title: Localization of hand motor activation in Broca's pli de passage moyen.
abstract: OBJECTIVE
  The object of this study was to identify a reliable surface landmark for the hand motor area and to demonstrate that it corresponds to a specific structural component of the precentral gyrus.
  
  
  METHODS
  Positron emission tomography (PET) activation studies for hand motor function were reviewed in 12 patients in whom magnetic resonance imaging results were normal. Each patient performed a hand opening and closing task. Using a computer-assisted three-dimensional reconstruction of the surface of each hemisphere studied, the relationship of the hand motor area with cortical surface landmarks was evaluated.
  
  
  CONCLUSIONS
  The region of hand motor activation can be reliably identified on the surface of the brain by assessing anatomical relationships to nearby structures. After identification of the central sulcus, the superior and middle frontal gyrus can be seen to arise from the precentral gyrus at a perpendicular angle. A bend or genu in the precentral gyrus is constantly seen between the superior and middle frontal gyrus, which points posteriorly (posteriorly convex). The location of hand motor function, identified using PET activation studies, is within the central sulcus at the apex of this posteriorly pointing genu. The apex of the genu of the precentral gyrus leads to a deep cortical fold connecting the pre- and postcentral gyri and elevating the floor of the central sulcus. This deep fold was described by Paul Broca as the pli de passage fronto-parietal moyen, and the precentral bank of the pli de passage represents the anatomical substratum of hand motor function. Observers blinded to the results of the activation studies were able to identify the hand motor area reliably after instruction in using these surface landmarks.
authors.affiliation: Department of Neurosurgery, Montreal Neurological Institute and Hospital, and the McConnell Brain Imaging Center, Quebec, Canada. warren@bic.mni.mcgill.ca
authors.forename: W
authors.initials: W
authors.lastname: Boling
authors.forename: A
authors.initials: A
authors.lastname: Olivier
authors.forename: R G
authors.initials: RG
authors.lastname: Bittar
authors.forename: D
authors.initials: D
authors.lastname: Reutens
mesh_terms: D000293:Adolescent; D000328:Adult; D001931:Brain Mapping; D004292:Dominance, Cerebral / Q000502:physiology; D005260:Female; D005625:Frontal Lobe / Q000502:physiology*; D006225:Hand / Q000294:innervation*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009048:Motor Skills / Q000502:physiology*; D012016:Reference Values; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed