scholarly journals STMO-12 Efforts for safe malignant brain tumor surgery at our hospital

2021 ◽  
Vol 3 (Supplement_6) ◽  
pp. vi13-vi13
Author(s):  
Yusuke Kobayashi ◽  
Yosuke Satou ◽  
Takashi Kon ◽  
Daisuke Tanioka ◽  
Katsuyoshi Shimizu ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Pyramidal Tract ◽  
Removal Rate ◽  
Karnofsky Performance Status ◽  
Premotor Cortex ◽  
Performance Status ◽  
Motor Evoked Potential ◽  
Malignant Brain Tumor ◽  
Tumor Surgery ◽  
Brain Tumor Surgery

Abstract Although maximal safe resection is the current standard for glioblastoma surgery, its safety and removal rate conflict with each other. Electrophysiological monitoring, such as motor evoked potential monitoring and awake craniotomy, can be utilized as safety measures; not all facilities can perform them. Herein, we present a representative case report on our efforts for a safe malignant brain tumor surgery. Case: A 77-year-old woman with glioblastoma in the premotor cortex presented with seizure of the upper left lower limb. Her pyramidal tract ran from the medial bottom to the posterior of the tumor. We performed excision from the site using the lowest gamma entropy. We then removed all parts of the tumor, with the exception of the pyramidal tract infiltration, and no paralysis was observed. She was definitively diagnosed with glioblastoma and is currently on maintenance chemotherapy. As a preoperative examination, we performed cerebrovascular angiography. We then performed various other tests to ascertain the patient’s condition. Considering lesions that affect language, Wada tests were performed regardless of laterality. For all patients with epilepsy onset, preoperative 256-channel electroencephalogram measurement and intraoperative the gamma entropy analysis were performed to confirm epileptogenicity. Considering lesions that affect eloquence, subdural electrodes were placed and brain function mapping was performed the next day. Based on the results, the safest cortical incision site and excision range were determined, and excision was performed on the following day. Of the 14 operated glioblastoma cases after November 2018, more than 85% of the contrast-enhanced lesions were completely removed in 7 cases, partially removed in 5 cases, and underwent biopsy in 2 cases. Postoperative Karnofsky performance status scores remained unchanged in 11 cases, improved in 1 case, and deteriorated in 2 cases. Our efforts have resulted in safe and sufficient removal of malignant brain tumors during surgery.

Three-dimensional Visualization of the Pyramidal Tract in a Neuronavigation System during Brain Tumor Surgery: First Experiences and Technical Note

Neurosurgery ◽  
2001 ◽  
Vol 49 (1) ◽  
pp. 86-93 ◽  
Author(s):  
Volker A. Coenen ◽  
Timo Krings ◽  
Lothar Mayfrank ◽  
Richard S. Polin ◽  
Marcus H.T. Reinges ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Pyramidal Tract ◽  
Three Dimensional ◽  
Technical Note ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Neuronavigation System ◽  
Surgery First

Three-dimensional Visualization of the Pyramidal Tract in a Neuronavigation System during Brain Tumor Surgery: First Experiences and Technical Note

Neurosurgery ◽  
2001 ◽  
Vol 49 (1) ◽  
pp. 86-93 ◽  
Author(s):  
Volker A. Coenen ◽  
Timo Krings ◽  
Lothar Mayfrank ◽  
Richard S. Polin ◽  
Marcus H.T. Reinges ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Pyramidal Tract ◽  
Three Dimensional ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Fiber Tracts ◽  
Pyramidal Tracts ◽  
Diffusion Weighted ◽  
Neuronavigation System ◽  
Large Fiber

Abstract OBJECTIVE To integrate spatial three-dimensional information concerning the pyramidal tracts into a customized system for frameless neuronavigation during brain tumor surgery. METHODS Four consecutive patients with intracranial tumors in eloquent areas underwent diffusion-weighted and anatomic magnetic resonance imaging studies within 48 hours before surgery. Diffusion-weighted datasets were merged with anatomic data for navigation purposes. The pyramidal tracts were segmented and reconstructed for three-dimensional visualization. The reconstruction results, together with the fused-image dataset, were available during surgery in the environment of a customized neuronavigation system. RESULTS In all four patients, the combination of reconstructed data and fused images was a helpful additional source of information concerning the tumor seat and topographical interaction with the pyramidal tract. In two patients, intraoperative motor cortex stimulation verified the tumor seat with regard to the precentral gyrus. CONCLUSION Diffusion-weighted magnetic resonance imaging allows individual estimation of large fiber tracts applicable as important information in intraoperative neuronavigation and in planning brain tumor resection. A three-dimensional representation of fibers associated with the pyramidal tract during brain tumor surgery is feasible with the presented technique and is a helpful adjunct for the neurosurgeon. The main drawbacks include the length of time required for the segmentation procedure, the lack of direct intraoperative control of the pyramidal tract position, and brain shift. However, mapping of large fiber tracts and its intraoperative use for neuronavigation have the potential to increase the safety of neurosurgical procedures and to reduce surgical morbidity.

