017-09-01 00:00:00
abstract::The surgical management of intramedullary spinal cord ependymomas remains a formidable challenge amongst neurosurgeons because of the potential risk of surgical morbidity. From on an oncological perspective, complete resection-if technically feasible-should be the goal of surgery, since this can result in excellent lo...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2012.V2.FOCUS12142
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2002.13.2.4
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2011.9.FOCUS11207
更新日期:2011-12-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2009.10.FOCUS09212
更新日期:2010-01-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2019.2.FocusVid.18702
更新日期:2019-04-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:
更新日期:2005-06-15 00:00:00
abstract::OBJECTIVE The accuracy of robot-guided pedicle screw placement has been proven to be high, but little is known about the impact of such guidance on clinical outcomes such as the rate of revision surgeries for screw malposition. In addition, there are very few data about the impact of robot-guided fusion on patient-rep...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2017.3.FOCUS16534
更新日期:2017-05-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2020.5.FOCUS20249
更新日期:2020-08-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/FOC/2008/24/3-4/E13
更新日期:2008-01-01 00:00:00
abstract::Germ line and somatic mutations in the neurofibromatosis Type 2 (NF2) tumor suppressor gene predispose individuals to tumors of the nervous system, including schwannomas and meningiomas. Since identification of the NF2 gene more than a decade ago, a large body of information has been collected on the nature and conseq...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2005.19.5.7
更新日期:2005-11-15 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2014.7.FOCUS14317
更新日期:2014-01-01 00:00:00
abstract::Lumbosacral interbody fusion may be indicated to treat degenerative disc disease at L5-S1, instability or spondylolisthesis at that level, and severe neural foraminal stenosis resulting from loss of disc space height. In addition, L5-S1 interbody fusion may provide anterior support to a long posterior fusion construct...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2014.2.FOCUS13467
更新日期:2014-05-01 00:00:00
abstract::In this paper, the authors' aim is to provide an evidence-based review of primary and secondary ischemic stroke prevention guidelines covering most of the common risk factors and stroke etiologies for the practicing neurosurgeon. The key to stroke prevention is in the identification and treatment of the major risk fac...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2011.2.FOCUS1164
更新日期:2011-06-01 00:00:00
abstract:OBJECT:A more comprehensive understanding of the epigenetic abnormalities associated with meningioma tumorigenesis, growth, and invasion may provide useful targets for molecular classification and development of targeted therapies for meningiomas. METHODS:The authors performed a review of the current literature to ide...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2013.10.FOCUS13360
更新日期:2013-12-01 00:00:00
abstract:OBJECT:Hypothalamic hamartomas (HHs) are devastating lesions causing refractory epilepsy, rage attacks, social ineptitude, and precocious puberty. Microsurgical and/or endoscopic resection offers an excellent risk/benefit profile for cure or improvement of epilepsy. METHODS:The authors reviewed a prospective database ...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2010.11.FOCUS10250
更新日期:2011-02-01 00:00:00
abstract:OBJECT:The purpose of this study was to evaluate the performance of a resorbable polylactide film in the sheep posterior spine in the presence of a combined laminectomy and durotomy defect. METHODS:A resorbable polylactide film was used to cover the combined defects in the eight sheep used in this study. Two surgical ...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.2004.16.3.3
更新日期:2004-03-15 00:00:00