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Neurochirurgie Scan 2016; 04(03): 233-245
DOI: 10.1055/s-0041-109537
Fortbildung
Imaging und Monitoring
© Georg Thieme Verlag KG Stuttgart · New York

Funktionelles Mapping

Sandro M. Krieg
,
Bernhard Meyer
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Publication History

Publication Date:
05 August 2016 (online)

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Zusammenfassung

Das Resektionsausmaß bestimmt bei dem Großteil der intrazerebralen Raumforderungen die Prognose. Allerdings schränkt die Nähe zu sogenannten eloquenten Hirnregionen die chirurgischen Möglichkeiten oft ein und erhöht das Risiko resektionsbedingter Defizite. Daher ist die Lokalisierung von funktionell eloquentem Kortex und zugehöriger subkortikaler Leitungsbahnen wichtig, um das Resektionsausmaß und das funktionelle Ergebnis zu verbessern. Verschiedene nichtinvasive Techniken lassen dies bereits präoperativ zu, wie funktionelles MRT (fMRT), diffusion tensor imaging fiber tracking (DTI FT) und neurophysiologische Methoden wie die Magnetenzephalografie (MEG) und die navigierte transkranielle Magnetstimulation (nTMS). Mit Hilfe dieser Methoden können die Operationsindikation und der operative Zugangsweg individuell angepasst werden. Intraoperativ erlauben es die direkte kortikale Stimulation (DCS) und die subkortikale Stimulation (SCS) nochmals, zu jeder Zeit die präoperativen Daten zu verifizieren. Durch den kombinierten Einsatz dieser Techniken konnte bereits gezeigt werden, dass das Resektionsausmaß und das funktionelle Ergebnis verbessert werden.

 

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