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2015 ; 55
(5
): 383-98
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Strategy of Surgical Resection for Glioma Based on Intraoperative Functional
Mapping and Monitoring
#MMPMID26185825
Tamura M
; Muragaki Y
; Saito T
; Maruyama T
; Nitta M
; Tsuzuki S
; Iseki H
; Okada Y
Neurol Med Chir (Tokyo)
2015[]; 55
(5
): 383-98
PMID26185825
show ga
A growing number of papers have pointed out the relationship between aggressive
resection of gliomas and survival prognosis. For maximum resection, the current
concept of surgical decision-making is in ?information-guided surgery? using
multimodal intraoperative information. With this, anatomical information from
intraoperative magnetic resonance imaging (MRI) and navigation, functional
information from brain mapping and monitoring, and histopathological information
must all be taken into account in the new perspective for innovative minimally
invasive surgical treatment of glioma. Intraoperative neurofunctional information
such as neurophysiological functional monitoring takes the most important part in
the process to acquire objective visual data during tumor removal and to
integrate these findings as digitized data for intraoperative surgical
decision-making. Moreover, the analysis of qualitative data and threshold-setting
for quantitative data raise difficult issues in the interpretation and processing
of each data type, such as determination of motor evoked potential (MEP) decline,
underestimation in tractography, and judgments of patient response for
neurofunctional mapping and monitoring during awake craniotomy. Neurofunctional
diagnosis of false-positives in these situations may affect the extent of
resection, while false-negatives influence intra- and postoperative complication
rates. Additionally, even though the various intraoperative visualized data from
multiple sources contribute significantly to the reliability of surgical
decisions when the information is integrated and provided, it is not uncommon for
individual pieces of information to convey opposing suggestions. Such conflicting
pieces of information facilitate higher-order decision-making that is dependent
on the policies of the facility and the priorities of the patient, as well as the
availability of the histopathological characteristics from resected tissue.
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