Operative treatment of primary brain tumors localized in motor zone with direct corticalis electrostimulation: Series of 62 patients

Abstract

In spite of the progress made in diagnostic procedures and development of the operating rooms technology, considerable neurological deficit after operation of tumors localized in the brain motor zone commits one to direct intraoperative identification of the motor zone. By introducing direct electrocortical stimulation into the routine intraoperative application the primary goal has been achieved - reaching the maximum degree of radicalness of surgical resection while preserving motor centres in the cerebral cortex. Method: We are hereby demonstrating a series of 60 patients operated for primary brain tumors localized in the area in the front and around the central sulcus. All operations have been performed under the general anesthetics. During the operations the method of direct electrostimulation (ES) was used for the purpose of identifying motor centres. Results: Intraoperatively a level of subtotal resection was achieved in 22 cases, while radical resection was possible in 38 cases. Significantly higher level of radicalness of surgical resection of the low grade glioma tumor was confirmed statistically in relation to the group of patients with glioblastoma multiforme by applying the ES cortex (p<0,05). Patients with slow developing brain glioma have statistically considerably higher KI value in relation to the KI values in the group of patients with glioblastoma multiforme (p<0,01). Difference in the measured values of distance from the coronal suture based on the results of MRI measuring and finding obtained by ES, has shown a statistically considerably higher difference with glioblastoma multiforme 8,26+4,288mm when comapred to slowly developing astrocitoma 5,88+3,080 (p<0,05). Conclusion: Electrostimulation of the brain cortex is a safe, simple and precise method for identification of the brain motor zone which enables prevention of additional postoperative deficit and higher level of surgical radicalness.