Flouty Oliver, Reddy Chandan, Holland Marshall, Kovach Christopher, Kawasaki Hiroto, Oya Hiroyuki, Greenlee Jeremy, Hitchon Patrick, Howard Matthew
Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Clin Neurol Neurosurg. 2017 Dec;163:60-66. doi: 10.1016/j.clineuro.2017.10.008. Epub 2017 Oct 10.
Electrical cortical stimulation mapping (ECSM) is the current gold standard functional mapping technique; however, it is burdened by several limitations. Our objective in this study is to show that extended functional mapping modalities can (1) allow neurosurgeons to map and preserve eloquent regions that are inaccessible by the traditional ECSM technique and (2) factor into the operative decision-making process and surgical trajectory during resection of Rolandic brain tumors.
A 55year old patient having a right Rolandic glioblastoma underwent subdural grid implantation followed by surgical resection. Multimodal functional mapping including electrical stimulation, high gamma power mapping, functional magnetic resonance imaging, and diffusion tensor imaging were performed to define the location of the patient's eloquent cortex and white matter tracts in relation to the tumor and determine the optimal surgical trajectory prior to resection.
The patient tolerated a safe surgical resection without any new postoperative deficits. ECSM mapping successfully delineated safe areas for resection as well as eloquent areas related to motor control and speech production. High gamma power analysis successfully mapped areas involved in arm reach. Functional MRI showed the regions related to finger tapping. DTI demonstrated the corticospinal tract and its relation to the hand motor cortex and the tumor.
Adjunct mapping techniques used to supplement the data offered by ECSM can help advance the field of functional mapping and Rolandic surgery via broadening our accessibility to the human brain and providing a comprehensive map of eloquent grey and white matter structures and their relation to the tumor.
皮层电刺激图谱（ECSM）是当前功能图谱的金标准技术；然而，它存在若干局限性。本研究的目的是表明扩展的功能图谱模式能够（1）使神经外科医生绘制并保留传统ECSM技术无法触及的明确区域，以及（2）在切除罗兰区脑肿瘤期间纳入手术决策过程和手术路径规划。
一名55岁的右侧罗兰区胶质母细胞瘤患者接受了硬膜下格栅植入，随后进行手术切除。进行了包括电刺激、高伽马功率图谱、功能磁共振成像和弥散张量成像在内的多模态功能图谱绘制，以确定患者明确皮层和白质束相对于肿瘤的位置，并在切除前确定最佳手术路径。
患者耐受了安全的手术切除，术后无任何新的神经功能缺损。ECSM图谱成功划定了安全切除区域以及与运动控制和言语产生相关的明确区域。高伽马功率分析成功绘制了与手臂伸展相关的区域。功能磁共振成像显示了与手指轻敲相关的区域。弥散张量成像显示了皮质脊髓束及其与手部运动皮层和肿瘤的关系。
用于补充ECSM提供的数据的辅助图谱技术，可通过拓宽我们对人脑的可及性，并提供明确的灰质和白质结构及其与肿瘤关系的全面图谱，来推动功能图谱和罗兰区手术领域的发展。