Transcranial Electrical Motor Evoked Potential Monitoring for Brain Tumor Resection

Neurosurgery ◽  
2001 ◽  
Vol 48 (5) ◽  
pp. 1075-1081 ◽  
Author(s):  
Henry H. Zhou ◽  
Patrick J. Kelly
Keyword(s):  
Brain Tumor ◽  
Evoked Potential ◽  
Tumor Resection ◽  
Motor Evoked Potential ◽  
Motor Deficits ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Stimulation Intensity ◽  
Potential System ◽  
Brain Tumor Resection

Abstract OBJECTIVE This study was designed to examine whether transcranial electrical motor evoked potential (MEP) monitoring is safe, feasible, and valuable for brain tumor surgery. METHODS Fifty consecutive patients undergoing brain tumor resection were studied, using nitrous oxide/propofol anesthesia. MEPs were continuously recorded throughout surgery, using a Sentinel 4 evoked potential system (Axon Systems, Inc., Hauppauge, NY). The MEPs were elicited by transcranial electrical stimulation (train of 5; stimulation rate, 0.5–2 Hz; square wave pulse with a time constant of 0.5 ms; stimulation intensity, 40–160 mA) through spiral electrodes placed over the primary motor cortex and were recorded by needle electrodes inserted into the contralateral orbicularis oris, biceps, abductor pollicis brevis, and anterior tibialis muscles. When MEP amplitudes decreased by more than 50%, MEP stimulation was repeated, with increased stimulation intensity, and MEP changes were reported to the surgeon. The motor function of each patient was examined before and after surgery, using a reproducible scale. The relationship between MEP amplitude decreases and worsening motor status was analyzed using linear regression. RESULTS Preoperative neurological examinations revealed mild to moderate motor deficits (2/5 to 4/5) for 38% of patients (19 of 50 patients). Most of the patients (96%) exhibited recordable baseline MEPs. Persistent MEP decreases of more than 50% were noted for eight patients (16%) (11 muscles). The MEPs were completely abolished in two patients (three muscles). The degree of postoperative worsening of motor status was correlated with the degree of intraoperative MEP amplitude reduction (r = −0.864; P < 0.001). CONCLUSION Persistent intraoperative MEP reductions of more than 50% were associated with postoperative motor deficits. The degree of MEP amplitude reduction was correlated with postoperative worsening of motor status. Transcranial electrical MEP monitoring is feasible, safe, and valuable for brain tumor surgery.

scholarly journals SURG-36. THE EVALUATION OF POSTOPERATIVE MOTOR FUNCTION DEFICITS AFTER SUPRATENTORIAL BRAIN TUMOR SURGERY THROUGH THE ANALYSIS OF INTRAOPERATIVE MEP AND ISCHEMIC LESION ON POSTOPERATIVE DWI

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii211-ii211
Author(s):  
Seung Ho Yang ◽  
Yong Kil Hong ◽  
Young Il Kim
Keyword(s):  
Brain Tumor ◽  
Motor Function ◽  
Statistical Significance ◽  
Motor Evoked Potential ◽  
Positive Finding ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Ischemic Lesion ◽  
Group A ◽  
Group B

