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Abstract: Recent publications had reported high rates of preoperative neurological impairments in WHO grade II gliomas (GIIG) that significantly affect the quality of life. Consequently, one step further in the analysis of surgical outcome in GIIG is to evaluate if surgery is capable to improve preoperative deficits. Here are reported two cases of GIIG infiltrating the primary motor cortex and pyramidal pathway that had a long-term paresis before surgery. Both patients were operated with intraoperative electrical stimulation mapping, with identification and preservation of the primary motor cortex and pyramidal tract. Despite the long-lasting paresis, both cases had a significant improvement of motor function after surgery. Knowledge of this potential recovery before surgery is of major significance for planning the surgical strategy in GIIG. Two possible predictors of motor recovery were analyzed: 1) reconstruction of the corticospinal tract with diffusion tensor imaging tractography is indicative of anatomo-functional integrity, despite tract deviation and infiltration; 2) intraoperative identification of motor response by electrostimulation confirms the presence of an intact peritumoral tract. Thus, resection should stop at this boundary even in cases of long lasting preoperative hemiplegia.
Fuente: Journal of Neurosurgical Sciences 2017 Feb;61(1):88-96
Editorial: Minerva Medica
Año de publicación: 2017
Nº de páginas: 38
Tipo de publicación: Artículo de Revista
DOI: 10.23736/S0390-5616.16.03090-3
ISSN: 0390-5616,1827-1855
Url de la publicación: https://doi.org/10.23736/S0390-5616.16.03090-3
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JUAN MARTINO GONZALEZ
HUGO DANIEL CABALLERO ARZAPALO
ENRIQUE MARCO DE LUCAS
SILVA FREITAS, ROUSINELLE DA
CARLOS JOSE VELASQUEZ RODRIGUEZ
MARIA ELSA GOMEZ CASANOVA
JAVIER VAZQUEZ BOURGON
ALFONSO VAZQUEZ BARQUERO
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