CORTICAL MAPPING USING MOTOR EVOKED POTENTIALS IN GLIOMA SURGERY
INTRODUCTION
The aim of glioma surgery is to get maximum resection of a tumor with minimal violation of normal brain tissue. A primary tenet of neurosurgical oncology is that survival can improve with greater tumor resection, but this principle must be tempered by the potential for functional loss after a radical removal. It has always been a challenge to achieve this ?functional? resection especially when eloquent cortex is close by or intimately involved with the tumor. Various methods of localizing eloquent cortex have been and are currently being used. Motor evoked potentials (MEPs) and other neurophysiological testing is now available to the neurosurgeon intraoperatively.
CASE
A 36 year old male presented to the emergency department at the University Hospital of the West Indies with a one week history of headaches and a first time seizure episode on the day of presentation. He was not known to have any chronic illnesses and was well until the headaches started. He described his headaches as pounding in nature, …show more content…
Low grade gliomas are Grade II tumors under the World Health Organization classification, while high grade gliomas are grade III - IV. Low grade gliomas represent up to 30% of gliomas and affect patients at a younger age than high-grade gliomas and are commonly located in or close to eloquent areas(1). GBM accounts for approximately 65 to 70% of all gliomas(2). The concept of brain function organization into well defined and localized areas is the legacy of pioneering studies of the 19th and 20th centuries. In 1909 German neurophysiologist Brodmann published ?Localisation in the Cerebral cortex? where he subdivided the function of the brains and numbered the areas from 1 to 47(3). Six areas can be identified as eloquent
INTRODUCTION
The aim of glioma surgery is to get maximum resection of a tumor with minimal violation of normal brain tissue. A primary tenet of neurosurgical oncology is that survival can improve with greater tumor resection, but this principle must be tempered by the potential for functional loss after a radical removal. It has always been a challenge to achieve this ?functional? resection especially when eloquent cortex is close by or intimately involved with the tumor. Various methods of localizing eloquent cortex have been and are currently being used. Motor evoked potentials (MEPs) and other neurophysiological testing is now available to the neurosurgeon intraoperatively.
CASE
A 36 year old male presented to the emergency department at the University Hospital of the West Indies with a one week history of headaches and a first time seizure episode on the day of presentation. He was not known to have any chronic illnesses and was well until the headaches started. He described his headaches as pounding in nature, …show more content…
Low grade gliomas are Grade II tumors under the World Health Organization classification, while high grade gliomas are grade III - IV. Low grade gliomas represent up to 30% of gliomas and affect patients at a younger age than high-grade gliomas and are commonly located in or close to eloquent areas(1). GBM accounts for approximately 65 to 70% of all gliomas(2). The concept of brain function organization into well defined and localized areas is the legacy of pioneering studies of the 19th and 20th centuries. In 1909 German neurophysiologist Brodmann published ?Localisation in the Cerebral cortex? where he subdivided the function of the brains and numbered the areas from 1 to 47(3). Six areas can be identified as eloquent