April 29, 2016
Let's present another video regarding resection of perirolandic gliomas and maximizing resection of these tumors using intra-operative mapping. This is a 32-year-old female who presented with seizures. MRI evaluation revealed a partially or minimally enhancing mass within the posterior aspect of the rolandic cortex, potentially affecting the sensory cortex. You can see this is a functional MRI with the red marker placed over the motor cortex. So I suspected that this tumor could be infiltrating the sensory cortex and potentially and part of that posterior aspect of the motor cortex, and intra-operative mapping was utilized. Let's go ahead and review the intra-operative findings are in this case. The patient positioning is illustrated. You can see the linear incision was utilized. Let's go ahead and orient our viewers, superior sagittal sinus is located here, strip electrode is used for corticography. Initially mapping was used at four milliamps. You can see the arm is moving, therefore, the motor cortex was immediately mapped. So here's the wrist area, here's the hand area, and this area corresponded to the area of the tumor. I suspect that the sensory cortex is somewhat pushed anteriorly since the stimulation of the area just over the tumor did not reveal any sensory changes. Since super stimulation of the area over the tumor did not reveal any evidence of paraesthesias, I went ahead and placed a very small corticotomy over the tumor and continued tumor removal. I removed the tumor in a sup heal fashion using an angle dissector to remove the tumor that was facing the pier of the next gyrus, which was the sensory gyrus. I avoided significant use of bi-polar coagulation to minimize thermal injury to the gyrus ahead of me. Here, you can see the technique of using superior resection and running into a relatively normal appearing. White matter subcortical stimulation was utilized continuously as well as frequent intra-operative examinations. Here is relatively normal appearing white matter. Here's the pia of the next gyrus. Again, you, please see this technique of removing the tumor against the pia of the next gyrus. Often the tumor does not invade the pia of the next gyrus. And as long as I stay on the gyrus of the tumor or the pia surface of the gyrus that harvest the tumor, I'm able to achieve intra-section of the tumor. Here's the post-operative MRI which revealed costal removal of the mass without any complicating features. And this patient made an excellent recovery without any new sensory or motor deficits. The final pathology of the tumor was consistent with a grade three oligoastrocytoma. Thank you.
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