In spite of the progress made in diagnostic procedures and development of the
operating rooms technology, considerable neurological deficit after operation
of tumors localized in the brain motor zone commits one to direct
intraoperative identification of the motor zone. By introducing direct
electrocortical stimulation into the routine intraoperative application the
primary goal has been achieved - reaching the maximum degree of radicalness
of surgical resection while preserving motor centres in the cerebral cortex.
Method: We are hereby demonstrating a series of 60 patients operated for
primary brain tumors localized in the area in the front and around the
central sulcus. All operations have been performed under the general
anesthetics. During the operations the method of direct electrostimulation
(ES) was used for the purpose of identifying motor centres. Results:
Intraoperatively a level of subtotal resection was achieved in 22 cases,
while radical resection was possible in 38 cases. Significantly higher level
of radicalness of surgical resection of the low grade glioma tumor was
confirmed statistically in relation to the group of patients with
glioblastoma multiforme by applying the ES cortex (p<0,05). Patients with
slow developing brain glioma have statistically considerably higher KI value
in relation to the KI values in the group of patients with glioblastoma
multiforme (p<0,01). Difference in the measured values of distance from the
coronal suture based on the results of MRI measuring and finding obtained by
ES, has shown a statistically considerably higher difference with
glioblastoma multiforme 8,26+4,288mm when comapred to slowly developing
astrocitoma 5,88+3,080 (p<0,05). Conclusion: Electrostimulation of the brain
cortex is a safe, simple and precise method for identification of the brain
motor zone which enables prevention of additional postoperative deficit and
higher level of surgical radicalness.
Operative treatment of primary brain tumors localized in motor zone with direct corticalis electrostimulation: Series of 62 patients