Safe resection of gliomas of the dominant angular gyrus availing of preoperative fMRI and intraoperative DTI.Preliminary series and surgical technique.

World Neurosurg. 2015 Nov 5;

Authors: D'Andrea G, Familiari P, Di Lauro A, Angelini A, Sessa G

Abstract
OBJECTIVE: Language dysfunction, visual deficit, numeracy impairment and Gerstmann's syndrome may often occur having approached this cortical area; furthermore, the subcortical white matter is the inviolable limit of "functional neurosurgery". Preoperative functional neuroimaging (fMRI) and tractography are capable of providing the data required for safe "surgical planning" both at cortical and subcortical level.
METHODS: We report our experience regarding high-grade gliomas affecting the dominant AG, SMG, IPS and their respective subcortical areas using intraoperative MRI and DTI. Retrospectively, we reviewed a consecutive series of 27 patients operated in a BrainSuite® for high-grade intra-parenchymal tumours of the left posterior temporo-parietal junction. We included tumours involving the dominant AG, SMG and /or IPS and the subcortical course of AF and all the patients who underwent preoperative fMRI and DTI to localize the AF and the eloquent cortical areas. Just after craniotomy, new volumetric MRI and DTI verified and corrected possible brain shift. After the gross total resection was carried out, and before approaching the residual mass close to the white matter tract, an intraoperative MRI was again performed.
RESULTS: We operated 27 patients, of whom 15 males and 12 females whose diagnosis was always high-grade glioma. During the preoperative neurological examination, 6 patients were asymptomatic, 3 presented a Gerstmann syndrome, 16 showed dysphasic disturbances, 6 of which associated with visual field deficits, and 2 showed weakness of the right limb.
CONCLUSIONS: Our results suggest that this approach is completely safe and effective as an alternative to awake surgery.

PMID: 26548825 [PubMed - as supplied by publisher]