Elsevier

Neurochirurgie

Volume 51, Issues 3–4, Part 2, September 2005, Pages 368-378
Neurochirurgie

Options thérapeutiques
Intérêt de la stimulation électrique directe dans la chirurgie des gliomes en zones fonctionnellesUsefulness of direct electrical stimulations during surgery for gliomas located within eloquent brain regions

https://doi.org/10.1016/S0028-3770(05)83496-4Get rights and content

Résumé

La chirurgie des gliomes en zones fonctionnelles s’est beaucoup développée ces dernières années grâce aux progrès de l’imagerie fonctionnelle pré-opératoire et de la stimulation électrique directe des aires corticales et des faisceaux d’association. L’objectif de ces techniques est d’obtenir une exérèse chirurgicale la plus complète possible des tumeurs situées dans les aires sensori-motrices et du langage, avec un risque de séquelles définitives très faible. Pour être fiable, ces techniques nécessitent une méthodologie rigoureuse. Si la cartographie corticale est d’application relativement simple, celle des faisceaux d’association demande plus d’expérience. De plus, à la difficulté du repérage sous-cortical s’associe, pour les résections tumorales en aires somato-sensorielles et du langage, celle de l’anesthésie locale et du choix des tâches pour évaluer l’intégrité des fonctions cognitives. Avec ces techniques, l’exérèse tumorale totale ou sub-totale est possible pour 52 à 76,2 % des patients. Une aggravation transitoire survient dans 13 à 80 % des cas ; le pourcentage de séquelles définitives est de 4 % en moyenne.

À condition de bien maîtriser les techniques de cartographie fonctionnelle per-opératoire, l’exérèse chirurgicale est une option thérapeutique à discuter dans la prise en charge des gliomes en zones fonctionnelles.

Summary

Glioma surgery in functional areas has undergone a dramatic development these last few years, thanks to improvements in both intraoperative functional imaging and direct electrical stimulation of cortical areas or association pathways. The goal of these techniques to achieve complete as possible surgical removal of tumors located in eloquent areas (sensitive, motor and language areas) with minimal risk of permanent sequelae. To be reliable, a rigorous methodology is required. Current cortical mapping is very easy to achieve, whereas mapping of association pathways will require much more experience. In case of tumors located in somatosensorial or language areas, the difficulties related to accurate sub cortical localization are combined with these of local anesthesia and the best task choice to evaluate the integrity of cognitive functions. These functional techniques allow total or sub total removal in 52% to 76.2% of patients. Transient worsening is observed in 13% to 80% of the patients; the rate of permanent sequelae averages 4%.

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