The Cinical Studies Of Multimodal Neuronavisation Combined With Direct Cortical Stimulation In The Treatment Of Central Sulcus Area Tumors

BackgroundTo date, the neuronavigation system can combine various photographic data due to the development of computer technology. The neuronavigation system has been developed from anatomic neuronavigation to functional neuronavigation. By combining different photographic data, the multimodal neuronavigation can design the surgical incision and route before the surgery to avoid the eloquent areas, and monitor the brain tumor as well as eloquent areas during the surgery in order to cut the tutor maximally while retain the neural function to the largest extent. In2012, a BrainLAB multimodal neuronavigation has been introduced by the153Hospital of PLA.ObjectiveExplore the Multimodal Neuronavigation surgery and conventional surgical treatment differences in various aspects of the central area of brain tumors; and compare the protection of nerve function.Materials and methods1Object of studyThe study by the hospital ethics committee approval. A retrospective analysis the number of64example patients with brain tumor in central sulcus area were selected from the153Hospital of PLA. These examples, including35males and29females and aging from14to73, were treated between the year of2009and2013in this hospital. The pathological showed that these examples involved40glioma patients,16meningioma patients,2metastatic cancer patients,3vascular malformations patients,1brain Abscess patient and2pathological calcification patients.2GroupingThese examples were divided into electrophysiologic monitoring group (33examples) and neuronavigation group (31examples) according to their differences in treatment time and treatment protocols. For the electrophysiologic monitoring group, the surgical incision was marked by anatomical location. Both direct cortical stimulation and direct subcortical stimulation were used in the surgery to protect eloquent areas. For the neuronavigation group, on the other hand, a series of method were conducted before the surgery to access the surgery risk, including reconstructing the3D anatomic structure, depicting the delineate tumor anatomic feature, and using the diffusion tensor tractography (DTT). The surgical incision and route were designed on the computer imaging station. During the surgery, the direct cortical stimulation was used to protect cortical motor area and the cutting of the tumor subcortex part was directed by the navigation image to protect the nerve fiber bundle without direct cortical stimulation. The nerves functional assessment was conducted after1month of the surgery for all examples and volumetric analysis was performed both before and after surgery by calculating the tumor volume on the images.3Statistical analysisThe statistical software SPSS17.0was used to process the data. The quantitative material was analyzed by t testing and the qualitative material was analyzed by χ2testing. A criteria of α=0.05was used for the testing, which means that when P was less than0.05, the data had statistical meaning.ResultsFor the neuronavigation group,27examples are gross total resection,2examples near total resection,1example subtotal resection and1example partial resection. The gross total resection rate is87.1%. The electrophysiologic monitoring group includes19examples are gross total resection,9examples near total resection,3example subtotal resection and1example partial resection, with a gross total resection rate of57.6%. The difference had statistical meaning as the P value was less than0.05. Comparing the Kpost value of the electrophysiologic monitoring group (83.94±7.04) and the Kpre value of neuronavigation group (79.70±12.12), the t value was2.235, with a difference having statistical meanings (pairing t test, P<0.05). Comparing the Kpost value of the neuronavigation group (89.03±7.00) and the Kpre value of neuronavigation group (79.68±10.80), the t value was5.609, with a difference having statistical meanings (pairing t test, P<0.05). Comparing the△KPS value of neuronavigation group (9.35±9.29) and the△KPS value of the electrophysiologic monitoring group, the t value was2.013, with a difference having statistical meanings (pairing t test, P<0.05). The surgery tims for the electrophysiologic monitoring group and the neuronavigation group was153.26±27.50min and130.38±27.92min, respectively. The difference also had statistical meanings (pairing t test, P<0.05).Conclusion1、Neural navigation system can be reasonably designed incision and into the road before surgery;2、intraoperative use neuronavigation fibers tracer, you can predict the structure of brain function, operation guide intraoperative electrical stimulation and accurately locate the lesion location;3、nervenavigation used clinically to improve the entire central area of brain tumor cut rates, reduce the incidence of postoperative neurologic dysfunction.