Functional approach using intraoperative brain mapping and neurophysiological monitoring for the surgical treatment of brain metastases in the central region
Objective: Brain metastases are the most frequent intracranial malignant tumor in adults. Surgical intervention for metastases in eloquent areas remains controversial and challenging. Even when metastases are not infiltrating intraparenchymal tumors, eloquent areas can be affected. Therefore, this s...
| Authors: | ; ; ; ; |
|---|---|
| Format: | Article |
| Status: | Published version |
| Publication date: | 2017 |
| Country: | España |
| Institution: | Universidad de Barcelona |
| Repository: | Dipòsit Digital de la UB |
| OAI Identifier: | oai:diposit.ub.edu:2445/218233 |
| Online Access: | https://hdl.handle.net/2445/218233 |
| Access Level: | Open access |
| Keyword: | Cervell Persones grans Mapatge del cervell Tumors cerebrals Brain Older people Brain mapping Brain tumors |
| _version_ | 1878740019356631040 |
|---|---|
| author | Sanmillan Blasco, Jose Luis |
| author2 | Fernandez-Coello, Alejandro Fernández-Conejero, Isabel Plans, Gerard Gabarrós, Andreu |
| author2_role | author author author author |
| author_browse | Fernandez-Coello, Alejandro Fernández-Conejero, Isabel Gabarrós, Andreu Plans, Gerard Sanmillan Blasco, Jose Luis |
| author_facet | Sanmillan Blasco, Jose Luis Fernandez-Coello, Alejandro Fernández-Conejero, Isabel Plans, Gerard Gabarrós, Andreu |
| author_role | author |
| collection | Dipòsit Digital de la UB |
| description | Objective: Brain metastases are the most frequent intracranial malignant tumor in adults. Surgical intervention for metastases in eloquent areas remains controversial and challenging. Even when metastases are not infiltrating intraparenchymal tumors, eloquent areas can be affected. Therefore, this study aimed to describe the role of a functional guided approach for the resection of brain metastases in the central region. Methods: Thirty-three patients (19 men and 14 women) with perirolandic metastases who were treated at the authors' institution were reviewed. All participants underwent resection using a functional guided approach, which consisted of using intraoperative brain mapping and/or neurophysiological monitoring to aid in the resection, depending on the functionality of the brain parenchyma surrounding each metastasis. Motor and sensory functions were monitored in all patients, and supplementary motor and language area functions were assessed in 5 and 4 patients, respectively. Clinical data were analyzed at presentation, discharge, and the 6-month follow-up. Results: The most frequent presenting symptom was seizure, followed by paresis. Gross-total removal of the metastasis was achieved in 31 patients (93.9%). There were 6 deaths during the follow-up period. After the removal of the metastasis, 6 patients (18.2%) presented with transient neurological worsening, of whom 4 had worsening of motor function impairment and 2 had acquired new sensory disturbances. Total recovery was achieved before the 3rd month of follow-up in all cases. Excluding those patients who died due to the progression of systemic illness, 88.9% of patients had a Karnofsky Performance Scale score greater than 80% at the 6-month follow-up. The mean survival time was 24.4 months after surgery. Conclusions: The implementation of intraoperative electrical brain stimulation techniques in the resection of central region metastases may improve surgical planning and resection and may spare eloquent areas. This approach also facilitates maximal resection in these and other critical functional areas, thereby helping to avoid new postoperative neurological deficits. Avoiding permanent neurological deficits is critical for a good quality of life, especially in patients with a life expectancy of over a year. |
| eu_rights_str_mv | openAccess |
| format | article |
| id | ES_cc2f41fe1d2e40d7bc8d120afd7a0621 |
| institution | Universidad de Barcelona |
| instname_str | Universidad de Barcelona |
| network_acronym_str | ES |
| network_name_str | España |
| oai_identifier_str | oai:diposit.ub.edu:2445/218233 |
| publishDate | 2017 |
| publishDateSort | 2017 |
| publisher | American Association of Neurological Surgeons |
| publisherStr | American Association of Neurological Surgeons |
| reponame_str | Dipòsit Digital de la UB |
