title: Clinical significance of preoperative fibre-tracking to preserve the affected pyramidal tracts during resection of brain tumours in patients with preoperative motor weakness.
abstract: OBJECTIVE
  To clarify the clinical usefulness of preoperative fibre-tracking in affected pyramidal tracts for intraoperative monitoring during the removal of brain tumours from patients with motor weakness.
  
  
  METHODS
  We operated on 10 patients with mild to moderate motor weakness caused by brain tumours located near the pyramidal tracts under local anaesthesia. Before surgery, we performed fibre-tracking imaging of the pyramidal tracts and then transferred this information to the neuronavigation system. During removal of the tumour, motor function was evaluated with motor evoked potentials elicited by cortical/subcortical electrical stimulation and with voluntary movement.
  
  
  RESULTS
  In eight patients, the locations of the pyramidal tracts were estimated preoperatively by fibre-tracking; motor evoked potentials were elicited on the motor cortex and subcortex close to the predicted pyramidal tracts. In the remaining two patients, in which fibre-tracking of the pyramidal tracts revealed their disruption surrounding the tumour, cortical/subcortical electrical stimulation did not elicit responses clinically sufficient to monitor motor function. In all cases, voluntary movement with mild to moderate motor weakness was extensively evaluated during surgery and was successfully preserved postoperatively with appropriate tumour resection.
  
  
  CONCLUSIONS
  Preoperative fibre-tracking could predict the clinical usefulness of intraoperative electrical stimulation of the motor cortex and subcortical fibres (ie, pyramidal tracts) to preserve affected motor function during removal of brain tumours. In patients for whom fibre-tracking failed preoperatively, awake surgery is more appropriate to evaluate and preserve moderately impaired muscle strength.
authors.affiliation: Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 6068507, Japan. mikunin@kuhp.kyoto-u.ac.jp
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Mikuni
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Okada
authors.forename: Rei
authors.initials: R
authors.lastname: Enatsu
authors.forename: Yukio
authors.initials: Y
authors.lastname: Miki
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Urayama
authors.forename: Jun A
authors.initials: JA
authors.lastname: Takahashi
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nozaki
authors.forename: Hidenao
authors.initials: H
authors.lastname: Fukuyama
authors.forename: Nobuo
authors.initials: N
authors.lastname: Hashimoto
mesh_terms: D000328:Adult; D000368:Aged; D001931:Brain Mapping / Q000379:methods; D001932:Brain Neoplasms / Q000150:complications* / Q000601:surgery*; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D019957:Motor Skills Disorders / Q000209:etiology*; D018908:Muscle Weakness / Q000209:etiology; D038361:Neuronavigation; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011712:Pyramidal Tracts / Q000473:pathology / Q000502:physiology* / Q000601:surgery*