Rolandic area meningioma resection controlled and guided by intraoperative cortical mapping

Ostrý, Svatopluk; Netuka, David; Beneš, Vladimı́r

doi:10.1007/s00701-012-1279-3

Cited by 20 publications

(38 citation statements)

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“…However, the usefulness of these modalities for meningiomas is debated and may only be indicated if the cleavage plane of dissection is lost. 16 Prior literature has highlighted the increased risk of postoperative morbidity for rolandic meningiomas. 10,16 However, the clinical, histological, and radiological predictors of postoperative weakness following resection of meningiomas over the motor cortex have not been reported in a larger case series.…”

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confidence: 99%

Predictors of postoperative motor function in rolandic meningiomas

Ottenhausen

Rumalla

Younus

et al. 2019

Journal of Neurosurgery

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OBJECTIVEResection of supratentorial meningiomas is generally considered a low-risk procedure, but tumors involving the rolandic cortex present a unique challenge. The rate of motor function deterioration associated with resecting such tumors is not well described in the literature. Thus, the authors sought to report the rates and predictors of postoperative motor deficit following the resection of rolandic meningiomas to assist with patient counseling and surgical decision-making.METHODSAn institution’s pathology database was screened for meningiomas removed between 2000 and 2017, and patients with neuroradiological evidence of rolandic involvement were identified. Parameters screened as potential predictors included patient age, sex, preoperative motor severity, tumor location, tumor origin (falx vs convexity), histological grade, FLAIR signal (T2-weighted MRI), venous involvement (T1-weighted MRI with contrast), intratumoral hemorrhage, embolization, and degree of resection (Simpson grade). Variables of interest included preoperative weakness and postoperative motor decline (novel or worsened permanent deficit). The SPSS univariate and bivariate analysis functions were used, and statistical significance was determined with alpha < 0.05.RESULTSIn 89 patients who had undergone resection of convexity (80.9%) or parasagittal (19.1%) rolandic meningiomas, a postoperative motor decline occurred in 24.7%. Of 53 patients (59.6%) with preoperative motor deficits, 60.3% improved, 13.2% were unchanged, and 26.4% worsened following surgery. Among the 36 patients without preoperative deficits, 22.2% developed new weakness. Predictors of preoperative motor deficit included tumor size (41.6 vs 33.2 cm3, p = 0.040) and presence of FLAIR signal (69.8% vs 50.0%, p = 0.046). Predictors of postoperative motor decline were preoperative motor deficit (47.2% vs 22.2%, p = 0.017), minor (compared with severe) preoperative weakness (25.6% vs 21.4%, p < 0.001), and preoperative embolization (54.5% vs 20.5%, p = 0.014). Factors that trended toward significance included parafalcine tumor origin (41.2% vs 20.8% convexity, p = 0.08), significant venous involvement (44.4% vs 23.5% none, p = 0.09), and Simpson grade II+ (34.2% vs 17.6% grade I, p = 0.07).CONCLUSIONSResection of rolandic area meningiomas carries a high rate of postoperative morbidity and deserves special preoperative planning. Large tumor size, peritumoral edema, preoperative embolization, parafalcine origin, and venous involvement may further increase the risk. Alternative surgical strategies, such as aggressive internal debulking, may prevent motor decline in a subset of high-risk patients.

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confidence: 99%

Predictors of postoperative motor function in rolandic meningiomas

Ottenhausen

Rumalla

Younus

et al. 2019

Journal of Neurosurgery

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“…To entirely preserve the function of the PMC in these situations, the tumors should be removed only in an intracapsular manner, and the tumoral layers attached to the cortex should remain as thin as possible because thinner tumoral layers would lower the MEP threshold. An intracapsular tumor resection should be stopped if the difference in MEP threshold between direct cortical stimulation and stimulation through the tumoral layer is 2 mA or lower [1]. In one of the cases described in the present study, new symptoms of motor weakness were induced by surgery for a meningioma because a total resection was attempted even though there was pial adhesion (Fig.…”

Section: Discussionmentioning

confidence: 85%

“…Thus, various tools such as neuronavigation, cortical mapping, and evoked electrophysiological monitoring have been applied to maximize the safety of marginal resections [123]. Additionally, awake surgery has been performed in such cases to preserve motor function, but this technique is typically associated with glial tumors that have naturally infiltrated the surrounding tissues [45].…”

Section: Introductionmentioning

confidence: 99%

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Surgical Resection of Non-Glial Tumors in the Motor Cortex

