Placement of functional regional localization electrodes in diffuse glioma surgery

For the first time at Viet Duc Friendship Hospital, the team applied the technique of placing electrodes to continuously monitor function while a patient with a large brain parenchymal glioma was under general anesthesia, replacing the awake surgery method which is difficult to apply with very large tumors and requires a long surgery time.

The team applied the technique of placing electrodes to continuously monitor function while the patient had a large brain parenchymal glioma.

Viet Duc Friendship Hospital admitted BVL (43 years old, Phu Tho ) in a state of severe headache, diagnosed with a large brain parenchymal glioma (about 8cm), the tumor spread deep into many important functional areas of the right hemisphere, including the motor area, language area and internal capsule area - the place that controls movement of half the body.

Dr. Nguyen Duy Tuyen, Head of Neurosurgery Department 2, Viet Duc Friendship Hospital, said: The challenge for the surgical team is to remove as much of the tumor as possible while still preserving neurological function. In particular, with highly malignant gliomas, surgical standards recommend removing an additional 4-5 mm of invasive tissue around the tumor to limit recurrence, but the closer to the functional area, the greater the risk of complications.

The electrode system is attached to the respective muscle groups.

The surgical procedure is carried out in strict steps, starting with the construction of a cortical map to guide the approach through the “non-functional” area, then when reaching the central gray nucleus – where the motor pathways are located, the surgeon uses probe electrodes to both aspirate the tumor and detect functional signals.

The electrode system is attached to the corresponding muscle groups (right hemisphere is attached to the left arm-leg and vice versa) to monitor motor response in real time. When approaching the functional area about 3-4 mm, the device gives a warning and when only 1 mm away, the signal is transmitted directly to help the surgeon stop at the right time, preserving maximum nerve function while removing maximum tumor tissue.

Thanks to this technique, the team can safely control even when the tumor invades almost the entire hemisphere, and at the same time evaluate the movement during the surgery. Before closing the incision, electrical stimulation test showed that the patient's limbs still functioned well; after surgery, the patient was re-evaluated and recorded that the motor function was completely preserved despite the tumor spreading very widely.

HAI NGO

Source: https://nhandan.vn/dat-dien-cuc-dinh-vi-vung-chuc-nang-trong-phau-thuat-u-than-kinh-dem-lan-toa-post927396.html