Intra-operative neurophysiological mapping and monitoring during brain tumour surgery in children: an update

Coppola, Angela; Tramontano, Vincenzo; Basaldella, Federica; Arcaro, C.; Squintani, Giovanna; Sala, Francesco

doi:10.1007/s00381-016-3180-5

Cited by 33 publications

(22 citation statements)

References 62 publications

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“…Schucht et al [28] in their series of 8 pediatric patients with 4 preadolescents found that the quantitative mapping thresholds for assessing the risk of direct damage to the motor cortex were similar to the established values found in adults [26]. Thus, the recent modifications in the technique of mapping and monitoring strategies in preadolescents have established it as reliable and safe as in adults [4, 25, 29, 30].…”

Section: Discussionmentioning

confidence: 93%

Technical Considerations in Awake Craniotomy with Cortical and Subcortical Motor Mapping in Preadolescents: Pushing the Envelope

Ratha¹,

Sampath²,

Subramaniam

et al. 2021

Pediatr Neurosurg

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Introduction: Unlike adult gliomas, the utility of combined application of awake anesthesia and intraoperative neurophysiological monitoring (IONM) for maximal safe resection in eloquent region gliomas (ERG) has not been established for pediatric population while it remains unexplored in preadolescents (below 11 years old). Case Presentation: We report 2 cases of awake craniotomy with IONM in an 8 and 9 year old for safe maximal resection of ERG. In both the cases, repeated preoperative visits of the operating room was performed to familiarize and educate the children about intraoperative communication, comfortable positioning, and neurological assessment. Under conscious sedation protocol, cortical and subcortical mapping, and electrocorticography, gross total resection was achieved. In both the cases, there were no postoperative neurodeficits or perioperative complications. Conclusion: Our 2 cases illustrate the first instance of successful use of awake IONM for maximal safe resection of ERG in preadolescent age-group. We believe, with proper preoperative planning and careful titration of anesthetics, it is safe and feasible. The blanket notion that preadolescent age-group should be excluded from awake mapping needs to be challenged, rather curated on a case basis.

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Section: Discussionmentioning

confidence: 93%

Technical Considerations in Awake Craniotomy with Cortical and Subcortical Motor Mapping in Preadolescents: Pushing the Envelope

Ratha¹,

Sampath²,

Subramaniam

et al. 2021

Pediatr Neurosurg

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“…Though limited, experience with high-frequency monopolar stimulation in pediatric cases has shown that it is safe and feasible and can be reliably used when coupled with other complementary techniques such as phase reversal. [ 3 ] During resection of tumors around the central motor areas, besides mapping the cortex, it is extremely important to preserve the descending fibers of the corticospinal tract. Subcortical mapping is therefore very crucial.…”

Section: Discussionmentioning

confidence: 99%

“…Intraoperative neurophysiological mapping and monitoring techniques have evolved in the last decade and provide a valuable means of assessing the functional status and thereby guide the resection even in pediatric cases. [ 3 ] Motor mapping (both cortical and subcortical) is one such very reliable technique. Recently, a new technique for continuous and dynamic subcortical mapping was described in adults using a suction monopolar stimulator device.…”

Section: Introductionmentioning

confidence: 99%

Continuous dynamic subcortical mapping using a suction monopolar device in a child: Case report and technical note

et al. 2018

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Extent of resection is a very important prognostic marker in adult and pediatric brain tumors. Therefore, radical resections confer an oncological benefit. Resection of intra-axial tumors in proximity to eloquent regions requires intraoperative mapping and monitoring. Continuous subcortical mapping using a suction monopolar device has been recently described for adult tumors. This allows a real-time dynamic mapping of the advancing resection cavity walls, synchronized with the surgeon’s actions during resection. We describe the application of this technique in a child who presented with a rapidly increasing right parietal mass. It was resected using this dynamic mapping technique. This is the first such report of its use in a pediatric brain tumor. We also review the relevant literature briefly.

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“…Neuromonitoring intraoperatively is considered to be the gold standard in localizing brain function in brain tumor surgery ( 40 ). Mapping is the process of identifying the proximity to eloquent areas in the brain and avoiding damage to these regions ( 41 ).…”

Section: Operative Interventionmentioning

confidence: 99%

“…Though there is sufficient evidence to support the use of ION in predicting neurological injury, there isn't much evidence for injury prevention ( 40 ).…”

Section: Operative Interventionmentioning

confidence: 99%

Pediatric Central Nervous System Tumors: State-of-the-Art and Debated Aspects

2018

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Pediatric neuro-oncology surgery continues to progress in sophistication, largely driven by advances in technology used to aid the following aspects of surgery: operative planning (advanced MRI techniques including fMRI and DTI), intraoperative navigation [preoperative MRI, intra-operative MRI (ioMRI) and intra-operative ultrasound (ioUS)], tumor visualization (microscopy, endoscopy, fluorescence), tumor resection techniques (ultrasonic aspirator, micro-instruments, micro-endoscopic instruments), delineation of the resection extent (ioMRI, ioUS, and fluorescence), and intraoperative safety (neurophysiological monitoring, ioMRI). This article discusses the aforementioned technological advances, and their multimodal use to optimize safe pediatric neuro-oncology surgery.

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Intra-operative neurophysiological mapping and monitoring during brain tumour surgery in children: an update

Cited by 33 publications

References 62 publications

Technical Considerations in Awake Craniotomy with Cortical and Subcortical Motor Mapping in Preadolescents: Pushing the Envelope

Technical Considerations in Awake Craniotomy with Cortical and Subcortical Motor Mapping in Preadolescents: Pushing the Envelope

Continuous dynamic subcortical mapping using a suction monopolar device in a child: Case report and technical note

Pediatric Central Nervous System Tumors: State-of-the-Art and Debated Aspects

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