Lee

Hwang

et al. 2016

Brain Tumor Res Treat

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BackgroundDirect surgery to resect tumors in the motor cortex could improve neurological symptoms or cause novel motor weakness. The present study describes the neurological outcomes of patients after the surgical resection of non-glial tumors in the primary motor cortex.MethodsThe present study included 25 patients who had pathologically confirmed non-glial tumors in the motor cortex for which they underwent surgery. Tumor location was verified using anatomical landmarks on preoperative magnetic resonance imaging scans. All surgeries involved a craniotomy and tumor resection, especially use of the sulcal dissecting approach for intra-axial tumors.ResultsOf the 25 patients, 10 exhibited metastasis, 13 had a meningioma, and 2 had a cavernous malformation. Motor weakness and seizures were the most common symptoms, while 3 patients experienced only a headache. The tumor size was less than 20 mm in 4 patients, 20–40 mm in 14, and greater than 40 mm in seven. Of the 25 patients, 13 exhibited motor weakness prior to the operation, but most of these symptoms (76.9%) improved following surgery. On the other hand, eight patients experienced seizures prior to the surgery, and in three of these patients (37.5%), the seizures were not controlled after the surgery. In terms of surgical complications, a postoperative hematoma developed in one of the meningioma patients, and the patient's hemiparesis was aggravated.ConclusionThe present findings show that careful and meticulous resection of non-glial tumors in the motor cortex can improve preoperative neurological signs, but it cannot completely control seizure activity.

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“…It has already been described that intraoperative neurophysiological monitoring of SSEPs and MEPs in the middle-third SSS meningiomas (in proximity to the motor strip) can guide tumor removal. 13 However, no data have been reported in the literature so far on the combined use of ICGVA and neurophysiological monitoring in meningioma resection. In our experience, intraop erative monitoring was used to monitor SSS ligation and bridging or cortical vein sacrifice (Fig.…”

Section: Comparison Of Our Data With Relevant Literaturementioning

confidence: 99%

Application of indocyanine green video angiography in parasagittal meningioma surgery

Puppa

Rustemi

Gioffrè

et al. 2014

FOC

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Object There are no doubts about the role that indocyanine green video angiography (ICGVA) can play in current vascular neurosurgery. Conversely, in brain tumor surgery, and particularly in meningioma surgery, this role is still unclear. Vein management is pivotal for approaching parasagittal meningiomas, because venous preservation is strictly connected to both extent of resection and clinical outcome. The authors present the technical traits and the postoperative outcome of the application of ICGVA in patients undergoing parasagittal meningioma surgery. Methods The authors retrospectively collected demographic, radiological, intraoperative, and follow-up data in 43 patients with parasagittal meningiomas who underwent surgery with the assistance of ICGVA at Padua Neurosurgical Department between October 2010 and July 2013. Intraoperative ICGVA findings at different stages (before dural opening, after dural opening, during resection, after resection) were reviewed. Additional data on functional monitoring, temporary venous clipping, and flow measurements were also recorded. The overall postoperative outcome was evaluated by assessing both the extent of resection and the clinical outcome data. Results The ICGVA studies were performed 125 times in 43 patients, providing helpful data for vein management and tumor resection in all stages of surgery. In 16% of meningiomas completely occluding the superior sagittal sinus, the ICGVA data differed from radiological findings and changed the surgical approach. In 20% of cases the intraoperative ICGVA findings directly guided the surgical strategy: venous sacrifice was necessary in 7 cases, without postoperative consequences; temporary clipping with neurophysiological monitoring proved to be predictive of safe venous sacrifice. In 7% of cases the ICGVA data needed to be supplemented with flow measurements. Simpson Grade I–II and Grade III resections were achieved in 86% and 14% of cases, respectively, with a 4.6% rate of overall morbidity. Conclusions This study shows that ICGVA can assist the different stages of parasagittal meningiomas surgery, guiding the vein management and tumor resection strategies with a favorable final clinical outcome. However, in the authors' experience the use of other complementary tools was mandatory in selected cases to preserve functional areas. Further studies are needed to confirm that the application of ICGVA in parasagittal meningioma surgery may improve the morbidity rate, as reported in this study.

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Rolandic area meningioma resection controlled and guided by intraoperative cortical mapping

Cited by 20 publications

References 50 publications

Predictors of postoperative motor function in rolandic meningiomas

Predictors of postoperative motor function in rolandic meningiomas

Surgical Resection of Non-Glial Tumors in the Motor Cortex

Application of indocyanine green video angiography in parasagittal meningioma surgery

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