![]() ![]() With the development of technology and equipment, SSEP is now applicable for majority of neurological and vascular surgeries that may cause neurological injury. Since last century, SSEP has been widely used to predict brain injury in the process of spinal cord surgery, such as regional ischemia ( 8). GTR was relatively low than iMRI and the incidence of PNDs was higher.įor localizing eloquent areas during general anesthesia and awake craniotomy and allows minimizing the incidence of PNDs while maximizing the EOR of tumorsįor monitoring spontaneous and stimulus-elicited epileptiform waves at the same time and show a potential for detecting glioma related epilepsy location Visualization of tumor cells and more sufficient for high-grade gliomas Insufficient sensitivity for small size tumor Substantially lengthens operation time and cannot contribute to avoid PNDs Good at detecting tumor boundaries and avoiding the effects of brain shift Time-consuming and inevitably affected by brain drift The brief description of intraoperative imaging techniques is shown in Table 1.Ĭombines with preoperative fMRI and presents real-time intuitive tumor detection Moreover, functional MRI does not distinguish between essential but compensable structures and those having to be retained for functional preservation ( 7). However, DTI cannot display the entire cortico-subcortical circuits, and the accuracy for exhibiting the anatomic regions depends on the fiber tracking software packages employed ( 5, 6). Regarding the technologies for achieving brain mapping, intraoperative functional neuronavigations are commonly applied in glioma resection, which combine with preoperative functional MRI ( 3, 4) to determine the brain functional localization. ![]() As a result, for surgery of gliomas involving eloquent areas, tumor boundary identification is not enough accurate brain mapping is also highly recommended. However, iMRI failed to lower the incidence of postoperative neurological dysfunction (PND) in this study ( 2). showed that 96% patients receiving iMRI got 100% tumor EOR compared with the 68% in the control group. Moreover, a clinical trial by Senft et al. In a previous study, the results showed that the combination of 5-ALA and contrast-enhanced ultrasound significantly improved the EOR compared with conventional strategy (median EOR%, 100 vs. Over the past few decades, intraoperative neuronavigation using magnetic resonance imaging (MRI), fluorescence imaging, and ultrasonography have been demonstrated as effective techniques in detecting tumor boundaries. For this reason, relevant assistive technologies have been introduced. As surgical operations are often accompanied by the risk of instant acute partial injuries to eloquent areas, the balance between maximal extent of resection (EOR) and neurological protection is always unmanageable. Surgical resection of gliomas involving eloquent areas has been a real challenge in glioma treatment. Gliomas involving eloquent areas present a specific subtype of gliomas, invading the cortex or subcortical structures associated with sensory, motor, language, and cognitive functions. For gliomas involving eloquent areas, the latter may be particularly important. Among these treatments, a generally accepted goal of glioma surgery is to achieve maximal safe resection, which reflects the need for both prolonging life and protecting neurological function. Currently, an optimal management of glioma requires a multidisciplinary approach including surgery, radiotherapy, chemotherapy, and supportive care. It generally originates from glial or precursor cells and can be characterized by complex genetic background and dismal prognosis. Glioma is the most common type of primary intracranial tumors and accounts for ~30% of them. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |