| VIDEO SECTION: STEP BY STEP: OPERATIVE NUANCES
|Year : 2021 | Volume
| Issue : 2 | Page : 311--314
Bone Wax as an Intra-Cavitary Fiducial for Intra-Operative Magnetic Resonance Imaging Guided Resections of Eloquent Cortex Glioma
Kirit Arumalla, Harsh Deora
Department of Neurosurgery, National institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
Background: The extent of resection of eloquent cortex low-grade glioma is improved by intraoperative magnetic resonance imaging (IOMRI) which is faced with challenges such as difficulty in automated registration after the MRI and prolongation of operative time.
Objective: We describe an easier and foolproof method of resection using bone wax as fiducial.
Surgical Procedure: A young male with right-frontal low-grade glioma anterior and superficial to the motor fibers was operated using IOMRI and awake craniotomy under neuromonitoring. Motor cortex mapping using phase reversal and continuous motor evoked potential (MEP) monitoring was used initially followed by continuous sub-cortical suction stimulation for deeper decompression until stimulation was seen. Bone wax in a triangular shape was placed at the suspicious margin and IOMRI was done.
Results: The tumor residue was seen anterior and deeper to the bone wax and removed subsequently.
Conclusion: The use of bone wax as a fiducial can aid in IOMRI-guided resection of eloquent cortex glioma in awake patients.
Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore - 560 029, Karnataka
Source of Support: None, Conflict of Interest: None
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