Surgical results of tumor resection using tractography-integrated navigation-guided fence-post catheter techniques and motor-evoked potentials for preservation of motor function in patients with glioblastomas near the pyramidal tracts

Abstract

The current optimal surgery for glioblastomas (GBMs) near the pyramidal tract (PT) is to remove as much tumor as possible and to preserve motor function. The purpose of this study is to investigate the usefulness of tractography-integrated navigation-guided fence-post catheter techniques and motor-evoked potentials (MEPs) for preserving postoperative motor function after GBM surgery. We retrospectively examined 49 patients who underwent resection for GBM near the PT. Diffusion tensor (DT) imaging-based tractography of the PT was performed preoperatively and integrated into the navigation system. When possible, silicon catheters were used as "fence-posts" and were inserted along the tumor boundaries, avoiding the PT, before tumor removal using the navigation system (fence-post catheter techniques). Cortical and subcortical MEPs were also monitored during resection of the tumor. Fence-post catheter techniques using a tractography-integrated navigation system were used in 45 of 49 patients. This technique enabled placement of the catheters, avoided the motor pathways, and allowed easier resection of the tumors. Tumors near the PT were resected using subcortical and cortical MEPs. The amplitudes of cortical MEPs after tumor removal were maintained at over 33 % of those obtained before resection. Thirty-six patients showed obvious responses of subcortical MEPs at ≤20 mA. The degree of resection was gross total in 21 patients, subtotal in 21, and partial in seven. One month after surgery, only one patient showed worsened motor function. Therefore, fence-post catheter techniques using a tractography-integrated navigation system and MEPs may contribute to preserving motor function after surgery for GBMs that are near the PT.

Significance of Glioma Stem-Like Cells in the Tumor Periphery That Express High Levels of CD44 in Tumor Invasion, Early Progression, and Poor Prognosis in Glioblastoma

“…Table S2 . The extent of resection (EOR) was evaluated by volumetric analysis on MRI before and after surgery as previously described [ 24 ]. Gross total resection (GTR: 100% resection of the tumor volume), subtotal resection (95 to 100% resection), and partial resection (<95% resection) were achieved in 10 (76.9%), 2 (15.4%), and 1 patient (7.7%), respectively.…”

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

“…Это объясняет-ся тем, что ПТ может быть поврежден выше места стимуляции. В этом случае контролировать сохран-ность трактов позволяют ТК МВП, которые должны при этом снизиться или исчезнуть совсем (сниже-ние амплитуды М-ответа, повышение его латентно-сти) [45]. По мнению многих авторов [42], прямая субкортикальная ЭС и ТК МВП являются взаимо-дополняющими методами.…”

“…По на-шим данным, сохранность ТК МВП во время опера-ции является надежным предиктором отсутствия нарастания неврологического дефицита в послеопе-рационном периоде, что соответствует данным S. Ohue и соавт. [45]. Снижение амплитуды ТК МВП во время резекции опухоли может указывать на не-посредственный контакт с ПТ или на сосудистое повреждение.…”

The fence post depth electrode technique to control both brain tumors and epileptic seizures in patients with brain tumor-related epilepsy

“…[11,21,22] Thus, both gross total removal (GTR) and the absence of epileptic seizures are ideal goals in patients with BTRE. The neuronavigation-guided fence post catheter technique is one procedure[4,7,13,22] that assists in performance of GTR.…”