RESUMEN
Preserving the function of the facial nerve is extremely important in surgery for vestibular schwannomas. Two methods of arachnoid dissection are described for resection of vestibular schwannoma via retrosigmoid approach (from the brain stem and internal auditory canal). OBJECTIVE: To evaluate the results of arachnoid dissection of the facial nerve from internal auditory canal when resecting the vestibular schwannoma. MATERIAL AND METHODS: We analyzed 61 patients with vestibular schwannomas. Patients were divided into 2 groups depending on surgical technique. We estimated facial nerve function before and after surgery, preoperative dimension of vestibular schwannoma and extent of resection. The influence of various factors on extent of resection and postoperative facial nerve function was studied. RESULTS: Vestibular schwannoma resection from the brain stem was performed in 30 patients, arachnoid dissection - in 31 patients. There was no significant between-group difference. Gross total resection was performed in 78.7% of cases. Both techniques demonstrated similar results regarding extent of resection. Arachnoid dissection showed the advantage regarding facial nerve function immediately after surgery (p=0.012) and 6 months later (p<0.001). Normal facial nerve function in 6 months after arachnoid dissection was observed in 80.7% of patients. Preoperative dimension of tumor influenced facial nerve function in addition to technique of resection (p=0.001). CONCLUSION: We identified the factors influencing facial nerve function after resection of vestibular schwannoma. Surgical technique was the most significant factor. These data expand and popularize arachnoid dissection in surgery of vestibular schwannomas.
Asunto(s)
Nervio Facial , Neuroma Acústico , Humanos , Neuroma Acústico/cirugía , Femenino , Masculino , Persona de Mediana Edad , Nervio Facial/cirugía , Adulto , Anciano , Aracnoides/cirugía , Disección/métodos , Procedimientos Neuroquirúrgicos/métodosRESUMEN
Robot-assisted implantation of deep electrodes for stereo-EEG monitoring has become popular in recent years in patients with drug-resistant epilepsy. However, there are still few data on safety of this technique. OBJECTIVE: To assess the incidence of complications in patients with drug-resistant epilepsy undergoing robot-assisted implantation of stereo-EEG electrodes. MATERIAL AND METHODS: We retrospectively studied the results of implantation of stereo-EEG electrodes in 187 patients with drug-resistant epilepsy. All patients underwent non-invasive preoperative examination (video-EEG, MRI, PET, SPECT, MEG). In case of insufficient data, stereo-EEG monitoring was prescribed. We determined electrode insertion trajectory using a robotic station and MR images. Implantation of electrodes was carried out using a Rosa robot (Medtech, France). All patients underwent invasive EEG monitoring after implantation. RESULTS: There were 11.25±3 electrodes per a patient. Implantation of one electrode took 7.5±4.9 min. Postoperative MRI revealed electrode malposition in 2.3% of cases. None was associated with complications. The complication rate per electrode was 0.6%. Complications affected stereo-EEG monitoring only in 3 cases (1.6%). The mortality rate was 0.5%. Bilateral implantation (p=0.005), insular (p=0.040) and occipital (p=0.045) deep electrode implantation were associated with lower incidence of complications. Longer duration of the procedure influenced the incidence of electrode placement in the lateral ventricle (p=0.028), and implantation in the frontal lobe was more often associated with epidural placement of electrodes (p=0.039). CONCLUSION: Robot-assisted implantation of stereo-EEG electrodes is a safe procedure with minimal risk of complications. Rare electrode malposition does not usually affect invasive monitoring.
Asunto(s)
Epilepsia Refractaria , Robótica , Humanos , Técnicas Estereotáxicas , Estudios Retrospectivos , Epilepsia Refractaria/diagnóstico por imagen , Epilepsia Refractaria/cirugía , Electroencefalografía/efectos adversos , Electroencefalografía/métodos , Electrodos Implantados/efectos adversosRESUMEN
Direct cortical stimulation during awake craniotomy with speech testing became the «gold standard¼ in brain mapping and preserving speech zones during neurosurgical procedures. However, there are many other cerebral functions, and their loss can be very critical for certain patients. For example, such a function is production and perception of music for musicians. This review presents the latest data on functional anatomy of musician brain, as well as aspects of neurosurgical treatment with awake craniotomy and music testing under brain mapping.
Asunto(s)
Neoplasias Encefálicas , Música , Humanos , Neoplasias Encefálicas/cirugía , Vigilia/fisiología , Monitoreo Intraoperatorio/métodos , Craneotomía/métodos , Mapeo Encefálico/métodos , Encéfalo/cirugíaRESUMEN
After surgical treatment of tumors of the supplementary motor area (SMA) post-operative speech and/or motor neurological deficit may occur. OBJECTIVE: To determinate frequency and reversibility of such deficit and identify risk factors for its development. MATERIAL AND METHODS: We retrospectively analyzed postoperative outcomes in 34 patients with SMA tumors. Pre- and postoperative neurological status, localization of tumors, extent of resection relative to adjacent regions and relationship of tumor with white matter tracts were assessed. We also analyzed the influence of these factors on the risk of postoperative neurological impairment. RESULTS: Postoperative neurological impairment occurred in 47% of cases. Complete or significant regression was observed in all patients within 5.7 month after surgery. Major risk factors were lesion of dominant hemisphere (p=0.029), tumor spreading to primary motor cortex (p=0.018) and resection of SMA together with cingulate gyrus (p=0.000). Location of frontal aslant tract in dominant hemisphere just near the tumor contributed to disorders regarding speech initiation and fluency (p=0.016). Resection of SMA with cingulate gyrus in dominant hemisphere affected development of more serious speech disorders (p=0.003). CONCLUSION: Surgery for SMA tumors is safe and followed by favorable functional outcomes.