Lesions of the sensorimotor region: Somatosensory evoked potentials and ultrasound guided surgery

Firsching, R; Klug, N.; Börner, U.; Sanker, P.

doi:10.1007/bf01401291

Cited by 33 publications

(16 citation statements)

References 11 publications

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“…The continuous intra-operative clinical monitoring also helps to avoid iatrogenically induced neurological deficits by arresting the resection just in time [12,33,34]. The procedure is very helpful but has to be carried out under local anaesthesia on awake co-operative patients [6,7,9,12,18,23,27], Although favourable results have also been reported by others who performed the resection under general anaestesia [10,14,15,37] we do not support it. Due to the complex anatomy of the area and the depth that is reached, we do not support it.…”

Section: Discussioncontrasting

confidence: 52%

Surgical treatment of insular gliomas

1997

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Surgical treatment of glial tumours arising in the insula is specially challenging due to the proximity of the internal capsule. Although small insular gliomas have been removed safely by a transylvian approach, in large dominant insular tumours only biopsy has been recommended to avoid postoperative deficits. Unfortunately that is a suboptimal form of treatment as low grade supratentorial gliomas should be removed radically to prevent tumour progression, malignization and to increase the recurrence-free-interval. Addition of radiotherapy to partial removal is associated with a much higher incidence of recurrences and early malignizations compared to radical removal and no radiotherapy. Between 1st October 1989 and 1st September 1996 we treated twenty-three patients harbouring insular gliomas. To increase the radicality of the resection the surgical procedure was performed under local anaesthesia whenever possible, as general anaesthesia usually leads to more conservative resections. In 20/23 (86.9%) patients complete resection was accomplished, and subtotal in three (13.1%). The removed tumours were: two oligodendrogliomas, five grade I astrocytomas, nine grade II, four grade III and three grade IV. Postoperative neurological deficits occurred in five patients. Four suffered a hemiparesis (that recovered in an average of 6 months) and one a motor dysphasia which took a week to recover. Two of the seventeen patients operated on for low grade insular gliomas underwent malignant change. We conclude that complete surgical removal of insular gliomas should be considered and at least attempted in all cases.

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Section: Discussioncontrasting

confidence: 52%

Surgical treatment of insular gliomas

1997

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“…Fiersching etal. [10] bypassed the disadvantage of localising the functional region, but not the therein embedded tumour by additionally using an ultrasound B-scan during surgery to detect the subcortical lesion.…”

Section: Discussionmentioning

confidence: 99%

Computer assisted brain surgery for small lesions in the central sensorimotor region

et al. 1996

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The capacity of a new optical navigation device is demonstrated by six microsurgical procedures for small subcortical lesions within the central sensorimotor strip. This small series is aimed at less invasive resection in this functionally critical region, independently of primary diagnosis and outcome. Guided by high resolution CT imaging data five brain tumours and one cavernous angioma was selectively located and most sparingly removed without additional sensorimotor deficit. In two cases improvement of a pre-operative paresis was observed immediately after surgery. Thanks to light-weight freehand pointing instruments and a ranging accuracy of +/- 1 mm, damage to functionally important brain areas and vessels was avoided by using uncommonly oblique, e.g., transsulcal ways of access which would hardly have been possible even with guidance by conventional stereotaxy. The demanding systematic cortical stimulation of the precentral gyrus applied in three cases was only sensitive in infiltrating tumours-e.g., low grade astrocytomas-where for want of adjuvant therapy it was essential to proceed to the extreme limits of resection. In general, precise anatomical localisation by computer aided surgery (CAS) is sufficient in small central lesions which guarantees minimally invasive surgery. The potential of this new, soon commercially available optical navigation system in (neuro) surgery, quality control and teaching is discussed.

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“…The somatomotor cortex may be identified during surgery by the electrocorticogram (ECoG) of sensory-evoked potentials, sometimes combined with intraoperative ultrasound, making it possible to successfully remove tumors in or near the central sulcus [Firsching et al, 1992]. ECoG involves placing an electrode on the cortical surface.…”

Section: Somatomotor Cortex Identificationmentioning

confidence: 99%

Clinical applications of magnetoencephalography

Stufflebeam

Tanaka

Ahlfors

2009

Human Brain Mapping

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Magnetoencephalography (MEG), in which magnetic fields generated by brain activity are recorded outside of the head, is now in routine clinical practice throughout the world. MEG has become a recognized and vital part of the presurgical evaluation of patients with epilepsy and patients with brain tumors. We review investigations that show an improvement in the postsurgical outcomes of patients with epilepsy by localizing epileptic discharges. We also describe the most common clinical MEG applications that affect the management of patients, and discuss some applications that are close to having a clinical impact on patients.

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Lesions of the sensorimotor region: Somatosensory evoked potentials and ultrasound guided surgery

Cited by 33 publications

References 11 publications

Surgical treatment of insular gliomas

Surgical treatment of insular gliomas

Computer assisted brain surgery for small lesions in the central sensorimotor region

Clinical applications of magnetoencephalography

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