SURG-36. IMPACT OF MULTIMODALITY MONITORING USING DIRECT ELECTRICAL STIMULATION TO DETERMINE CORTICOSPINAL TRACT SHIFT AND INTEGRITY IN THE iMRI suite

Preserving the integrity of the corticospinal tract (CST) while maximizing the extent of tumor resection is one of the key principles of brain tumor surgery to prevent new neurological deficits. The goal of this project was to determine the impact of the use of peri-operative DTI fiber-tracking protocols for localization of the CSTs, in conjunction with intraoperative direct electrical stimulation (DES) on patient neurological outcomes. Fifty-three patients underwent resection of tumors adjacent to the motor gyrus and the underlying CST. Preoperative and postoperative DTI mapping, intraoperative cortical and subcortical direct electrical stimulation (DES) were performed in all patients. Eighteen patients (34%) had a re-resection after the first intraoperative scan. In the immediate postoperative period, 55% of patients developed a new neurological deficit. At the three-month follow up, however, only 6 patients (11%) had a persistent neurological deficit that was worse than the preoperative state. The proximity of the tumor to the CSTs was determined from preoperative studies. Tumor location further than 15 mm from CSTs correlated with better neurological outcomes at one and three months postoperatively (p=0.001 and 0.007 respectively) despite achieving a similar degree of resection (p=0.61). The current of subcortical DES performed with monopolar probe showed a linear correlation with the distance to the CST (R=1.10+/-0.83). Intraoperative imaging demonstrated that CST shifts...
Source: Neuro-Oncology - Category: Cancer & Oncology Authors: Tags: SURGICAL THERAPY Source Type: research