Assessment of the Benefit of Intraoperative Cortical Stimulation in Patients with Lesions within Eloquent Brain Regions

Abstract

Objective The present study sought to evaluate the benefits of intraoperative cortical stimulation (CS) for reducing morbidity in neurosurgery.

Method A total of 56 patients were submitted to neurosurgical procedure with the aid of CS. Initially, surgical exposure and planned resection were based on anatomy and imaging exams, which were followed by CS. According to the findings, the patients were divided into two groups. In group 1 the previous surgical strategy had to be altered, while in group 2 the surgical planning did not suffer any interference. Patients were also divided into subgroups according to the underlying disease: gliomas or other etiologies. Transient and definitive deficits occurrence were compared between groups 1 and 2 and subgroups of etiologies. The real benefit of CS technique was calculated by a specific formula.

Results There were 20 patients (37.5%) whose surgical strategy was changed based on CS findings. Furthermore, 65% of group 1 patients had transient deficit, in comparison to 30.5% of patients in group 2 (p = 0.013). As for the definitive deficit, it occurred in 15.0% of group 1 patients versus 8.3% of patients in group 2 (p = 0.643). Definitive deficits with no statistical difference (p = 0.074) were found in 17.2% of patients with gliomas, while none were found in the other etiologies subgroup. The rate of real benefit of intraoperative CS was 30.4%. Considering the subgroups of gliomas and other etiologies, the benefit rates were 25.7% and 38.1%, respectively.

Conclusions The surgical decision was influenced by CS in 35.7% of the cases and prevented definitive deficit in 30% of patients.

Resumo

Objetivos O presente estudo procurou avaliar os benefícios da estimulação cortical (EC) intraoperatória na redução da morbidade em neurocirurgias.

Métodos Um total de 56 pacientes foram submetidos ao procedimento neurocirúrgico com ajuda da EC. Inicialmente, a exposição cirúrgica e o panejamento da ressecção eram baseados nos achados de anatomia e imagem, que eram seguidos pela EC. De acordo com os achados neurofisiológicos, os pacientes foram divididos em dois grupos. No grupo 1, a estratégia cirúrgica teve que ser modificada, enquanto no grupo 2, o planejamento cirúrgico não foi alterado. Os pacientes foram ainda divididos em dois subgrupos de acordo com a doença subjacente: gliomas ou outras etiologias. A ocorrência de déficits transitórios e definitivos foram comparadas entre os grupos 1 e 2 e entre os subgrupos de etiologias. O benefício real da técnica de estimulação cortical foi calculado por uma fórmula específica.

Resultados A estratégia cirúrgica foi alterada em 20 (37,5%) pacientes após a estimulação cortical. Além disso, 65% dos pacientes do grupo 1 tiveram déficits transitórios, em comparação com 30,5% dos pacientes do grupo 2 (p = 0,013). Quanto ao déficit definitivo, este ocorreu em 15% dos casos do grupo 1 contra 8,3% dos pacientes do grupo 2 (p = 0,643). Déficit definitivo sem diferença significativa (p = 0,074) foi observado em 17,2% dos pacientes com gliomas, enquanto nenhum foi encontrado no subgrupo de outras etiologias. A taxa de benefício real da EC intraoperatória foi de 30,4%. Considerando os subgrupos de gliomas e outras etiologias as taxas de benefício foram 25,7% e 38,1%, respectivamente.

Conclusões A EC influenciou a decisão cirúrgica em 35,7% dos casos. Embora 90% dos pacientes não tenham cursado com déficits a longo prazo, a estimulação cortical preveniu tais déficits em cerca de um terço deles.

Keywords

intraoperative neurophysiological monitoring - gliomas - brain mapping - neuronal plasticity - surgery - direct electrical stimulation

Palavras Chaves

monitorização neurofisiológica intraoperatória - gliomas - mapeamento cerebral - plasticidade neuronal - cirurgia - estimulação elétrica direta

Publikationsverlauf

Eingereicht: 09. März 2023

Angenommen: 21. Juni 2023

Artikel online veröffentlicht:
31. Oktober 2023

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