Transsulcal approach supported by navigation-guided neurophysiological monitoring for resection of paracentral cavernomas

Zhou, Hongyu; Miller, Dorothea; Schulte, Dirk Michael; Benes, Ludwig; Rosenow, Felix; Bertalanffy, Helmut; Sure, Ulrich

doi:10.1016/j.clineuro.2008.09.025

« Previous Next »Clinical Neurology and Neurosurgery
Volume 111, Issue 1 , Pages 69-78, January 2009

Transsulcal approach supported by navigation-guided neurophysiological monitoring for resection of paracentral cavernomas

Hongyu Zhou
- Department of Neurosurgery, Philipps-University, Baldingerstrasse, 35033 Marburg, Germany
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University, 200127 Shanghai, PR China
- Corresponding author at: Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University, 200127 Shanghai, PR China. Tel.: +86 13311713837.
Dorothea Miller
- Department of Neurosurgery, Philipps-University, Baldingerstrasse, 35033 Marburg, Germany
Dirk Michael Schulte
- Department of Neurosurgery, Philipps-University, Baldingerstrasse, 35033 Marburg, Germany
Ludwig Benes
- Department of Neurosurgery, Philipps-University, Baldingerstrasse, 35033 Marburg, Germany
Felix Rosenow
- Department of Neurology, Philipps-University, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany
Helmut Bertalanffy
- Department of Neurosurgery, University Clinic Zuerich, CH-8091 Zuerich, Switzerland
Ulrich Sure
- Department of Neurosurgery, Philipps-University, Baldingerstrasse, 35033 Marburg, Germany

Received 8 November 2007; received in revised form 30 August 2008; accepted 4 September 2008.

Abstract

Objectives

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.

Patients and 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.

Keywords: Transsulcal approach, Ultrasonography-assisted neuronavigation, Neurophysiological monitoring, Functional mapping, Paracentral cavernoma, Concomitant epilepsy