Functional approach using intraoperative brain mapping and neurophysiological monitoring for the surgical treatment of brain metastases in the central region

Objective: Brain metastases are the most frequent intracranial malignant tumor in adults. Surgical intervention for metastases in eloquent areas remains controversial and challenging. Even when metastases are not infiltrating intraparenchymal tumors, eloquent areas can be affected. Therefore, this s...

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Autores: Sanmillan Blasco, Jose Luis, Fernandez-Coello, Alejandro, Fernández-Conejero, Isabel, Plans, Gerard, Gabarrós, Andreu
Tipo de documento: artigo
Estado:Versão publicada
Data de publicação:2017
País:España
Recursos:Universidad de Barcelona
Repositório:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/218233
Acesso em linha:https://hdl.handle.net/2445/218233
Access Level:Acceso aberto
Palavra-chave:Cervell
Persones grans
Mapatge del cervell
Tumors cerebrals
Brain
Older people
Brain mapping
Brain tumors
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spelling Functional approach using intraoperative brain mapping and neurophysiological monitoring for the surgical treatment of brain metastases in the central regionSanmillan Blasco, Jose LuisFernandez-Coello, AlejandroFernández-Conejero, IsabelPlans, GerardGabarrós, AndreuCervellPersones gransMapatge del cervellTumors cerebralsBrainOlder peopleBrain mappingBrain tumorsObjective: Brain metastases are the most frequent intracranial malignant tumor in adults. Surgical intervention for metastases in eloquent areas remains controversial and challenging. Even when metastases are not infiltrating intraparenchymal tumors, eloquent areas can be affected. Therefore, this study aimed to describe the role of a functional guided approach for the resection of brain metastases in the central region. Methods: Thirty-three patients (19 men and 14 women) with perirolandic metastases who were treated at the authors' institution were reviewed. All participants underwent resection using a functional guided approach, which consisted of using intraoperative brain mapping and/or neurophysiological monitoring to aid in the resection, depending on the functionality of the brain parenchyma surrounding each metastasis. Motor and sensory functions were monitored in all patients, and supplementary motor and language area functions were assessed in 5 and 4 patients, respectively. Clinical data were analyzed at presentation, discharge, and the 6-month follow-up. Results: The most frequent presenting symptom was seizure, followed by paresis. Gross-total removal of the metastasis was achieved in 31 patients (93.9%). There were 6 deaths during the follow-up period. After the removal of the metastasis, 6 patients (18.2%) presented with transient neurological worsening, of whom 4 had worsening of motor function impairment and 2 had acquired new sensory disturbances. Total recovery was achieved before the 3rd month of follow-up in all cases. Excluding those patients who died due to the progression of systemic illness, 88.9% of patients had a Karnofsky Performance Scale score greater than 80% at the 6-month follow-up. The mean survival time was 24.4 months after surgery. Conclusions: The implementation of intraoperative electrical brain stimulation techniques in the resection of central region metastases may improve surgical planning and resection and may spare eloquent areas. This approach also facilitates maximal resection in these and other critical functional areas, thereby helping to avoid new postoperative neurological deficits. Avoiding permanent neurological deficits is critical for a good quality of life, especially in patients with a life expectancy of over a year.American Association of Neurological Surgeons2017info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/218233Articles publicats en revistes (Patologia i Terapèutica Experimental)reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.3171/2016.2.JNS152855Journal of Neurosurgery, 2017, vol. 126, num.3, p. 698-707https://doi.org/10.3171/2016.2.JNS152855(c) American Association of Neurological Surgeons, 2017info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/2182332026-05-27T06:46:51Z
dc.title.none.fl_str_mv Functional approach using intraoperative brain mapping and neurophysiological monitoring for the surgical treatment of brain metastases in the central region
title Functional approach using intraoperative brain mapping and neurophysiological monitoring for the surgical treatment of brain metastases in the central region
spellingShingle Functional approach using intraoperative brain mapping and neurophysiological monitoring for the surgical treatment of brain metastases in the central region
Sanmillan Blasco, Jose Luis
Cervell
Persones grans
Mapatge del cervell
