open access

Vol 45, No 4 (2011)
ARTYKUŁ ORYGINALNY
Submitted: 2010-06-04
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Surgical treatment of insular tumours with tractography, functional magnetic resonance imaging, transcranial electrical stimulation and direct subcortical stimulation support

Krzysztof Majchrzak, Barbara Bobek-Billewicz, Michał Tymowski, Piotr Adamczyk, Henryk Majchrzak, Piotr ładziński
DOI: 10.1016/S0028-3843(14)60106-7
·
Neurol Neurochir Pol 2011;45(4):351-362.

open access

Vol 45, No 4 (2011)
ARTYKUŁ ORYGINALNY
Submitted: 2010-06-04

Abstract

Background and purpose

Surgical treatment of insular tumours carries significant risks of limb paresis or speech disturbances due to their localization. The development of intraoperative neuromonitoring techniques that involve evoked motor potentials induced via both direct and transcranial cortical electrical stimulation as well as direct subcortical white matter stimulation, intraoperative application of preoperative tractography and functional magnetic resonanceimaging (fMRI) in conjunction with neuronavigation resulted in significant reduction of postoperative disabilities that enabled widening of indications for surgical treatment. The aim of this study was to present the authors’ own experience with surgical treatment of insular gliomas.

Material and methods

Our cohort comprises 30 patients with insular gliomas treated at the Department of Neurosurgery in Sosnowiec. Clinical symptoms included sensorimotor partial seizures in 86.6%; generalized seizures in 23.3%; persistent headaches in 16.6% and hemiparesis in 6.6%. All the patients were operated on with intraoperative neuromonitoring that included transcranial cortical stimulation, direct subcortical white matter stimulation as well as tractography and fMRI concurrently with neuronavigation. The analysis included postoperative neurological evaluation along with the assessment of the radicalism of resection evaluated based on postoperative MRI.

Results

Postoperatively, four patients had permanent hemiparesis (13.3%); importantly, two out of those patients had preoperative deficits (6.6%). Persistent speech disturbances were present in four patients (13.3%). Partial sensorimotor seizures were noted in two patients (6.6%). Seizures in the other patients receded. Intraoperative transcranial electrical stimulation as well as direct subcortical white matter stimulation along with tractography (DTI) and fMRI facilitated gross total resection of insular gliomas in 53.5%, subtotal in 13.3% and partial resection in 33.1%.

Conclusions

Implementation of TES, direct subcortical white master stimulation, DTI and fMRI into the management protocol of the surgical treatment of insular tumours resulted in total and subtotal resections in 66% of cases with permanent motor disability in 6.6% of patients. Poor prognosis for independent living after surgery mainly affects patients with WHO grade III or IV.

Abstract

Background and purpose

Surgical treatment of insular tumours carries significant risks of limb paresis or speech disturbances due to their localization. The development of intraoperative neuromonitoring techniques that involve evoked motor potentials induced via both direct and transcranial cortical electrical stimulation as well as direct subcortical white matter stimulation, intraoperative application of preoperative tractography and functional magnetic resonanceimaging (fMRI) in conjunction with neuronavigation resulted in significant reduction of postoperative disabilities that enabled widening of indications for surgical treatment. The aim of this study was to present the authors’ own experience with surgical treatment of insular gliomas.

Material and methods

Our cohort comprises 30 patients with insular gliomas treated at the Department of Neurosurgery in Sosnowiec. Clinical symptoms included sensorimotor partial seizures in 86.6%; generalized seizures in 23.3%; persistent headaches in 16.6% and hemiparesis in 6.6%. All the patients were operated on with intraoperative neuromonitoring that included transcranial cortical stimulation, direct subcortical white matter stimulation as well as tractography and fMRI concurrently with neuronavigation. The analysis included postoperative neurological evaluation along with the assessment of the radicalism of resection evaluated based on postoperative MRI.

Results

Postoperatively, four patients had permanent hemiparesis (13.3%); importantly, two out of those patients had preoperative deficits (6.6%). Persistent speech disturbances were present in four patients (13.3%). Partial sensorimotor seizures were noted in two patients (6.6%). Seizures in the other patients receded. Intraoperative transcranial electrical stimulation as well as direct subcortical white matter stimulation along with tractography (DTI) and fMRI facilitated gross total resection of insular gliomas in 53.5%, subtotal in 13.3% and partial resection in 33.1%.

Conclusions

Implementation of TES, direct subcortical white master stimulation, DTI and fMRI into the management protocol of the surgical treatment of insular tumours resulted in total and subtotal resections in 66% of cases with permanent motor disability in 6.6% of patients. Poor prognosis for independent living after surgery mainly affects patients with WHO grade III or IV.

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Keywords

insular gliomas, surgery, DTI, fMRI, transcranial electrical stimulation, subcortical stimulation

About this article
Title

Surgical treatment of insular tumours with tractography, functional magnetic resonance imaging, transcranial electrical stimulation and direct subcortical stimulation support

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 45, No 4 (2011)

Pages

351-362

DOI

10.1016/S0028-3843(14)60106-7

Bibliographic record

Neurol Neurochir Pol 2011;45(4):351-362.

Keywords

insular gliomas
surgery
DTI
fMRI
transcranial electrical stimulation
subcortical stimulation

Authors

Krzysztof Majchrzak
Barbara Bobek-Billewicz
Michał Tymowski
Piotr Adamczyk
Henryk Majchrzak
Piotr ładziński

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