Supratentorial Cavernous Malformations Involving the Corticospinal Tract and Sensory Motor Cortex: Treatment Strategies, Surgical Considerations, and Outcomes
Supratentorial Cavernous Malformations Involving the Corticospinal Tract and Sensory Motor Cortex: Treatment Strategies, Surgical Considerations, and Outcomes
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DOI：
10.1093/ons/opx281
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发表时间：
2018-11-01
影响因子：
2.3
通讯作者：
Tuniz, Francesco
中科院分区：
文献类型：
--
作者：
Skrap, Miran;Vescovi, Maria Caterina;Tuniz, Francesco
背景：海绵状血管畸形（CM）是一种先天性畸形，可发生在大脑的任何部位。我们提出了一系列位于运动感觉皮质或皮质脊髓束（CST）附近或内部的CM，其临床发作是由于出血或占位效应。在这种情况下，手术成为一个可接受的选择。目的：评估扩散张量成像（DTI），功能磁共振成像（fMRI），术中神经生理监测，神经导航，脑映射和手术治疗CMs在这个关键location.METHODS的临床结果的作用：该研究包括54例患者窝藏22皮质和32深的位置。这一系列是不同的，因为在第一组，其中的DTI没有得到，在第二组，在此evaluation was performed.Results：术后永久性发病率为4%，在历史组的更深的CMs，并没有发病率在第二组。DTI和fMRI使我们能够估计CM与皮质激活簇和锥体束之间的距离。除了术中标测和监测之外，这些数据还使我们有必要对第二系列中的2例患者进行部分切除。结论：CM是先天性病变，CST纤维可以直接在其表面运行。整合功能磁共振成像和DTI数据与术中功能监测和直接皮质和皮质下映射是强制性的，以实现最佳的切除，定制最佳的手术方法，可接受的发病率。对于较深的部位，次全切除术可被视为一种选择。
BACKGROUND: Cavernous malformations (CMs) are congenital malformations and may be located anywhere in the brain. We present a series of CMs located close to or inside of the motor-sensory cortex or corticospinal tract (CST) with clinical onset due to hemorrhage or mass effect. In such cases, surgery becomes an acceptable option.OBJECTIVE: To evaluate the role of diffusion tensor imaging (DTI), functional-magnetic-resonance imaging (fMRI), intraoperative neurophysiological monitoring, neuronavigation, and brain-mapping and the clinical results of surgical treatment of CMs in this critical location.METHODS: The study included 54 patients harboring 22 cortical and 32 deep locations. This series was distinct because in group I, where the DTI was not obtained, and in the group II, where this evaluation was performed.RESULTS: The postoperative permanent morbidity rate was 4% in the historical group for the deeper CMs, and there was no morbidity in the second group. DTI and fMRI permitted us to estimate the distance between the CMs and both the cortical activation cluster and the pyramidal tract. These data, in addition to intraoperative mapping and monitoring, made it necessary for us to perform a partial resection in 2 cases in the second series.CONCLUSION: CMs are congenital lesions and CST fibers can run directly on their surface. Integration of fMRI and DTI data with intraoperative functional monitoring and direct cortical and subcortical mapping are mandatory to accomplish an optimal resection, tailoring the best surgical approach to the acceptable morbidity. A subtotal resection could be considered an option for deep locations.