Sınırlı Cerrahi Kaynaklar Altında Korteks Glioma Rezeksiyonunda İşaretleyici Olarak Kemik Balmumu Kullanımı: İlk Deneyim ve Teknik Not

Abstract

Background: Glial tümör rezeksiyonu sırasında tümör dokusunun normal beyin parankiminden ayırt edilmesi oldukça zorlayıcı olabilir. Cerrahi navigasyon sistemlerinin bulunmadığı ve kısıtlı kaynaklar nedeniyle nöromonitörizasyon kullanımının sınırlı olduğu durumlarda, uygun maliyetli ve pratik alternatiflere ihtiyaç vardır. Aim: Bu çalışmada, manyetik rezonans görüntüleme (MRG) ile birlikte kemik mumu (bone wax) kullanılarak düşük dereceli gliomaların rezeksiyon sınırlarının belirlenmesine yönelik basit bir tekniği tanımlıyoruz. Materials and methods: Tümör rezeksiyonu sırasında, steril kemik mumundan küçük parçalar rezeksiyon kavitesi içine yerleştirilerek intrakaviter fidüsiyel belirteçler olarak kullanıldı. Ardından MRG çekilerek, kemik mumunun çevre beyin parankimiyle olan konumu gerçek zamanlı olarak görüntülendi. Results: Kemik mumu fidüsiyelleri, tümör sınırlarının belirlenmesi ve rezeksiyonun kapsamının değerlendirilmesi için net referans noktaları sağladı. Gelişmiş nöronavigasyon sistemlerinin olmadığı durumlarda, kemik mumu belirteçleri ile rezidüel kontrast tutan doku arasındaki mekânsal ilişkiye dayanarak cerrahi sınırlar belirlendi ve bu sayede doğru tümör çıkarımı gerçekleştirildi. Tümör rezeksiyonu, preoperatif görüntüleme ve intraoperatif anatomik belirteçler yardımıyla tanımlanan eloquent kortikal ve subkortikal bölgeler dikkatle korunarak yapıldı. Conclusion: Kemik mumu, kaynakların kısıtlı olduğu ortamlarda pratik ve düşük maliyetli bir alternatif sunmakta olup, cerrahi sırasında oluşabilecek navigasyon sistemi hatalarını en aza indirmek için basit bir yöntem sağlamaktadır. Sınırlı teknik olanaklara sahip merkezlerde güvenli ve etkili bir şekilde kullanılabilir.

Keywords

• Eloquent
• Tümör cerrahisi
• kemik mumu
• fidüsiyel
• MRG

Use of Bone Wax as a Marker in Cortex Glioma Resection under Limited Surgical Resources: First Experience and A Technical Note

Abstract

Background: Differentiating tumor tissue from normal brain parenchyma during glial tumor resection can be highly challenging. In situations where surgical navigation systems are unavailable and the use of neuromonitoring is limited due to restricted resources, there is a need for affordable and practical alternatives. Aim: we describe a simple technique for delineating the resection margins of low-grade gliomas using bone wax as an intra-cavitary marker in conjunction with magnetic resonance imaging (MRI). Materials and Methods: During tumor resection, small sterile fragments of bone wax were placed within the resection cavity to serve as intra-cavitary fiducial markers. MRI was subsequently performed, allowing real-time visualization of the bone wax positions relative to the surrounding brain parenchyma. Results: Bone wax fiducials provided clear reference points for delineating tumor boundaries and assessing the extent of resection. Surgical margins were determined based on the spatial relationship between the bone wax markers and the residual enhancing tissue, facilitating accurate tumor removal in the absence of advanced neuronavigation systems. Tumor resection was carried out with careful preservation of eloquent cortical and subcortical regions, as identified by preoperative imaging and intraoperative anatomical landmarks. Conclusion: Bone wax represents a practical and cost-effective alternative in resource-limited settings, providing a simple method to minimize navigation system inaccuracies that may occur during surgery. It can be safely and effectively used in centers with limited technical resources.

Keywords

• Eloquent
• tumor surgery
• bone wax
• MRI
• fiducial

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