Estimulación cortical intraoperatoria en el tratamiento quirúrgico de los gliomas de bajo grado situados en áreas elocuentes

Resumen Introduccion La seleccion de pacientes para cirugia en los gliomas de bajo grado, basada en criterios radiologicos, es, en ocasiones, insuficiente, dada la variabilidad individual en la localizacion de las areas elocuentes y la preservacion de funcion en el tejido cerebral infiltrado. Evaluamos la seguridad de la tecnica de estimulacion cortical intraoperatoria en un subgrupo de pacientes con tumores gliales de bajo grado, analizando en que medida la aplicacion de esta modifica la posibilidad de resecciones completas y la aparicion de deficits postquirurgicos. Material y metodos Veinticinco pacientes con gliomas de bajo grado (II/IV OMS) localizados en areas cerebrales elocuentes fueron intervenidos para exeresis guiada con estimulacion cortical intraoperatoria. La cirugia se efectuo bajo anestesia local y sedacion o bajo anestesia general sin relajacion muscular, en dependencia de la funcion a explorar. Todas las intervenciones se efectuaron desde una perspectiva oncologica, buscando la reseccion tumoral maxima, y deteniendose al hallar tejido cerebral funcionante en la lesion o proximo a ella. Resultados Se logro una exeresis completa o parcial maxima en 16 pacientes (64%); en cinco casos (20%) la reseccion fue parcial, y en el resto (16%), solo pudo efectuarse biopsia. Los tumores de area motora suplementaria (AMS) y los de la region fronto-opercular, fueron los que con mas frecuencia pudieron resecarse completamente. Trece pacientes (52%) presentaron un empeoramiento de su situacion neurologica previa, pero en ocho de ellos se observo mejoria progresiva durante los dias siguientes, con practica resolucion de la clinica a los 6 meses. Conclusiones La estimulacion cortical intraoperatoria permite optimizar el grado de reseccion minimizando las secuelas postoperatorias. La existencia de areas funcionales y vias subcorticales en el seno de estos tumores es una realidad a tener en cuenta. La localizacion en region fronto-opercular izquierda y AMS permiten mayor grado de exeresis con menor morbilidad, mientras que las lesiones insulares continuan siendo un reto incluso con el apoyo de esta tecnica.

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