Download PDF
CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
DOI: 10.1055/s-0043-1776280
Original Article

Assessment of the Benefit of Intraoperative Cortical Stimulation in Patients with Lesions within Eloquent Brain Regions

Avaliação do benefício da estimulação cortical intraoperatória em pacientes com lesões em áreas cerebrais eloquentes
Luiz Alberto Otoni Garcia
2   Service of Neurosurgery, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
,
Alexandre Varella Giannetti 
1   Department of Surgery, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
2   Service of Neurosurgery, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Objective The present study sought to evaluate the benefits of intraoperative cortical stimulation (CS) for reducing morbidity in neurosurgery.

Method A total of 56 patients were submitted to neurosurgical procedure with the aid of CS. Initially, surgical exposure and planned resection were based on anatomy and imaging exams, which were followed by CS. According to the findings, the patients were divided into two groups. In group 1 the previous surgical strategy had to be altered, while in group 2 the surgical planning did not suffer any interference. Patients were also divided into subgroups according to the underlying disease: gliomas or other etiologies. Transient and definitive deficits occurrence were compared between groups 1 and 2 and subgroups of etiologies. The real benefit of CS technique was calculated by a specific formula.

Results There were 20 patients (37.5%) whose surgical strategy was changed based on CS findings. Furthermore, 65% of group 1 patients had transient deficit, in comparison to 30.5% of patients in group 2 (p = 0.013). As for the definitive deficit, it occurred in 15.0% of group 1 patients versus 8.3% of patients in group 2 (p = 0.643). Definitive deficits with no statistical difference (p = 0.074) were found in 17.2% of patients with gliomas, while none were found in the other etiologies subgroup. The rate of real benefit of intraoperative CS was 30.4%. Considering the subgroups of gliomas and other etiologies, the benefit rates were 25.7% and 38.1%, respectively.

Conclusions The surgical decision was influenced by CS in 35.7% of the cases and prevented definitive deficit in 30% of patients.

Resumo

Objetivos O presente estudo procurou avaliar os benefícios da estimulação cortical (EC) intraoperatória na redução da morbidade em neurocirurgias.

Métodos Um total de 56 pacientes foram submetidos ao procedimento neurocirúrgico com ajuda da EC. Inicialmente, a exposição cirúrgica e o panejamento da ressecção eram baseados nos achados de anatomia e imagem, que eram seguidos pela EC. De acordo com os achados neurofisiológicos, os pacientes foram divididos em dois grupos. No grupo 1, a estratégia cirúrgica teve que ser modificada, enquanto no grupo 2, o planejamento cirúrgico não foi alterado. Os pacientes foram ainda divididos em dois subgrupos de acordo com a doença subjacente: gliomas ou outras etiologias. A ocorrência de déficits transitórios e definitivos foram comparadas entre os grupos 1 e 2 e entre os subgrupos de etiologias. O benefício real da técnica de estimulação cortical foi calculado por uma fórmula específica.

Resultados A estratégia cirúrgica foi alterada em 20 (37,5%) pacientes após a estimulação cortical. Além disso, 65% dos pacientes do grupo 1 tiveram déficits transitórios, em comparação com 30,5% dos pacientes do grupo 2 (p = 0,013). Quanto ao déficit definitivo, este ocorreu em 15% dos casos do grupo 1 contra 8,3% dos pacientes do grupo 2 (p = 0,643). Déficit definitivo sem diferença significativa (p = 0,074) foi observado em 17,2% dos pacientes com gliomas, enquanto nenhum foi encontrado no subgrupo de outras etiologias. A taxa de benefício real da EC intraoperatória foi de 30,4%. Considerando os subgrupos de gliomas e outras etiologias as taxas de benefício foram 25,7% e 38,1%, respectivamente.

Conclusões A EC influenciou a decisão cirúrgica em 35,7% dos casos. Embora 90% dos pacientes não tenham cursado com déficits a longo prazo, a estimulação cortical preveniu tais déficits em cerca de um terço deles.

Keywords

intraoperative neurophysiological monitoring - gliomas - brain mapping - neuronal plasticity - surgery - direct electrical stimulation

Palavras Chaves

monitorização neurofisiológica intraoperatória - gliomas - mapeamento cerebral - plasticidade neuronal - cirurgia - estimulação elétrica direta


