Radical surgical resection of midbrain gliomas using occipital transtentorial approach: Effectiveness of intraoperative motor-evoked potential monitoring and mapping of descending motor pathway for preserving the motor function

DOI
  • Handa Hajime
    Department of Neurosurgery, Kitasato University School of Medicine
  • Shibahara Ichiyo
    Department of Neurosurgery, Kitasato University School of Medicine
  • Yamamoto Daisuke
    Department of Neurosurgery, Kitasato University School of Medicine
  • Inukai Madoka
    Department of Neurosurgery, Kitasato University School of Medicine
  • Sato Sumito
    Department of Neurosurgery, Kitasato University School of Medicine
  • Hide Takuichiro
    Department of Neurosurgery, Kitasato University School of Medicine
  • Kumabe Toshihiro
    Department of Neurosurgery, Kitasato University School of Medicine

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  • 中脳実質内神経膠腫に対するOccipital transtentorial approachによる摘出術：錐体路障害を来さないための経頭蓋運動誘発電位モニタリングおよび白質刺激錐体路マッピングの有用性

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Abstract

<p>There are still few reports about radical surgical resection for midbrain gliomas. Considering the surgery of midbrain gliomas, it is reasonable to refer the classification reported by Cavalheiro, et al. They classified midbrain gliomas into anterior (ventral), central, and posterior (dorsal) type on the basis of surgical approaches. It is possible to achieve total removal of non-infiltrating posterior type midbrain gliomas because they tend to be exophytic and extend backward. In such cases, the supracerebellar infratentorial approach or the occipital transtentorial approach has been used without requiring brainstem incision. We experienced two central-posterior type rosette-forming glioneuronal tumors and one posterior recurrent extention of an anterior-central-posterior type pilocytic astrocytoma and achieve radical resection via occipital transtentorial approach in combination with intraoperative motor-evoked potential monitoring and mapping without damage of pyramid tract. In this report, we described these surgical methods and reviewed reports emphasizing the radical surgery of midline gliomas.</p>

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