Transsulcal approach supported by navigation-guided neurophysiological monitoring for resection of paracentral cavernomas.
OBJECTIVE
The aim of the study is to evaluate tools that can improve surgical precision and minimize surgical trauma for removal of cavernomas in the paracentral area. Moreover, the surgical strategies for the treatment of symptomatic epilepsy in cavernoma patients are discussed.


METHODS
Between June 2000 and July 2007, 17 patients suffering from paracentral cavernoma underwent surgery via a transsulcal approach with the aid of neuronavigation, functional mapping and neurophysiological intraoperative monitoring. To optimize outcome for procedures in the paracentral area, the hemosiderin-stained tissue was removed entirely except for a small proportion on the side of precentral gyrus.


RESULTS
All cavernomas and their adjacent sulci could be precisely located with the aid of ultrasonography-assisted neuronavigation. By combining preoperative fMRI and intraoperative neurophysiological monitoring, including SEP, MEP and cortical mapping, the motor cortex could be defined in all cases. Thus damage to the primary motor area could be avoided during resection of cavernomas. All the lesions located in the paracentral area were removed completely via transsulcal microsurgical approach without neurological deficits. No significant seizures were induced during surgery.


CONCLUSIONS
The successful excision of these lesions was effected by the following four key factors: (1) the precise location of the lesion supported by intraoperative neuronavigation; (2) the preservation of the eloquent area with the aid of functional mapping; (3) a minimally invasive transsulcal microsurgical approach; and (4) the entire removal of cavernoma and hemosiderin-stained tissue.
Zhou
Hongyu
H
Department of Neurosurgery, Philipps-University, Baldingerstrasse, Marburg, Germany. hy_zhou@tom.com
Miller
Dorothea
D
Schulte
Dirk Michael
DM
Benes
Ludwig
L
Rosenow
Felix
F
Bertalanffy
Helmut
H
Sure
Ulrich
U
D000293:Adolescent; D000328:Adult; D000368:Aged; D001931:Brain Mapping / Q000379:methods; D016543:Central Nervous System Neoplasms / Q000503:physiopathology* / Q000601:surgery; D019054:Evoked Potentials, Motor / Q000502:physiology; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005260:Female; D020786:Hemangioma, Cavernous, Central Nervous System / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D020646:Intralaminar Thalamic Nuclei / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D016343:Monitoring, Intraoperative / Q000379:methods*; D009044:Motor Cortex / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D038361:Neuronavigation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult