Safe Resection of Gliomas of the Dominant Angular Gyrus Availing of Preoperative FMRI and Intraoperative DTI: Preliminary Series and Surgical Technique

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• 作者：Giancarlo D'Andrea¹ ; ^{gdandrea2002@yahoo.it" class="auth_mail" title="E-mail the corresponding author} ; Pietro Familiari¹ ; Antonio Di Lauro² ; Albina Angelini¹ ; Giovanni Sessa¹
• 关键词：Dominant angular gyrus ; Glioma ; Intraoperative DTI
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：87
• 期：Complete
• 页码：627-639
• 全文大小：8615 K

文摘

Language dysfunction, visual deficit, numeracy impairment, and Gerstmann syndrome often occur in the cortical area; furthermore, the subcortical white matter is the inviolable limit of “functional neurosurgery.” Preoperative functional magnetic resonance imaging (fMRI) and tractography are capable of providing the data required for safe “surgical planning” at both the cortical and subcortical levels.

ec_2">Methods

We report our experience regarding high-grade gliomas affecting the dominant angular gyrus (AG), supramarginal gyrus (SMG), intraparietal sulcus (IPS), and their respective subcortical areas using intraoperative MRI and diffusion tensor imaging (DTI).

Retrospectively, we reviewed a consecutive series of 27 patients operated in a BrainSuite for high-grade intraparenchymal tumors of the left posterior temporoparietal junction. We included tumors involving the dominant AG, SMG, and/or IPS and the subcortical course of arcuate fasciculus (AF) and all the patients who underwent preoperative fMRI and DTI to localize the AF and the eloquent cortical areas. Just after craniotomy, new volumetric MRI and DTI verified and corrected possible brain shift. After the gross total resection was carried out, and before approaching the residual mass close to the white matter tract, an intraoperative MRI was again performed.

ec_3">Results

We operated on 27 patients, 15 males and 12 females, whose diagnosis was always high-grade glioma. During the preoperative neurologic examination, 6 patients were asymptomatic; 3 presented a Gerstmann syndrome; 16 showed dysphasic disturbances, 6 of which were associated with visual field deficits; and 2 showed weakness of the right limb.

ec_4">Conclusions

Our results suggest that this approach is completely safe and effective as an alternative to awake surgery.