Intraoperative subcortical input function of module pathways in a serial program of 115 patients with Grade II glioma in the mitt dominating hemisphere.

J Neurosurg. 2008 Sep;109(3):461-471

Authors: Duffau H, Peggy Gatignol ST, Mandonnet E, Capelle L, Taillandier L

Object Despite meliorate noesis of cortical module organization, its subcortical anatomofunctional connectivity relic poorly understood. The authors utilised intraoperative subcortical input in awaken patients undergoing activeness for a glioma in the mitt dominating hemisphere to transpose the module pathways and to watch the effort of much a method to preoperative results. Methods One cardinal cardinal patients harboring a World Health Organization Grade II glioma within module areas underwent activeness after input of topical anesthesia, using candid electrical input to action online cortical and subcortical module function throughout the resection. Results After spotting of cortical module sites, the authors identified 1 or individualist of the mass subcortical module pathways in every patients: 1) arcuate fasciculus, eliciting phonemic paraphasia when stimulated; 2) base frontooccipital fasciculus, generating semantic paraphasia when stimulated; 3) subcallosal fasciculus, causation transcortical locomote aphasia during stimulation; 4) frontoparietal phonological loop, eliciting style apraxia during stimulation; and 5) fibers reaching from the dorsoventral premotor cortex, causation anarthria when stimulated. These structures were preserved, representing the limits of the resection. Despite a transient unmediated postoperative worsening, every but 2 patients (98%) returned to line or better. On curb MR imaging, 83% of resections were amount or subtotal. Conclusions These results equal the maximal undergo with manlike subcortical module function ever reported. The ingest of intraoperative cortical and subcortical input gives a unequalled possibleness to action an faithful and sure real-time anatomofunctional think of module connectivity. Such noesis of the individualist methodicalness of module networks enables practitioners to behave the benefit-to-risk ratio of surgery for Grade II glioma within the mitt dominating hemisphere.

PMID: 18759577 [PubMed - as supplied by publisher]

(Source: Journal of Neurosurgery)

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Tags: glioma, Health, imaging, Led, Lim, Risk, surgery