January 14, 2016
Let's review the feasibility for aggressive resection of gliomas in the premotor area and a supplementary motor area. This is a 50-year-old male who presented with a seizure on MRI evaluation, harbored, a low grade glioma, just anterior to the central lobule and within the SMA cortex. Function MRI demonstrated the location of the central lobule and the vicinity of the mass to the functional cortices. Coronal MRI demonstrate the extent of the tumor to the level of the corpus callosum. This lesion was relatively non-enhanced sync. The patient underwent an awake craniotomy. I would rather use awake craniotomy and more stimulation for reliable mapping of the functional cortices, when the tumor is intimately associated with the central lobule. The incision crosses the midline. You can see the large draining vein separating the area of the cortices affected by the tumor versus the central lobule. The tumor-infiltrated cortices are expanded. Here's the margins of the tumor marked with a segment of the suture. The peel surfaces over the tumor are coagulated. Standard microsurgical techniques for a section of gliomas are used to remove the tumor. Biopsy's performed early. White matter dissection is continued using navigation to remove the middle of the tumor. So peel remove the tumor along the medial peel membranes is continued after the bulk of the tumor is removed. The bipolar forceps are used to emulsify the tumor. This technique relatively easily differentiates between the normal white matter or pre-tumoral white matter, and the neoplastic areas. Here you can see how the forceps are used to dissect the pre-tumoral areas. All the walls of the resection cavity are carefully inspected.
Frequent intra-operative neurological examinations are used to guide the surgeon. Furthermore, subcortical mapping is used along the posterior aspect of the resection cavity. To allow aggressive, safe removal of the tumor. Here you can see the peel membranes over the fox. Dissection is extended to the level of the corpus callosum. Navigation confirms gross total removal of the tumor with preservation of function. The vein of Trolard was also protected. Postoperative MRI confirms good resection of the tumor. This patient did not suffer from any neurological deficit subsequent to his resection operation. Thank you.
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