Tumors cerebrals
Brain
Older people
Brain mapping
Brain tumors
title_short Functional approach using intraoperative brain mapping and neurophysiological monitoring for the surgical treatment of brain metastases in the central region
title_full Functional approach using intraoperative brain mapping and neurophysiological monitoring for the surgical treatment of brain metastases in the central region
title_fullStr Functional approach using intraoperative brain mapping and neurophysiological monitoring for the surgical treatment of brain metastases in the central region
title_full_unstemmed Functional approach using intraoperative brain mapping and neurophysiological monitoring for the surgical treatment of brain metastases in the central region
title_sort Functional approach using intraoperative brain mapping and neurophysiological monitoring for the surgical treatment of brain metastases in the central region
dc.creator.none.fl_str_mv Sanmillan Blasco, Jose Luis
Fernandez-Coello, Alejandro
Fernández-Conejero, Isabel
Plans, Gerard
Gabarrós, Andreu
author Sanmillan Blasco, Jose Luis
author_facet Sanmillan Blasco, Jose Luis
Fernandez-Coello, Alejandro
Fernández-Conejero, Isabel
Plans, Gerard
Gabarrós, Andreu
author_role author
author2 Fernandez-Coello, Alejandro
Fernández-Conejero, Isabel
Plans, Gerard
Gabarrós, Andreu
author2_role author
author
author
author
dc.subject.none.fl_str_mv Cervell
Persones grans
Mapatge del cervell
Tumors cerebrals
Brain
Older people
Brain mapping
Brain tumors
topic Cervell
Persones grans
Mapatge del cervell
Tumors cerebrals
Brain
Older people
Brain mapping
Brain tumors
description Objective: Brain metastases are the most frequent intracranial malignant tumor in adults. Surgical intervention for metastases in eloquent areas remains controversial and challenging. Even when metastases are not infiltrating intraparenchymal tumors, eloquent areas can be affected. Therefore, this study aimed to describe the role of a functional guided approach for the resection of brain metastases in the central region. Methods: Thirty-three patients (19 men and 14 women) with perirolandic metastases who were treated at the authors' institution were reviewed. All participants underwent resection using a functional guided approach, which consisted of using intraoperative brain mapping and/or neurophysiological monitoring to aid in the resection, depending on the functionality of the brain parenchyma surrounding each metastasis. Motor and sensory functions were monitored in all patients, and supplementary motor and language area functions were assessed in 5 and 4 patients, respectively. Clinical data were analyzed at presentation, discharge, and the 6-month follow-up. Results: The most frequent presenting symptom was seizure, followed by paresis. Gross-total removal of the metastasis was achieved in 31 patients (93.9%). There were 6 deaths during the follow-up period. After the removal of the metastasis, 6 patients (18.2%) presented with transient neurological worsening, of whom 4 had worsening of motor function impairment and 2 had acquired new sensory disturbances. Total recovery was achieved before the 3rd month of follow-up in all cases. Excluding those patients who died due to the progression of systemic illness, 88.9% of patients had a Karnofsky Performance Scale score greater than 80% at the 6-month follow-up. The mean survival time was 24.4 months after surgery. Conclusions: The implementation of intraoperative electrical brain stimulation techniques in the resection of central region metastases may improve surgical planning and resection and may spare eloquent areas. This approach also facilitates maximal resection in these and other critical functional areas, thereby helping to avoid new postoperative neurological deficits. Avoiding permanent neurological deficits is critical for a good quality of life, especially in patients with a life expectancy of over a year.
publishDate 2017
dc.date.none.fl_str_mv 2017
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/218233
url https://hdl.handle.net/2445/218233
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.3171/2016.2.JNS152855
Journal of Neurosurgery, 2017, vol. 126, num.3, p. 698-707
https://doi.org/10.3171/2016.2.JNS152855
dc.rights.none.fl_str_mv (c) American Association of Neurological Surgeons, 2017
info:eu-repo/semantics/openAccess
rights_invalid_str_mv (c) American Association of Neurological Surgeons, 2017
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv American Association of Neurological Surgeons
publisher.none.fl_str_mv American Association of Neurological Surgeons
dc.source.none.fl_str_mv Articles publicats en revistes (Patologia i Terapèutica Experimental)
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,81155

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