Neuro-Oncology: Intraoperative DTI and brain mapping for surgery of neoplasm of the motor cortex and the corticospin

Abstract

We report our preliminary series of patients treated for lesions involving the motor cortex and the corticospinal tract in BrainSuite, with intraoperative MRI, tractography and "neuronavigated" electrophysiological cortical and subcortical mapping. An exact localization of the cortical and subcortical functional areas is mandatory for executing surgery of intra-parenchymal neoplasm involving the motor cortex and the corticospinal tract. Nowadays modern technology offers a variety of tools to reduce as much as possible postoperative deficits during surgery of cerebral eloquent areas. From December 2008 and June 2010, 18 patients underwent functional surgery, for neoplasm involving the motor cortex and/or the subcortical pathway, in BrainSuite. Our preliminary series include 14 gliomas and 4 metastases; Table 1 summarizes all of the data. We included in this series patients with complete removal of lesions of eloquent areas with an average distance from the corticospinal tract of 4 mm. Six neoplasms were considered in contact and/or involving the motor cortex, while in 18 cases (100%) the tumour involved eloquent areas concerning the corticospinal tract. All of the patients underwent complete removal of the lesion as subsequently demonstrated by intraoperative postsurgical MRI. Our series highlights the good integration and the high compatibility between BrainSUITE with 1.5 T intraoperative magnetic field and neurophysiological monitoring. We strongly believe that intraoperative MRI with DTI allows us to treat complex surgery tumours that without its auxilium we would not be able to deal with.

Table 1 Summary of intraoperative data

Case	Name	Age	Sex	Histology	Surgical risk	Resection	Distance from tract	Distance of MEP (mm)	Immediate outcome	Quality of life	Recovery
1	A. M.	68	M	Low grade	Tract	Complete	In contact	0	Improved	Excellent	Immediate
2	B. S.	39	F	Metastasis	Tract	Complete	7 mm	7	Unchanged	Excellent	Immediate
3	C. M.	77	M	Glioma	Tract	Complete	In contact	0	Improved	Excellent	Immediate
4	D. C.	67	M	Glioma	Tract	Complete	In contact	0	Unchanged	Excellent	Immediate
5	D. M. N.	42	M	Metastasis	Tract/cortex	Complete	In contact	5	Improved	Excellent	Immediate
6	F. V.	66	F	Glioma	Tract	Complete	15 mm	15	Unchanged	Excellent	Immediate
7	P. A.	37	M	Oligodendroglioma	Tract/cortex	Complete	In contact	2	Mild paresis	Excellent	3 months
8	S. M.	65	F	Low grade	Tract/cortex	Complete	In contact	0	Unchanged	Excellent	Immediate
9	M. L.	66	F	Glioma	Tract	Complete	4 mm	4	Improved	Excellent	Immediate
10	R. G.	40	F	Glioma	Tract	Complete	12 mm	12	Improved	Excellent	Immediate
11	Q. A.	26	M	Glioma	Tract	Complete	6 mm	6	Improved	Excellent	Immediate
12	A. G.	68	F	Glioma	Tract	Complete	8 mm	8	Improved	Excellent	Immediate
13	P. C.	50	F	Glioma	Tract	Complete	In contact	2	Improved	Excellent	Immediate
14	P. I.	50	M	Metastasis	Tract/cortex	Complete	In contact	0	Unchanged	Excellent	Immediate
15	C. A.	75	F	Glioma	Tract	Complete	In contact	2	Improved	Optimum	Immediate
16	C. L.	76	M	Glioma	Tract	Complete	In contact	0	Unchanged	Optimum	Immediate
17	R. A.	54	F	Glioma	Tract/cortex	Complete	In contact	0	Improved	Excellent	Immediate
18	D. N.	43	M	Metastasis	Tract/cortex	Complete	In contact	0	Monoparesis	Excellent	1 month

Content Type Journal Article
Category Original Article
Pages 1-12
DOI 10.1007/s10143-012-0373-6
Authors
- Giancarlo D'Andrea, S Andrea Hospital, Institute of Neurosurgery, University of Rome "La Sapienza", V. Raineri 27, 00151 Rome, Italy
- Albina Angelini, S Andrea Hospital, Institute of Neurosurgery, University of Rome "La Sapienza", V. Raineri 27, 00151 Rome, Italy
- Andrea Romano, S Andrea Hospital, Institute of Neuroradiology, University of Rome "La Sapienza", Rome, Italy
- Antonio Di Lauro, S Andrea Hospital, Institute of Anesthesiology, University of Rome "La Sapienza", Rome, Italy
- Giovanni Sessa, S Andrea Hospital, Institute of Neurosurgery, University of Rome "La Sapienza", V. Raineri 27, 00151 Rome, Italy
- Alessandro Bozzao, S Andrea Hospital, Institute of Neuroradiology, University of Rome "La Sapienza", Rome, Italy
- Luigi Ferrante, S Andrea Hospital, Institute of Neurosurgery, University of Rome "La Sapienza", V. Raineri 27, 00151 Rome, Italy