| spelling | Functional approach using intraoperative brain mapping and neurophysiological monitoring for the surgical treatment of brain metastases in the central region Sanmillan Blasco, Jose Luis Fernandez-Coello, Alejandro Fernández-Conejero, Isabel Plans, Gerard Gabarrós, Andreu Cervell Persones grans Mapatge del cervell Tumors cerebrals Brain Older people Brain mapping Brain tumors Objective: Brain metastases are the most frequent intracranial malignant tumor in adults. Surgical intervention for metastases in eloquent areas remains controversial and challenging. Even when metastases are not infiltrating intraparenchymal tumors, eloquent areas can be affected. Therefore, this study aimed to describe the role of a functional guided approach for the resection of brain metastases in the central region. Methods: Thirty-three patients (19 men and 14 women) with perirolandic metastases who were treated at the authors' institution were reviewed. All participants underwent resection using a functional guided approach, which consisted of using intraoperative brain mapping and/or neurophysiological monitoring to aid in the resection, depending on the functionality of the brain parenchyma surrounding each metastasis. Motor and sensory functions were monitored in all patients, and supplementary motor and language area functions were assessed in 5 and 4 patients, respectively. Clinical data were analyzed at presentation, discharge, and the 6-month follow-up. Results: The most frequent presenting symptom was seizure, followed by paresis. Gross-total removal of the metastasis was achieved in 31 patients (93.9%). There were 6 deaths during the follow-up period. After the removal of the metastasis, 6 patients (18.2%) presented with transient neurological worsening, of whom 4 had worsening of motor function impairment and 2 had acquired new sensory disturbances. Total recovery was achieved before the 3rd month of follow-up in all cases. Excluding those patients who died due to the progression of systemic illness, 88.9% of patients had a Karnofsky Performance Scale score greater than 80% at the 6-month follow-up. The mean survival time was 24.4 months after surgery. Conclusions: The implementation of intraoperative electrical brain stimulation techniques in the resection of central region metastases may improve surgical planning and resection and may spare eloquent areas. This approach also facilitates maximal resection in these and other critical functional areas, thereby helping to avoid new postoperative neurological deficits. Avoiding permanent neurological deficits is critical for a good quality of life, especially in patients with a life expectancy of over a year. American Association of Neurological Surgeons https://hdl.handle.net/2445/218233 |
| spellingShingle | Functional approach using intraoperative brain mapping and neurophysiological monitoring for the surgical treatment of brain metastases in the central region Sanmillan Blasco, Jose Luis Cervell Persones grans Mapatge del cervell Tumors cerebrals Brain Older people Brain mapping Brain tumors |
| status_str | publishedVersion |
| title | Functional approach using intraoperative brain mapping and neurophysiological monitoring for the surgical treatment of brain metastases in the central region |
| title_full | Functional approach using intraoperative brain mapping and neurophysiological monitoring for the surgical treatment of brain metastases in the central region |
| title_fullStr | Functional approach using intraoperative brain mapping and neurophysiological monitoring for the surgical treatment of brain metastases in the central region |
| title_full_unstemmed | Functional approach using intraoperative brain mapping and neurophysiological monitoring for the surgical treatment of brain metastases in the central region |
| title_short | Functional approach using intraoperative brain mapping and neurophysiological monitoring for the surgical treatment of brain metastases in the central region |
| title_sort | Functional approach using intraoperative brain mapping and neurophysiological monitoring for the surgical treatment of brain metastases in the central region |
| topic | Cervell Persones grans Mapatge del cervell Tumors cerebrals Brain Older people Brain mapping Brain tumors |
| topic_facet | Cervell Persones grans Mapatge del cervell Tumors cerebrals Brain Older people Brain mapping Brain tumors |
| url | https://hdl.handle.net/2445/218233 |