Awake craniotomy for the sensorimotor tumors : combined use of synthesized surface anatomy scanning, stimulation cortical mapping and frameless neuronavigation system
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- Imai Fumihiro
- Department of Neurosurgery, Ichiriyama-Imai Clinic Department of Neurosurgery, Fujita Health University School of Medicine
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- Shibata Junpei
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine
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- Yoneda Minoru
- Department of Neurosurgery, Ichiriyama-Imai Clinic
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- Yamauchi Akihiro
- Joint Research Laboratory of Clinical Medicine, Fujita Health University Hospital
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- Kuno Atsuhiro
- Joint Research Laboratory of Clinical Medicine, Fujita Health University Hospital
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- Imai Haruna
- Department of Neurosurgery, Ichiriyama-Imai Clinic
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- Oda Jumpei
- Department of Neurosurgery, Fujita Health University School of Medicine
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- Omi Tatsuo
- Department of Neurosurgery, Fujita Health University School of Medicine
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- Oeda Motoki
- Department of Neurosurgery, Fujita Health University School of Medicine
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- Suzuki Takeya
- Department of Neurosurgery, Fujita Health University School of Medicine
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- Tanaka Riki
- Department of Neurosurgery, Fujita Health University School of Medicine
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- Kogame Hirotaka
- Department of Neurosurgery, Fujita Health University School of Medicine
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- Maeda Shingo
- Department of Neurosurgery, Fujita Health University School of Medicine
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- Yamashiro Kei
- Department of Neurosurgery, Fujita Health University School of Medicine
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- Hirose Yuichi
- Department of Neurosurgery, Fujita Health University School of Medicine
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抄録
Objectives: Functional brain mapping and precise localization are essential for the resection of centrally located tumors. We describe our initial experience with awake craniotomy for sensorimotor tumors in 15 patients using synthesized surface anatomy scanning (SSAS), intraoperative functional brain mapping, and an infrared-based navigation system (INS) without fixation of the patient’s head.<br> Methods: Craniotomy positioning was planned using the images created by SSAS. Fiducial markers were placed along the skin incision line for intraoperative registration of an INS. The resection of the tumor was performed under local anesthesia using both intraoperative functional brain mapping and an INS. In or near the motor cortex or the descending motor pathway, the extent of the resection was determined by the stimulation induced motor response and the intraoperative neurologic findings.<br> Results: Appropriately centered craniotomies were obtained in all cases using the presurgical planning images of SSAS. Reliable functional localization was identified with direct cortical and subcortical stimulation. The location of the tumors was detected within 3.5 mm of that predicted by the computation (target registration error). Postoperative computed tomography scans showed grossly total resection of the tumor in 13 of 15 cases and subtotal resection in 2 cases. Although 10 patients had mild to severe neurologic deficits in the immediate postoperative period, there were no permanent deficits.<br> Conclusions: Sensorimotor tumors can be resected effectively with the combined use of SSAS, stimulation cortical mapping and an INS with clinical acceptable morbidity.
収録刊行物
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- Fujita Medical Journal
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Fujita Medical Journal 2 (2), 31-37, 2016
藤田学園医学会