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Image guidance and neuromonitoring in neurosurgery

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Abstract

Introduction

The localization of tumors and epileptogenic foci within the somatosensory or language cortex of the brain of a child poses unique neurosurgical challenges. In the past, lesions in these regions were not treated aggressively for fear of inducing neurological deficits. As a result, while function may have been preserved, the underlying disease may not have been optimally treated, and repeat neurosurgical procedures were frequently required. Today, with the advent of preoperative brain mapping, image guidance or neuronavigation, and intraoperative monitoring, peri-Rolandic and language cortex lesions can be approached directly and definitively with a high degree of confidence that neurosurgical function will be maintained.

Methods and results

The preoperative brain maps can now be achieved with magnetic resonance imaging (MRI), functional MRI, magnetoencephalography, and diffusion tensor imaging. Image guidance systems have improved significantly and include the use of the intraoperative MRI. Somatosensory, motor, and brainstem auditory-evoked potentials are used as standard neuromonitoring techniques in many centers around the world. Added to this now is the use of continuous train-of-five monitoring of the integrity of the corticospinal tract while operating in the peri-Rolandic region.

Conclusion

We are in an era where continued advancements can be expected in mapping additional pathways such as visual, memory, and hearing pathways. With these new advances, neurosurgeons can expect to significantly improve their surgical outcomes further.

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Acknowledgements

This work was made possible through funds from the Wiley Fund and Jack Beqaj Fund at the Hospital for Sick Children in Toronto. WH Ng is funded by the Singapore Health Services Health Manpower Development Programme (HMDP) Fellowship and National Neuroscience Institute Scholarship (Singapore).

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  1. Division of Neurosurgery, Suite 1503, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Karim Mukhida & James T. Rutka

  2. Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore

    Wai Hoe Ng

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Correspondence to James T. Rutka.

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Ng, W.H., Mukhida, K. & Rutka, J.T. Image guidance and neuromonitoring in neurosurgery. Childs Nerv Syst 26, 491–502 (2010). https://doi.org/10.1007/s00381-010-1083-4

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