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Preserved function in brain invaded by tumor

J G Ojemann1, J W Miller, D L Silbergeld

  • 1Department of Neurological Surgery, Washington University Epilepsy Program, Washington University School of Medicine, St. Louis, Missouri, USA.

Neurosurgery
|August 1, 1996
PubMed
Summary
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Intrinsic brain tumors infiltrate functional brain regions, challenging safe resection even when limited to visibly abnormal cortex. This infiltration means seemingly normal brain near tumors may be essential, complicating surgical removal.

Area of Science:

  • Neurosurgery
  • Neuro-oncology
  • Brain Tumor Research

Background:

  • Intrinsic brain tumors frequently occur in critical cortical areas governing language, motor, and somatosensory functions.
  • Current surgical dogma suggests safe resection is achievable by limiting excision to grossly abnormal cortical tissue.

Purpose of the Study:

  • To evaluate the safety and feasibility of resecting intrinsic brain tumors located in functionally critical cortical regions.
  • To determine if limiting tumor resection to grossly abnormal cortex ensures functional preservation.

Main Methods:

  • A cohort of 14 patients with intrinsic brain tumors of varying grades underwent surgical resection.
  • Cortical mapping was performed either intraoperatively or extraoperatively using intracranial electrodes to identify functional areas.

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Main Results:

  • Tumors were found to grossly invade language (frontal and temporal lobes), motor, and somatosensory cortices in all evaluated patients.
  • Gross tumor invasion of functional cortex significantly limited the extent of safe resection.
  • Postoperative complications included transient neurological deficits and one case of persistent motor aphasia due to delayed hemorrhage.

Conclusions:

  • Intrinsic brain tumors exhibit infiltrative growth patterns, invading surrounding normal brain tissue.
  • Brain regions appearing abnormal may retain critical functions, precluding complete and safe tumor resection based solely on visual assessment.