Clinical application of electrophysiologic monitoring in surgical treatment of glioma locating in gyri centrales or the adjacent area

Abstract

Objective To explore the application of cortical sensory evoked potential (Co ⁃SEP), motor evoked potential (Co⁃MEP) and electrocorticogram (ECoG) for locating functional area to enhance the effectiveness and safety of glioma resection. Methods Eighteen cases of glioma located in or adjacent to the gyri centrales were screened by iconography. fMRI and magnetoencephalography (MEG) were used to locate functional area. During operation, the Co⁃SEP and Co⁃MEP were performed to further define the functional area, and ECoG was performed to detect the epileptogenic focus. The glioma was removed as much as possible, avoiding the invasion of brain functional area. 125I and 5⁃FU were embeded in the tumor bed during operation. Results In 18 cases, one case was total resected; 13 cases were subtotal resected; 4 cases were partial resected. The curative effect was evaluated at 6 months, 12 months, and 24 months after operation. Progression⁃free survival (PFS) was 11 months on the average. Objective effective rate was 13/18, 9/18 and 6/18, respectively. Disease control rate (DCR) was 15/18, 13/18 and 10/18, respectively. Karnofsky Performance Scale Score at preoperation and 6 months, 12 months and 24 months after operation was (84.13 ± 12.88), (78.20 ± 15.13), (62.35 ± 13.21) and (46.57 ± 16.93) respectively, and the differences were all significant (P < 0.01). Incidence rate for post ⁃ operative complication was 6/18 (2 cases with hypomyodynamia, 3 case with hypoesthesia, and one case with both). Conclusion Neuro ⁃ electrophysiologic monitoring guided surgery of glioma located in or adjacent to the gyri centrales is effective for the resection of glioma as much as possible, avoiding the invasion of important functional area, and can improve patient's quality of life. After gloma resection, application of interstitial radiotherapy combined with chemotherapy may extend patient's life span, and decrease the recurrence of glioma.

DOI：10.3969/j.issn.1672-6731.2011.06.007