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The guided neurophysiological surgical treatment peculiarities of the supratentorial cerebral tumors in the eloquent regions


Author: Maxian Viorel
Degree:doctor of medicine
Speciality: 14.00.28 - Neurosurgery
Year:2019
Scientific consultants: Grigore Zapuhlih
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Stanislav Groppa
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

Term of presenting of the thesis 18 December, 2019

Abstract

Adobe PDF document1.19 Mb / in romanian

Thesis

CZU 616.831-006.04-089

Adobe PDF document 6.26 Mb / in romanian
189 pages


Keywords

cerebral tumors in the eloquent regions, postoperative neurological deficit, intraoperative electrophysiological monitoring, somatosensit ive potentials, direct cortical electrostimulation

Summary

Thesis structure. The thesis consists of introduction, 4 chapters, conclusions and recommendations, bibliography from 156 sources, 4 annexes, 137 the main text pages, 76 figures, 18 tables. The obtained results are published in 12 scient ific journals.

Field of research: neurosurgery – 321.21.

Aim of research: assessment of the guided neurophysiological surgical treatment features in supratentorial cerebral tumors in the eloquent regions in order to establish an optimizing recommendation set perioperat ive management at in patients.

Thesis goal: the study of intraoperative neurophysiological monitoring (ESP, DCS, EMP) in the treatment of the supratentorial cerebra l tumors in the eloquent areas; the assessment of the intraoperative neurophysiological monitoring (INM) parameters according to clinicalimaging and topographic peculiarities in the method establishment of the neurosurgical treatment; the determinat ion of the INM using importance in order to improve the urgent and distant ly neurophysiological postoperat ive prognosis; the elaboration of the improvement recommendation set in surgical management and intraoperative neurophysiological monitoring for the ablation increase level of the tumor and postoperat ive neurological deficit decrease. Scientific innovation and originality consist of the neurophysiological intraoperative monitoring using in the cerebral supratentorial eloquent areas neurosurgical treatment, research results give us the possibilit y to perform the total ablat ion in 78,6% cases, subtotal – 8,9%, partial – 5,4% and tumor biopsy – in 7,1%. In 21,4% cases the intraoperat ive neurophysiological monitoring using significantly contributes to the surgical medical tactics in order to avoid the postoperative neurological deficit.

Theoretic significance. The results of this study completed the theoretical principles o f INM in the neurological treatment of the cerebral supratentorial tumors, in the eloquent areas regarding to the localized anatomical variations of the motor eloquent areas and of the motor ways in relation to tumor localization in the cerebral tissue, followed by the correct selection of the surgical access which includes maximal resection of t he tumors and minimal postoperative neurophysiological deficit appearance.

The applicative value of the research: Optimization of intraoperative neurophysiological monitoring methods that give the possibility to determine the localization of the intraoperative motor regions for the improvement of surgical treatment results of the supratentorial cerebral tumors in the functional regions of the brain.

Practical implementation. The performed results of the study are used in the operatoryroom of the Neurology and Neurosurgery Institute. Also, the obtained data from the study as well as the main principles of INM will be included in the curriculum of Neurosurgery Chair of the Nicolae Testemitanu State University of Medicine and Pharmacy.