Publication History

Received: 09 March 2023

Accepted: 21 June 2023

Article published online:
31 October 2023

© 2023. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Berger MS, Ojemann GA. Intraoperative brain mapping techniques in neuro-oncology. Stereotact Funct Neurosurg 1992; 58 (1-4): 153-161
    CrossrefPubMedGoogle Scholar
  • 2 Sanai N, Berger MS. Glioma extent of resection and its impact on patient outcome. Neurosurgery 2008; 62 (04) 753-764 , discussion 264–266
    CrossrefPubMedGoogle Scholar
  • 3 Sanai N, Berger MS. Operative techniques for gliomas and the value of extent of resection. Neurotherapeutics 2009; 6 (03) 478-486
    CrossrefPubMedGoogle Scholar
  • 4 Rudà R, Soffietti R. Extent of surgery in low-grade gliomas: an old question in a new context. Neuro-oncol 2018; 20 (01) 6-7
    CrossrefPubMedGoogle Scholar
  • 5 Duffau H, Capelle L, Sichez J. et al. Intra-operative direct electrical stimulations of the central nervous system: the Salpêtrière experience with 60 patients. Acta Neurochir (Wien) 1999; 141 (11) 1157-1167
    CrossrefPubMedGoogle Scholar
  • 6 Duffau H, Capelle L. [Functional recuperation after resection of gliomas infiltrating primary somatosensory fields. Study of perioperative electric stimulation]. Neurochirurgie 2001; 47 (06) 534-541
    PubMedGoogle Scholar
  • 7 Uematsu S, Lesser R, Fisher RS. et al. Motor and sensory cortex in humans: topography studied with chronic subdural stimulation. Neurosurgery 1992; 31 (01) 59-71 , discussion 71–72
    PubMedGoogle Scholar
  • 8 Boling W, Reutens DC, Olivier A. Functional topography of the low postcentral area. J Neurosurg 2002; 97 (02) 388-395
    CrossrefPubMedGoogle Scholar
  • 9 Duffau H. Lessons from brain mapping in surgery for low-grade glioma: insights into associations between tumour and brain plasticity. Lancet Neurol 2005; 4 (08) 476-486
    CrossrefPubMedGoogle Scholar
  • 10 Duffau H, Lopes M, Arthuis F. et al. Contribution of intraoperative electrical stimulations in surgery of low grade gliomas: a comparative study between two series without (1985-96) and with (1996-2003) functional mapping in the same institution. J Neurol Neurosurg Psychiatry 2005; 76 (06) 845-851
    CrossrefPubMedGoogle Scholar
  • 11 Pereira LC, Oliveira KM, L'Abbate GL, Sugai R, Ferreira JA, da Motta LA. Outcome of fully awake craniotomy for lesions near the eloquent cortex: analysis of a prospective surgical series of 79 supratentorial primary brain tumors with long follow-up. Acta Neurochir (Wien) 2009; 151 (10) 1215-1230
    CrossrefPubMedGoogle Scholar
  • 12 De Witt Hamer PC, Robles SG, Zwinderman AH, Duffau H, Berger MS. Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis. J Clin Oncol 2012; 30 (20) 2559-2565
    CrossrefPubMedGoogle Scholar
  • 13 Magill ST, Han SJ, Li J, Berger MS. Resection of primary motor cortex tumors: feasibility and surgical outcomes. J Neurosurg 2018; 129 (04) 961-972
    CrossrefPubMedGoogle Scholar
  • 14 Duffau H, Gatignol P, Mandonnet E, Peruzzi P, Tzourio-Mazoyer N, Capelle L. New insights into the anatomo-functional connectivity of the semantic system: a study using cortico-subcortical electrostimulations. Brain 2005; 128 (Pt 4): 797-810
    CrossrefPubMedGoogle Scholar
  • 15 Skirboll SS, Ojemann GA, Berger MS, Lettich E, Winn HR. Functional cortex and subcortical white matter located within gliomas. Neurosurgery 1996; 38 (04) 678-684 , discussion 684–685
    CrossrefPubMedGoogle Scholar
  • 16 Agresti A, Min Y. Unconditional small-sample confidence intervals for the odds ratio. Biostatistics 2002; 3 (03) 379-386
    CrossrefPubMedGoogle Scholar
  • 17 Sanai N, Polley MY, McDermott MW, Parsa AT, Berger MS. An extent of resection threshold for newly diagnosed glioblastomas. J Neurosurg 2011; 115 (01) 3-8
    CrossrefPubMedGoogle Scholar
  • 18 Sanai N, Berger MS. Surgical oncology for gliomas: the state of the art. Nat Rev Clin Oncol 2018; 15 (02) 112-125
    CrossrefPubMedGoogle Scholar
  • 19 Robles SG, Gatignol P, Lehéricy S, Duffau H. Long-term brain plasticity allowing a multistage surgical approach to World Health Organization Grade II gliomas in eloquent areas. J Neurosurg 2008; 109 (04) 615-624
    CrossrefPubMedGoogle Scholar
  • 20 Southwell DG, Hervey-Jumper SL, Perry DW, Berger MS. Intraoperative mapping during repeat awake craniotomy reveals the functional plasticity of adult cortex. J Neurosurg 2016; 124 (05) 1460-1469
    CrossrefPubMedGoogle Scholar
  • 21 Ojemann G, Ojemann J, Lettich E, Berger M. Cortical language localization in left, dominant hemisphere. An electrical stimulation mapping investigation in 117 patients. 1989. J Neurosurg 2008; 108 (02) 411-421
    CrossrefPubMedGoogle Scholar
  • 22 Ojemann GA. Cortical organization of language. J Neurosci 1991; 11 (08) 2281-2287
    CrossrefPubMedGoogle Scholar