1/28/2024 0 Comments Eloquent brain![]() Because brain tumors in eloquent areas are relatively rare, the prospective observational study was not limited to a specific brain tumor type or region. The research team analyzed the results of 72 patients who had surgery to remove brain tumors in eloquent areas using the tubular approach from 2018-2021 at the Hospital Infantil Universitario de San Jose in Bogota, Colombia. “The neurosurgeon checks with the neuronavigation that all the tracts are not touched by the tube, puts the tube in and then puts the instrument inside the hole in the tube and to remove the tumor.” “The average length of the tube is 7 centimeters, but you can also use smaller tubes,” Palmisciano said. Since the imaging technology pinpoints where the tumor is located, where to avoid important brain tissue and where the shortest distance to the tumor will be, the tube can be inserted directly into the exact spot of the brain where the tumor is located, then the tumor can be removed through the tube. This method involves removing a much smaller portion of the skull, and there is no need to retract the brain. The researchers studied the effectiveness of a different, minimally invasive approach using a small tube. “If too much traction is used, the surgeon can cause damage to the neurons and also cause tissue death.” "When the neurosurgeon retracts the brain, the brain is mushy and very soft,” Palmisciano said. Palmisciano said all three techniques are used together to help surgeons remove as much of the tumor as possible while causing the least amount of damage to the surrounding tissue.Įven using these new technologies, traditional methods of neurosurgery involve removing large portions of the skull, then pulling back large sections of the brain using retractors to get access to the tumor. The third technology, tractography, specifically maps the location and direction of white matter within the brain using advanced imaging software. “So you want to do cortical mapping during the surgery to see how far you are from the eloquent area.” “Neurosurgeons know the detailed brain anatomy, but sometimes the tracts are not in the place you think they are because they are displaced by the tumor,” he said. This helps identify exactly where the regions that control things like speech, motor function and vision are located so that surgeons can avoid these important areas. “It’s important because otherwise, you can see where the tumor is in the image but you don’t know exactly where in relation to the patient’s anatomy.”Īnother technique, called cortical mapping, uses a small amount of electricity to stimulate the brain during the surgery to see if specific regions light up. “So basically when you do the surgery, you use the pen and you touch the head of the patient and you see on the screen where you are going,” Palmisciano said. The patient’s MRI is connected with the navigation system, and surgeons can use a pen-like device to register the brain to match the MRI. These technologies include neuronavigation, which functionally acts as a GPS to guide the surgeon exactly to the tumor. A clinical–radiological suspicion combined with precise diagnosis obviates the unwarranted surgery-related morbidities especially in eloquent areas of the brain.Subscribe to Technology Networks’ daily newsletter, delivering breaking science news straight to your inbox every day. 1Ĭerebral tuberculoma is essentially a medical disease. The differentials to be borne in mind for a suspected case of tuberculoma include primary central nervous system lymphoma and other infectious etiologies such as fungal granulomas, toxoplasmosis, and cysticercosis. 1 A lesion with a caseating solid center, such as the one described here, depicts ring enhancement with a T2 hypointense appearance. The imaging depends on the pathological stage (i.e., caseating or non-caseating) of the center of the tuberculoma. 1 These lesions contain epithelioid cells and Langhans giant cells with central caseation. 2 Tuberculomas occur when the hematogenous spread of mycobacterial infection leads to formation of microgranulomatous foci (Rich foci), which coalesce to form non-caseating and caseating granulomas. 1 A diffuse involvement of the brain manifests as leptomeningitis, whereas localized disease gives rise to tuberculomas, abscesses, and cerebritis. Central nervous system tuberculosis constitutes about 1% to 5% of all cases of tuberculosis.
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