Introduction: The preservation of motor tract in glioma surgery is an essential issue to maintain the patients’ quality of life. Information from DTI in neuronavigation image is not reliable due to intraoperative brain shift.
The best way to recognize the under-passing motor tract is the real-time intraoperative identification of motor fibers. To overcome this issue, we developed a novel method to position the motor fiber during glioma surgery.
Methods: An electrode (NYTF) designed for navigation-assisted detection of motor tract in cerebral white matter, was used during the resection of 24 gliomas adjacent to motor tract. 25mm-long plastic 16-gauge (G) needle’s sheaths were inserted at the point of 5mm short of the motor fibers by this electrode with EMG recording. Neuronavigational information was used to determine the inserting direction but not the depth. Multiple plastic needle sheaths were placed to track the motor fibers for surgical guidance.
Results: The tracking of motor fibers was practicable in surgical field. Inserted plastic sheaths enabled the recognition of under-passing motor pathways even if they were not exposed. Plastic sheaths could guide safe resection of tumors without the injury of functioning motor fibers.
Conclusions: Three-dimensional understanding of motor pathways is feasible by this method. It is important to know the role of neuronavigation system and solution of brain shift problems for safe tumor resections.
Patient Care: This research will avoid postoperative neurological deterioration and improve patients' ADL.
Learning Objectives: Audiences will understand the role of neuronavigation system and solution of brain shift problems for safe tumor resections.