Abstract BACKGROUND The authors investigated the incidence of ischemic lesions on immediate postoperative diffusion-weighted imaging (DWI) according to the findings of intraoperative motor evoked potential (MEP) and the correlation with postoperative motor function deficits. METHODS From January 2016 to June 2018, total 127 supratentorial brain tumor patients were enrolled in this study. The intraoperative MEP results were analyzed in the following three groups: no decline below 50 % of baseline (A), transient decline below 50 % of baseline (B), no recovery until end stage of surgery (C). Postoperative magnetic resonance imaging was performed within 48 hours after surgery. RESULTS Of the total 127 patients, MEP changes (group B&C) were observed in 25 patients (25/127, 19.7%), DWI positive findings were identified in 31 patients (31/127, 24.4%) and motor function deficits were observed in 19 patients (19/127, 15%), respectively. DWI positive finding rate was higher in gliomas (14/43, 32.6%) than meningiomas (8/51, 15.7%) or other tumors including metastasis (6/32, 18.8%), however, there was no statistical significance. In MEP changes, group B&C (16/25, 64%) showed higher DWI positive rate than group A (13/102, 12.7%). In DWI findings, the DWI positive cases (16/31, 51.6%) showed a higher motor function deficit rates than the DWI negative cases (3/96, 3%). These two results were all statistically significant (P<0.01). In group A, motor function deficits were presented in 3 of 13 DWI positive case, all of which were transient. In group B, motor function deficits were presented in 9 out of 13 DWI positive cases with permanent 4 and transient 5. In group C, motor function deficits were presented in 4 out of 5 DWI positive cases with permanent 3 and transient 1. CONCLUSIONS Both intraoperative MEP changes and postoperative DWI positive findings in supratentorial brain tumor surgery were significant related with postoperative motor function deficits. Even if intraoperative MEP changes occur during supratentorial brain tumor surgery, active and appropriate efforts to prevent irreversible MEP changes may reduce the occurrence of permanent postoperative motor function deficits.

Sodium fluorescein–guided resection under the YELLOW 560 nm surgical microscope filter in malignant brain tumor surgery—a feasibility study

2013 ◽  
Vol 155 (4) ◽  
pp. 693-699 ◽  
Author(s):  
Karl-Michael Schebesch ◽  
Martin Proescholdt ◽  
Julius Höhne ◽  
Christoph Hohenberger ◽  
Ernil Hansen ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Feasibility Study ◽  
Malignant Brain Tumor ◽  
Sodium Fluorescein ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Surgical Microscope ◽  
Yellow 560

scholarly journals Surgical complications following malignant brain tumor surgery: An analysis of 2002–2011 data

2016 ◽  
Vol 140 ◽  
pp. 6-10 ◽  
Author(s):  
Rafael De la Garza-Ramos ◽  
Panagiotis Kerezoudis ◽  
Rafael J. Tamargo ◽  
Henry Brem ◽  
Judy Huang ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Surgical Complications ◽  
Malignant Brain Tumor ◽  
Tumor Surgery ◽  
Brain Tumor Surgery

scholarly journals COT-13 Luminance analysis of 5-aminolevulinic acid using Image J for malignant brain tumor

2021 ◽  
Vol 3 (Supplement_6) ◽  
pp. vi30-vi30
Author(s):  
Takashi Kon ◽  
Yusuke Kobayashi ◽  
Yosuke Sato ◽  
Katsuyoshi Shimizu ◽  
Tohru Mizutani
Keyword(s):  
Brain Tumor ◽  
Malignant Glioma ◽  
Aminolevulinic Acid ◽  
Malignant Gliomas ◽  
Malignant Brain Tumor ◽  
Photodynamic Diagnosis ◽  
Tumor Surgery ◽  
Maximum Luminance ◽  
Brain Tumor Surgery ◽  
Average Maximum

Abstract Purpose: For malignant brain tumor surgery, photodynamic diagnosis (PDD) with 5-aminolevulinic acid (5-ALA) is useful for maximal removal of the tumor. Although it has the advantage of identifying the presence or absence of residual tumors during surgery, there are variations in positive rates, and the classification is limited, based on visual inspection such as Stummer’s classification (strong, vague, none). We analyzed the luminance of positive findings using software Image J for brain tumor surgery using 5-ALA, and we report the results. Materials and Methods: From April 2018 to March 2021, 31 patients with suspected malignant glioma before surgery were included. Intraoperative 5-ALA positive findings were analyzed by software Image J (Wayne Rasband: NIH), the luminance was measured with a histogram, and compared the maximum luminance titer. Results: Among the positive cases, the average maximum luminance value for malignant glioma was 101 (50–168), which consisted of 11 cases of Glioblastoma, 1 case of Oligodendroglioma, and 1 case of anaplastic astrocytoma. The average maximum brightness of metastatic brain tumors is lower than that of malignant gliomas, even if they are visually strong, 83.5 (28–121). Conclusions: Even if it is visually strong in the conventional Stummer classification, it may be possible to classify in detail by analyzing luminance with Image J. In addition, more objective index is necessary to classify the vague findings.

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