RU2380048C1 - Surgical approach to intracerebral tumour located in functionally significant cerebral area - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, namely neurosurgery. It involves subcortical approach. In a projection of the tumour, a furrow is separated on border of a functionally significant area at least 2 centimetres long and 1.5 centimetres deep. The pia is dissected at the furrow bottom to uncover the tumour.

EFFECT: method allows for more considerable eradication of the tumour and reduced operative traumas.

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Description

The invention relates to medicine, namely to neurosurgery and can be used to remove intracerebral tumors located in functionally significant areas.

There is a method of surgical access to an intracerebral tumor located in a functionally significant area of the brain, in which a transcortical approach is performed by dissecting the cortex directly above the tumor followed by its resection (Yasargil M.C. Microneurosurgery, Vol IV B. Thieme, 1984, p. 292).

The disadvantages of the method:

- the use of the method is possible only with the spread of tumors on the surface of the brain;

- dissection of the cortex in a functionally significant zone can lead to neurological deficit.

Closest to the claimed is a method of surgical access to a tumor located in a functionally significant zone of the brain through functionally insignificant zones (Ugryumov V.M. Surgery of the central nervous system. Part One. Publishing House "Medicine" Leningrad Department. 1969. - S.364-403), adopted as a prototype. They perform craniotomy, dissect the dura mater, dissect the cortex at a distance from the tumor, and then subcortically approach the neoplasm and remove it. Then, the dura mater is sutured in layers, bone is fixed, and soft tissues are sutured.

The disadvantages of the prototype:

- with remote non-projective access, the wound course is long, which limits the visualization of the object and reduces the radical removal of the tumor;

- trauma, since the length of the wound course requires a large traction of the cortex;

- there is a high risk of damage to functionally significant zones, pathways and vascular collectors and the development of postoperative neurological prolapse and bleeding.

The invention is aimed at creating a method of surgical access to an intracerebral tumor located in a functionally significant area of the brain, providing increased radical removal of the neoplasm, reducing trauma, and reducing the risk of damage to a functionally significant area.

The specified technical result in the implementation of the invention is achieved by the fact that in the known method of surgical access to an intracerebral tumor located in a functionally significant area of the brain, including dissection of the cerebral cortex and subcortical approach to neoplasm, the peculiarity is that a groove is secured in the projection of the tumor at the border of a functionally significant zone with a length of at least 2 cm and a depth of at least 1.5 cm, then the bottom of the furrow is exposed and cut.

Access to the tumor through a groove located in the immediate vicinity of the tumor and at the border of the functionally significant zone allows to reduce the wound course, increase the visualization of the tumor and thereby increase its degree of removal. A decrease in the degree of traction of the brain reduces trauma, as it avoids damage to the functional area of the brain, which in turn reduces the risk of postoperative neurological deficiency. The length of the selected furrow is less than 2 cm and the depth is less than 1.5 cm will not allow for sufficient visualization of the tumor and require excessive traction of the brain.

The method is as follows. After a craniotomy, the dura mater is dissected over the area of the brain affected by the blastomatous process, and according to the combined data of CT, MRI, EEG, intraoperative ultrasound and morphometry, the location of the tumor, the localization, and the boundaries of functionally significant zones are determined. A groove is distinguished in the projection of the tumor at the border of a functionally significant zone with a length of at least 2 cm and a depth of at least 1.5 cm. The soft medulla is dissected and the wall of the furrow is pushed to expose its bottom. Then, the pia mater is coagulated and dissected at the bottom of the sulcus with a 2-3 cm section and the tumor is exposed. The neoplasm is gradually removed by fragmentation. Brain layers are sutured in layers, a bone flap and soft tissues are fixed.

The inventive method is developed and passed clinical trials at the Russian National Scientific Research Institute named after prof. A.L. Polenova in the treatment of 5 patients with intracerebral tumors of the cerebral hemispheres located in functionally significant areas (2 patients with tumors of the left frontal lobe, 2 patients with neoplasms of the left parietal and frontal lobes, 1 patient with a tumor of the right frontal and parietal lobes ) As a result of treatment, the number of postoperative complications decreased, neurological deficit in the postoperative period was less frequently observed, and the duration of the patients' recovery period decreased.

We give an example extract from the medical history.

Patient I., 5 years old, IB No. 2258, was treated with a diagnosis of Astrocytoma of the right parietal and frontal lobe. The operation was performed: osteoplastic trepanation in the right frontotoparietal region, removal of the tumor of the parietal and frontal lobe. After craniotomy and dissection of the dura mater, it was revealed that the surface of the anterior sections of the deformed motor cortex in the area 2.5 × 3.5 cm in size has a grayish-cyanotic color, a smooth surface. Using ultrasound navigation, a tumor 3.5 × 4.0 cm in size was located under the motor cortex, not reaching the midline 1 cm. Parallel to the front edge of the motor cortex and 1.0 cm anteriorly, along the edge of the pathologically altered tissue, the pia mater over 2.5 cm dissected. A furrow 23 mm long and 16 mm deep was highlighted. The pathological tissue is moved dorsally. Blastomatous tissue is located subcortical (1.5 mm). The tumor was removed by out-of-projection access with an ultrasonic disintegrator along the border with little-changed tissues. The surface of the brain became more pink, venous plethora regressed. The dura mater is sutured tightly. Layered seams on the wound.

The course of the immediate postoperative period is smooth. The wound healed by first intention, the sutures were removed on the 10th day. During the first 3 days after surgery, paresis of the left hand was noted, which gradually regressed. The patient was discharged for radiation therapy.

Using the proposed method allows for surgical access to an intracerebral tumor located in a functionally significant zone, increases the radicalism of the operation, reduces the morbidity and likelihood of damage to functionally significant zones and the development of neurological loss.

Claims (1)

A method of surgical access to an intracerebral tumor located in a functionally significant area of the brain, including a subcortical approach, characterized in that a furrow is isolated in the projection of the tumor at the border of a functionally significant area with a length of at least 2 cm and a depth of at least 1.5 cm, then soft the meninges are at the bottom of the sulcus and the tumor is exposed.