• Zhibao Li, Mingran Wang, Liwei Zhang, Xing Fan, Xiaorong Tao, Lei Qi, Miao Ling, Xiong Xiao, Yuliang Wu, Dongze Guo, and Hui Qiao.
• Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neuroelectrophysiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
• World Neurosurg. 2018 Aug 1; 116: e291-e297.

ObjectiveTo evaluate a new technique in brainstem surgery, neuronavigation (NN)-guided corticospinal tract (CST) mapping, in a retrospective study of patients undergoing brainstem tumor surgery.MethodsWe studied 40 patients with a brainstem tumor who were enrolled in this study. Patients whose worst preoperative muscle strength of the 4 limbs was greater than 3 levels from normal on the Lovett scale were divided into 2 groups: a treatment group of 21 patients who underwent NN-guided CST mapping and routine intraoperative neurophysiology monitoring (IONM) and a control group of 19 patients who underwent routine NN and IONM. Preoperative muscle strength and postoperative (day 90 postsurgery) muscle strength were assessed and compared between the 2 groups.ResultsIn the NN-guided CST mapping group, 3 patients (14.3%) had a decrease in muscle strength by 1 level postoperatively, and no patient experienced a decrease of >1 level. In the control group, 4 patients (21.1%) had a 1-level decrease in muscle strength, and 5 (26.3%) had a decrease of >1 level. Patients in the NN-guided CST mapping group had significantly better surgical outcomes compared with those in the control group (P = 0.018, Fisher exact test).ConclusionsBrainstem tumor resection using NN-guided CST mapping achieved better preservation of motor function compared with routine NN and IONM. NN-guided CST mapping not only decreased the difficulty of the surgery, but also significantly improved the efficiency of surgery.Copyright © 2018. Published by Elsevier Inc.

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