Neuronavigation-Guided Corticospinal Tract Mapping n Brainstem Tumor Surgery: Better Preservation of Motor Function

作者：Li, Zhibao; Wang, Mingran; Zhang, Liwei; Fan, Xing; Tao, Xiaorong; Qi, Lei; Ling, Miao; Xiao, Xiong; Wu, Yuliang; Guo, Dongze; Qiao, Hui^*

来源：World Neurosurgery, 2018, 116: E291-E297.

DOI：10.1016/j.wneu.2018.04.189

• Brainstem
• Corticospinal tract
• Intraoperative neurophysiology monitoring
• Neuronavigation

OBJECTIVE: To evaluate a new technique in brainstem surgery, neuronavigation (NN)-guided corticospinal tract (CST) mapping, in a retrospective study of patients undergoing brainstem tumor surgery. @@@ METHODS: We studied 40 patients with a brainstem tumor who were enrolled in this study. Patients whose worst preoperative muscle strength of the 4 limbs was greater than 3 levels from normal on the Lovett scale were divided into 2 groups: a treatment group of 21 patients who underwent NN-guided CST mapping and routine intraoperative neurophysiology monitoring (IONM) and a control group of 19 patients who underwent routine NN and IONM . Preoperative muscle strength and postoperative (day 90 postsurgery) muscle strength were assessed and compared between the 2 groups. @@@ RESULTS: In the NN-guided CST mapping group, 3 patients (14.3%) had a decrease in muscle strength by 1 level postoperatively, and no patient experienced a decrease of >1 level. In the control group, 4 patients (21.1%) had a 1-level decrease in muscle strength, and 5 (26.3%) had a decrease of >1 level. Patients in the NN-guided CST mapping group had significantly better surgical outcomes compared with those in the control group (P = 0.018, Fisher exact test). @@@ CONCLUSIONS: Brainstem tumor resection using NN-guided CST mapping achieved better preservation of motor function compared with routine NN and IONM. NN-guided CST mapping not only decreased the difficulty of the surgery, but also significantly improved the efficiency of surgery.

• 出版日期2018-8
• 单位北京市神经外科研究所; 首都医科大学