The Role of the Intraoperative Auxiliary Methods in the Resection of Motor Area Lesions

Abstract

Objective In recent years, technologies have advanced considerably in improving surgical outcome following treatment of lesions in eloquent brain areas. The aim of this study is to explore which method is best in the resection of motor area lesions.

Methods Prospective, non-randomized study Evaluate on 74 patients who underwent surgery to remove lesions around the motor area.

Results Total lesion removal was achieved in 68 patients (93.1%). Fifty-four patients (73.9%) presented normal motor function in the preoperative period; of these, 20 (37.3%) developed transitory deficits. Nevertheless, 85% of these patients later experienced a complete recovery. Nineteen patients presented with motor deficits preoperatively; of these, five presented deteriorating motor abilities. Intraoperative stimulation methods were used in 65% of the patients, primarily in cases of glioma.

Conclusions The morbidity in patients submitted to resections of motor area lesions is acceptable and justify the surgical indication with the purpose of maximal resection. Intraoperative stimulation is an important tool that guides glioma resection in many cases.

Resumo

Objetivo Nos últimos anos, consideráveis avanços tecnológicos têm surgido no sentido de melhorar os resultados cirúrgicos no tratamento de lesões em áreas eloquentes do cérebro. O objetivo deste estudo é investigar qual o melhor método para ressecção de lesões em área motora.

Método Estudo prospectivo não aleatório que avaliou os resultados pós-operatórios em 74 pacientes submetidos à ressecção de lesões em área motora ou adjacente.

Resultados A ressecção cirúrgica foi considerada total em 68 (93,1%) pacientes. 54 pacientes (73,9%) apresentavam força muscular normal no pré-operatório. Destes, 20 (37,3%) apresentaram déficit no pós-operatório imediato, sendo que 17 (85%) recuperaram completamente o déficit. 19 pacientes apresentavam déficit no pré-operatório, sendo que 05 apresentaram piora do déficit no pós-operatório imediato. A estimulação intraoperatória foi utilizada em 65% dos casos, principalmente nos gliomas.

Conclusão A morbidade em pacientes operados de lesões em área motora é bastante aceitável e justifica a indicação cirúrgica com objetivo de ressecção máxima. A estimulação intraoperatória é uma ferramenta importante para guiar a resseção dos gliomas em muitos casos.

Keywords

motor cortex - brain neoplasms - stereotaxic techniques - neuronavigation

Palavras-chave

córtex motor - neoplasia cerebral - técnicas estereotáxicas - neuronavegação

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