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Keyhole Tumor Removal Under Local Anesthesia

Author(s): Sertac ISLEKEL

Journal: Journal of Neurological Sciences
ISSN 1300-1817

Volume: 23;
Issue: 2;
Start page: 108;
Date: 2006;
Original page

Objective: Surgery of the lesions involving eloquent cortex carries the risk of neurological deficits. We performed resection of the lesions under local anesthesia in order to prevent new neurological deficits.Methods: We performed keyhole craniotomies under local anesthesia with stereotactic guidance. The eloquent areas were chosen using of anatomical landmarks and functional MRI studies. The most distant gyrus from the eloquent brain area where the tumor is most superficial was chosen for cortical incision. The resection of the lesions was performed with cortical-subcortical stimulation and under continuous neurological examination. Postoperative MRI controls were taken within 24-72 hours and 3 months after the operation.Results: In 92 patients functional MRI and stereotactic guidance were used for surgical planning. In 90% of the cases the lesions were totally removed. One patient died because of intracerebral hemorrhage, in 13 cases (14%) the surgery caused or worsened the neurological deficits. Three cases had permanent worsening. For the remaining cases the worsening was transient and resolved within a few days.Conclusion: Stereotactic guidance with the help of fMRI provides safe tumor resection under local anesthesia alone through keyhole craniotomy.

Tango Jona
Tangokurs Rapperswil-Jona

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