An intraoperative motor tract positioning method in brain tumor surgery: technical note

Area of Science:

• Neurosurgery
• Neuroscience
• Medical Technology

Background:

• Intraoperative identification of motor tracts is crucial for preventing neural fiber injury during brain tumor surgery.
• Conventional mapping methods can present challenges in precisely localizing these critical tracts.
• Gliomas adjacent to motor tracts pose a significant risk of intraoperative pyramidal tract damage.

Purpose of the Study:

• To develop and evaluate a novel brain mapping method for 3D recognition of motor tracts in intrinsic brain tumor surgeries.
• To enhance surgical precision and safety by improving the localization of motor tracts.
• To minimize the risk of neurological deficits associated with brain tumor resection near motor pathways.

Main Methods:

• A handheld brain-mapping probe, the NY Tract Finder (NYTF), was used for electrical stimulation and identification of motor tracts.
• Sixteen-gauge plastic tubes were mounted on the NYTF and inserted along the estimated motor tract direction using navigational guidance.
• The NYTF was removed post-stimulation, leaving the tubes in place to mark the motor tract's position.

Main Results:

• The novel technique successfully identified motor tracts in all 40 patients undergoing glioma resection.
• Neurophysiologically placed plastic tubes provided accurate 3D localization of motor tracts.
• The positioned tubes served as visual guides, defining the resection limit and enabling safe tumor removal with a defined margin.

Conclusions:

• The developed motor tract positioning method allows for effective 3D recognition of motor tracts during surgery.
• This technique facilitates safe tumor resection by clearly delineating critical neural structures.
• The method resulted in safe tumor removal without postoperative neurological deterioration in patients with gliomas near motor tracts.