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Related Experiment Videos

Functional cortex and subcortical white matter located within gliomas

S S Skirboll1, G A Ojemann, M S Berger

  • 1Department of Neurological Surgery, University of Washington, Seattle, USA.

Neurosurgery
|April 1, 1996
PubMed
Summary

Functional brain tissue can be found within gliomas, challenging assumptions about safe tumor resection. Intraoperative mapping is crucial for identifying and preserving critical functions during surgery to minimize neurological deficits.

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Cortical language localization in left, dominant hemisphere. An electrical stimulation mapping investigation in 117 patients. 1989.

Journal of neurosurgery·2008

Area of Science:

  • Neurosurgery
  • Neuro-oncology
  • Neurophysiology

Background:

  • Traditionally, intra-axial tumor resection focused on removing grossly abnormal tissue, assuming functional areas adjacent to the tumor were safe if undisturbed.
  • This approach risked neurological deficits if functional tissue was unexpectedly within or infiltrated by the tumor.

Observation:

  • A retrospective analysis identified 28 patients (age 22-73) with infiltrative gliomas where functional tissue was located within tumor boundaries.
  • Intraoperative stimulation mapping revealed motor, sensory, and language functions within the tumor or surrounding infiltrated brain.
  • Post-operative deficits were observed in 19 patients, but significantly improved or resolved in 20 patients by 3 months.

Findings:

  • Functional cortical and subcortical tissue can be unexpectedly present within or adjacent to gliomas, irrespective of tumor appearance.

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  • Intraoperative stimulation mapping effectively identified these critical functional areas during glioma resection.
  • Preservation of function is possible even in distorted or infiltrated brain regions.

    • Implications:

    • Intraoperative stimulation mapping is essential for maximizing glioma resection while minimizing permanent neurological injury in functional areas.
    • This technique allows for safer and more effective surgical management of brain tumors located in eloquent brain regions.
    • It challenges the conventional approach of solely relying on gross tumor removal in functional areas.