Biopsy of Brain Stem Glioma Using Motor-Evoked Potential Mapping by Direct Peduncular Stimulation and Individual Adjuvant Therapy : Case Report

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概要

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• A 23-year-old man presented with a brain stem glioma manifesting as a 6-month history of right hemiparesis and diplopia. Serial magnetic resonance imaging showed an intrinsic diffuse brain stem glioma that gradually localized to the left cerebral peduncle after initial adjuvant therapy. Surgery was performed through a left subtemporal transtentorial approach under motor-evoked potential (MEP) mapping by direct peduncular stimulation. The lateral aspect of the midbrain was exposed, a train of five bipolar 25 mA pulses was applied, and MEPs recorded from the extremities. MEPs Were only recorded from the left extremities even with left cerebral peduncular stimulation. Partial resection of the tumor was safely performed, with slight temporary neurological worsening. The histological diagnosis was anaplastic astrocytoma. Individual adjuvant therapy based on the results of real-time reverse transcription-polymerase chain reaction of O^6-methylguanine-deoxyribonucleic acid methyltransferase achieved an almost complete tumor response. Surgery under pyramidal tract mapping and intensive postoperative adjuvant therapy resulted in a good outcome despite the presence of a generally intractable intrinsic brain stem glioma.

• 2005-01-15

著者

• TANAKA Satoshi

  Department of Physical Science, Osaka Prefecture University

• Tanaka Satoshi

  Department Of Nutritional Sciences Faculty Of Nutritional Science Nakamura Gakuen University

• Sagiuchi Takao

  Kitasato Univ. School Of Medicine

• Kobayashi Ikuo

  Department Of Neurosurgery Kitasato University School Of Medicine

• Kobayashi Ikuo

  Department Of Laboratory Medicine And Pathology Mayo Clinic

• UTSUKI Satoshi

  Department of Neurosurgery, Kitasato University School of Medicine

• Iwamoto Kazuhisa

  Department of Neurosurgery, Kitasato University School of Medicine

• Utsuki S

  Department Of Neurosurgery Kitasato University School Of Medicine

• Utsuki Satoshi

  Department Of Neurosurgery Kitasato University School Of Medicine

• TAKANASHI Junko

  Clinical Laboratory, The Kitasato Institute Medical Center Hospital

• Takanashi Junko

  Clinical Laboratory The Kitasato Institute Medical Center Hospital

• Kobayashi Ikuo

  Department Of Neurosurgery The Kitasato Institute Medical Center Hospital

• Iwamoto Kazuhisa

  Department Of Neurosurgery The Kitasato Institute Medical Center Hospital

• Iwamoto Kazuhisa

  Department Of Neurosurgery Kitasato University School Of Medicine

• Tanaka Satoshi

  Department Of Anesthesia Nagano Municipal Hospital

• Tanaka Satoshi

  Department Of Neurosurgery The Kitasato Institute Medical Center Hospital

• Tanaka Satoshi

  Department Of Agricultural Chemistry Faculty Of Agriculture Tottori University

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