Neuronavigation-guided corticospinal tract mapping in brainstem tumor surgery: better preservation of motor function.

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Neuronavigation-guided corticospinal tract mapping in brainstem tumor surgery: better preservation of motor function.

World Neurosurg. 2018 May 04;:

Authors: Li Z, Wang M, Zhang L, Fan X, Tao X, Qi L, Ling M, Xiao X, Wu Y, Guo D, Qiao H

Abstract
BACKGROUND: A new method in brainstem surgery, neuronavigation (NN)-guided corticospinal tract (CST) mapping, was used 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 four limbs was greater than three levels from normal on the Lovett scale were divided into two groups: a treatment group of 21 patients that included NN-guided CST mapping and routine intraoperative neurophysiology monitoring (IONM), and a control group of 19 patients that included routine NN and routine IONM. Preoperative muscle strength and postoperative (day 90 after surgery) muscle strength of patients from the two groups were assessed.
RESULTS: In the NN-guided CST mapping group, three (14.3%) patients' muscle strength declined one level postoperatively, and no patients experienced a decline in muscle strength greater than one level. In the control group, four (21.1%) patients' muscle strength declined one level, and five (26.3%) patients' muscle strength declined more than one level. Patients in the NN-guided CST mapping group had a significantly better surgical outcome (p = 0.018, Fisher's exact test) than patients in the control group.
CONCLUSIONS: Brainstem tumor resection utilizing NN-guided CST mapping achieved better preservation of motor function than routine NN and IONM. NN-guided CST mapping not only decreased the difficulty of the surgery but also significantly improved the efficiency of the surgery.

PMID: 29733992 [PubMed - as supplied by publisher]

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