S Andrea Hospital, Institute of Neurosurgery, University of Rome "La Sapienza", V. Raineri 27, 00151, Rome, Italy.
Neurosurg Rev. 2012 Jul;35(3):401-12; discussion 412. doi: 10.1007/s10143-012-0373-6. Epub 2012 Feb 28.
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.
我们报告了在 BrainSuite 中使用术中 MRI、轨迹和“神经导航”皮质和皮质下映射治疗涉及运动皮层和皮质脊髓束的病变的初步系列患者。对于涉及运动皮层和皮质脊髓束的脑内肿瘤手术，必须对皮质和皮质下功能区进行精确定位。如今，现代技术提供了多种工具，可在大脑功能区手术中最大程度地减少术后缺陷。从 2008 年 12 月至 2010 年 6 月，18 名患者在 BrainSuite 中接受了涉及运动皮层和/或皮质下通路的肿瘤功能手术。我们的初步系列包括 14 例胶质瘤和 4 例转移瘤；表 1 总结了所有数据。我们将有能力完全切除运动区病变且病变与皮质脊髓束之间平均距离为 4 毫米的患者纳入本系列。6 个肿瘤被认为与运动皮层接触和/或涉及运动皮层，而在 18 例（100%）中肿瘤涉及皮质脊髓束的语言区。所有患者均通过术中术后 MRI 证实完全切除了病变。我们的系列强调了 BrainSUITE 与 1.5 T 术中磁场和神经生理监测的良好集成和高度兼容性。我们坚信，DTI 术中 MRI 使我们能够治疗复杂的手术肿瘤，如果没有它的辅助，我们将无法处理。
