Lorenzo Bello1, Marco Riva1, Enrica Fava1, Valentina Ferpozzi1, Antonella Castellano1, Fabio Raneri1, Federico Pessina1, Alberto Bizzi1, Andrea Falini1, Gabriella Cerri1. 1. Neurosurgical Oncology, Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Humanitas Clinical and Research Center, Milan, Italy (L.B., M.R., E.F., F.R., F.P.); Laboratory of Motor Control, Department of Medical Biotechnology and Translational Medicine, University of Milan, Humanitas Clinical and Research Center, Milan, Italy (V.F., G.C.); Scientific Institute and University, Ospedale San Raffaele IRCCS, Neuroradiology, CERMAC, Milan, Italy (A.C., A.F.); Neuroradiology, Humanitas Clinical and Research Center, Milan, Italy (A.B.).
Abstract
BACKGROUND: Resection of motor pathway gliomas requires the intraoperative recognition of essential cortical-subcortical motor structures. The degree of involvement of motor structures is variable, and increases as result of treatments patients are submitted to. Intraoperative neurophysiology offers various stimulation modalities, which efficiency is based on the ability to recognize essential sites with the highest possible resolution in most clinical conditions. Two stimulation paradigms evolved for intraoperative guidance of motor tumors removal: the 60 Hz-technique [low frequency (LF)] and the pulse-technique [high frequency-(HF)], delivered by bipolar or monopolar probe respectively. Most surgical teams rely on to either of the 2 techniques. The key point is the integration of the choice of the stimulation modality with the clinical context. METHODS: In 591 tumors involving the corticospinal tract, the use of HF and LF was tailored to the clinical context defined by patient clinical history and tumor features (by imaging). The effect was evaluated on the feasibility of mapping, the impact on immediate and permanent morbidity, the extent of resection, and the number of patients treated. RESULTS: By integrating the choice of the probe and the stimulation protocol with patient clinical history and tumor characteristics, the best probe-frequency match was identified for the different sets of clinical conditions. This integrative approach allows increasing the extent of resection and patient functional integrity, and greatly expands the number of patients who could benefit from surgery. CONCLUSIONS: The integration of stimulation modalities with clinical context enhances the extent and safety of resection and expands the population of patients who could benefit from surgical treatment.
BACKGROUND: Resection of motor pathway gliomas requires the intraoperative recognition of essential cortical-subcortical motor structures. The degree of involvement of motor structures is variable, and increases as result of treatments patients are submitted to. Intraoperative neurophysiology offers various stimulation modalities, which efficiency is based on the ability to recognize essential sites with the highest possible resolution in most clinical conditions. Two stimulation paradigms evolved for intraoperative guidance of motor tumors removal: the 60 Hz-technique [low frequency (LF)] and the pulse-technique [high frequency-(HF)], delivered by bipolar or monopolar probe respectively. Most surgical teams rely on to either of the 2 techniques. The key point is the integration of the choice of the stimulation modality with the clinical context. METHODS: In 591 tumors involving the corticospinal tract, the use of HF and LF was tailored to the clinical context defined by patient clinical history and tumor features (by imaging). The effect was evaluated on the feasibility of mapping, the impact on immediate and permanent morbidity, the extent of resection, and the number of patients treated. RESULTS: By integrating the choice of the probe and the stimulation protocol with patient clinical history and tumor characteristics, the best probe-frequency match was identified for the different sets of clinical conditions. This integrative approach allows increasing the extent of resection and patient functional integrity, and greatly expands the number of patients who could benefit from surgery. CONCLUSIONS: The integration of stimulation modalities with clinical context enhances the extent and safety of resection and expands the population of patients who could benefit from surgical treatment.
Authors: Lorenzo Bello; Enrica Fava; Giuseppe Casaceli; Giulio Bertani; Giorgio Carrabba; Costanza Papagno; Andrea Falini; Sergio M Gaini Journal: Neuroimaging Clin N Am Date: 2009-11 Impact factor: 2.264
Authors: Giulio Bertani; Enrica Fava; Giuseppe Casaceli; Giorgio Carrabba; Alessandra Casarotti; Costanza Papagno; Antonella Castellano; Andrea Falini; Sergio M Gaini; Lorenzo Bello Journal: Neurosurg Focus Date: 2009-10 Impact factor: 4.047
Authors: Justin S Smith; Edward F Chang; Kathleen R Lamborn; Susan M Chang; Michael D Prados; Soonmee Cha; Tarik Tihan; Scott Vandenberg; Michael W McDermott; Mitchel S Berger Journal: J Clin Oncol Date: 2008-03-10 Impact factor: 44.544
Authors: Federico Pessina; Pierina Navarria; Luca Cozzi; Anna Maria Ascolese; Matteo Simonelli; Armando Santoro; Elena Clerici; Marco Rossi; Marta Scorsetti; Lorenzo Bello Journal: J Neurooncol Date: 2017-07-08 Impact factor: 4.130