RESUMEN
A major dilemma in brain-tumor surgery is the identification of tumor boundaries to maximize tumor excision and minimize postoperative neurological damage. Gliomas, especially low-grade tumors, and normal brain have a similar color and texture, which poses a challenge to the neurosurgeon. Advances in glioma resection techniques combine the experience of the neurosurgeon and various advanced technologies. Intraoperative methods to delineate gliomas from normal tissue consist of (1) image-based navigation, (2) intraoperative sampling, (3) electrophysiological monitoring, and (4) enhanced visual tumor demarcation. The advantages and disadvantages of each technique are discussed. A combination of these methods is becoming widely accepted in routine glioma surgery. Gross total resection in conjunction with radiation, chemotherapy, or immune/gene therapy may increase the rates of cure in this devastating disease.
RESUMEN
This study investigated electrophysiological and histological changes as well as alterations of myelin relevant proteins of descending motor tracts in rat pups. Motor-evoked potentials (MEPs) represent descending conducting responses following stimulation of the motor cortex to responses being elicited from the lower extremities. MEP responses were recorded biweekly from postnatal (PN) week 1 to week 9 (adult). MEP latencies in PN week 1 rats averaged 23.7 ms and became shorter during early maturation, stabilizing at 6.6 ms at PN week 4. During maturation, the conduction velocity (CV) increased from 2.8 ± 0.2 at PN week 1 to 35.2 ± 3.1 mm/ms at PN week 8. Histology of the spinal cord and sciatic nerves revealed progressive axonal myelination. Expression of the oligodendrocyte precursor markers PDGFRα and NG2 were downregulated in spinal cords, and myelin-relevant proteins such as GalC, CNP, and MBP increased during maturation. Oligodendrocyte-lineage markers Olig2 and MOG, expressed in myelinated oligodendrocytes, peaked at PN week 3 and were downregulated thereafter. A similar expression pattern was observed in neurofilament M/H subunits that were extensively phosphorylated in adult spinal cords but not in neonatal spinal cords, suggesting an increase in axon diameter and myelin formation. Ultrastructural morphology in the ventrolateral funiculus (VLF) showed axon myelination of the VLF axons (99.3%) at PN week 2, while 44.6% were sheathed at PN week 1. Increased axon diameter and myelin thickness in the VLF and sciatic nerves were highly correlated to the CV (rs > 0.95). This suggests that MEPs could be a predicator of morphological maturity of myelinated axons in descending motor tracts.