title: Ultrasound guided mini-invasive tailored approach and intraoperative neurophysiological monitoring: a synergistic strategy for the removal of tumors near the motor cortex. A preliminary experience.
abstract: BACKGROUND
  The aim of this paper was to evaluate the synergic strategy comprising intraoperative neurophysiological monitoring and ultrasound sonography in terms of clinical motor scores and extent of resection.
  
  
  METHODS
  Patients harboring tumors in close relationship with the motor cortex were operated on with image-guided mini-invasive approach and multimodal neurophysiological monitoring. The peculiarity is the partial exposure of the motor cortex and the limited electrophysiological mapping used to search for negative spots. Multimodal neurophysiological monitoring comprised the electrocortical stimulation, somatosensory evoked potentials, motor evoked potentials and subcortical stimulation. Ultrasound sonography guided the tumor removal. The post-op clinical motor scores and the extent of resection were assessed.
  
  
  RESULTS
  Twelve patients were operated on with the combined approach and were further analyzed. Six had high grade gliomas, 1 anaplastic astrocytoma, 1 oligodendroglioma, 1 pilocytic astrocytoma and three had metastasis. One out of 12 had a worsening of the motor scores at the last follow-up. The mean extent of resection was 90% ranging from 60% to 100%, but in 9 out of 12 patients, it reached or exceeded 90%.
  
  
  CONCLUSIONS
  The synergic strategy comprising intraoperative multimodal neurophysiological monitoring and the ultrasound sonography is feasible in all surgeries. Data are promising in terms of both clinical motor scores and extent of resection. This strategy represents an alternative approach to the treatment of supratentorial tumors, although further studies are necessary to confirm the long-term efficacy of this procedure.
authors.affiliation: Department of Neurosurgery, IRCCS Neurologic Institute &quot;C. Besta&quot; Foundation, Milan, Italy - rcordella@istituto-besta.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cordella
authors.affiliation: Department of Neuroradiology, IRCCS Neurologic Institute &quot;C. Besta&quot; Foundation, Milan, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Nava
authors.affiliation: Department of Neurosurgery, IRCCS Neurologic Institute &quot;C. Besta&quot; Foundation, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Prada
authors.affiliation: Division of Neurosurgery, Department of Neuroscience, Molinette Hospital, University of Turin, Turin, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Agnoletti
authors.affiliation: Department of Neurosurgery, IRCCS Neurologic Institute &quot;C. Besta&quot; Foundation, Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Legnani
authors.affiliation: Department of Neurosurgery, IRCCS Neurologic Institute &quot;C. Besta&quot; Foundation, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Meco
mesh_terms: D000328:Adult; D001931:Brain Mapping; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods; D018084:Ultrasonography, Interventional / Q000379:methods*; D055815:Young Adult