PAPER

Use of neuronavigation and electrophysiology in surgery of subcortically located lesions in the sensorimotor strip

W Eisner¹, J Burtscher¹, R Bale², R Sweeney⁴, F Koppelstätter³, S Golaszewski³, C Kolbitsch⁵ and K Twerdy¹

¹ Department of Neurosurgery, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck; Austria
² Department of Radiology I, University of Innsbruck
³ Department of Radiology II, University of Innsbruck
⁴ Department of Radiotherapy-Oncology, University of Innsbruck
⁵ Department of Anaesthesia and Intensive Care, University of Innsbruck

Correspondence to:
Correspondence to:
Dr Wilhelm Eisner, Neurosurgical Department, University of Innsbruck, Anichstrasse 35, A-6090 Innsbruck, Austria;
wilhelm.eisner{at}uklibk.ac.at

Objectives: Subcortical lesions in the sensorimotor strip are often considered to be inoperable. The purpose of this study was to evaluate the usefulness of a combined approach for surgery in this region, aided by a robotic neuronavigation system under electrophysiological control.

Methods: In a prospective study on 10 patients, space occupying lesions in the sensorimotor central area were removed using the Surgiscope® robotic navigation system and the Nicolet Viking IV® electrophysiological system.

Results: Precise tumour localisation with the neuronavigation system and the information on the patient's cortical motor distribution obtained by bipolar cortical stimulation led to postoperative improvement in motor function in all but one patient. Seven of the patients had focal, defined pathology (four metastases; two cavernoma; one aspergilloma).

Conclusion: Due to the implementation of two recent technologies, surgery of lesions in the subcortical sensorimotor region can be performed with greater confidence.

Keywords: stereotaxy; neuronavigation; electrophysiological monitoring

Abbreviations: TIVA, total intravenous anaesthesia; fMRI, functional magnetic resonance imaging

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