June 11, 2014
Let's discuss details for resection of gliomas associated with postcentral gyrus and analyze mapping strategies to maximize tumor resection. This is a 34 year-old male with headaches, was found to have an incidental, right posterior parietal glioma with minimal amount of enhancement. Due to location of the mass, he underwent evaluation via functional MRI. The location of the model cortex was noted to be displaced superiorly in relation to the tumor, as demonstrated on the sagittal MRI image. An awake craniotomy was deemed appropriate. The patient was placed in the lateral position, a right poster frontal and parietal craniotomy was elevated. Ear is located just about here to dura was open currently fashion subdural electrode was also passed more posteriorly subdermally mapping was used and the motor cortex was mapped. Here's the location of the sensory cortex, stimulation of this area led to Paris Theseus in the contralateral opera extremity location of the tumor based of neuronavigation is mark using the black suture. As you can see, the tumor is very intimately associated with a sensory cortex. In this situation, I attempted removal of the tumor staying just as posteriorly as possible in relation to the sensory cortex standard microsurgical techniques were used to remove the tumor so purely following circumferential disconnection of the tumor from the surrounding white matter, I continue to remove the tumor within the deeper portion of the white matter tracks. Subcortical stimulation was also used for removal of the more anterior deeper support of the tumor, here's extraction of the more superficial part of the tumor. There is additional tumor left behind this location, the sensory cortex was undermined and the tumor was resected after removal of this piece of the tumor subcortical stimulation guided the rest of resection upon motor activity in the contralateral upper extremity for the resection was stopped. Neuro navigation confirmed adequate remove the mass can see the moral cortex in relation to our resection cavity, post operative MRI demonstrated reasonable removal of the mass. This patient had some deficits in proprioception. However, these deficits resolved within one month after surgery and he returned to work at that time. Thank you.
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