Neuronavigation-Guided Corticospinal Tract Mapping in Brainstem Tumor Surgery: Better Preservation of Motor Function
Zhibao Lia b, Mingran Wanga b, Liwei Zhangc, Xing Fana b, Xiaorong Taoa b, Lei Qia b, Miao Linga b, Xiong Xiaoc, Yuliang Wuc, Dongze Guoa b, Hui Qiaoa b d✉
- aBeijing Neurosurgical Institute, Capital Medical University, Beijing, China
- bDepartment of Neuroelectrophysiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- cDepartment of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- dDepartment of Neuroelectrophysiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. Electronic address: hqiao1215@sina.com
- ✉Corresponding author
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Abstract
OBJECTIVE To evaluate a new technique in brainstem surgery, neuronavigation (NN)-guided corticospinal tract (CST) mapping, 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 4 limbs was greater than 3 levels from normal on the Lovett scale were divided into 2 groups: a treatment group of 21 patients who underwent NN-guided CST mapping and routine intraoperative neurophysiology monitoring (IONM) and a control group of 19 patients who underwent routine NN and IONM. Preoperative muscle strength and postoperative (day 90 postsurgery) muscle strength were assessed and compared between the 2 groups. RESULTS In the NN-guided CST mapping group, 3 patients (14.3%) had a decrease in muscle strength by 1 level postoperatively, and no patient experienced a decrease of >1 level. In the control group, 4 patients (21.1%) had a 1-level decrease in muscle strength, and 5 (26.3%) had a decrease of >1 level. Patients in the NN-guided CST mapping group had significantly better surgical outcomes compared with those in the control group (P = 0.018, Fisher exact test). CONCLUSIONS Brainstem tumor resection using NN-guided CST mapping achieved better preservation of motor function compared with routine NN and IONM. NN-guided CST mapping not only decreased the difficulty of the surgery, but also significantly improved the efficiency of surgery.
TL;DRBrainstem tumor resection using NN-guided CST mapping achieved better preservation of motor function compared with routine NN and IONM and significantly improved the efficiency of surgery. (Semantic Scholar)