Cortical and subcortical motor mapping in rolandic and perirolandic glioma surgery: impact on postoperative morbidity and extent of resection.
OBJECTIVE
Surgery for gliomas located inside or in proximity of motor cortex or tracts requires cortical and subcortical mapping to locate motor function; direct electrical stimulation of brain cortex or subcortical pathways allows identification and preservation of motor function. In this study we evaluated the effect which subcortical motor mapping had on postoperative morbidity and extent of resection in a series of patients with gliomas involving motor areas or pathways.


METHODS
One hundred and forty-six patients were included in the study. Intraoperative findings of primary motor cortex or subcortical tracts were reported, together with incidence of new postoperative deficits at short (1 week) and long term (1 month) examination. The relationship between intraoperative identification of subcortical motor tracts and extent of resection was reported.


RESULTS
The motor strip was found in 133 patients (91%) and subcortical motor tracts in 91 patients (62.3%). New immediate postoperative motor deficits were documented in 59.3% of patients in whom a subcortical motor tract was identified intra-operatively and in 10.9% of those in whom subcortical tracts were not observed; permanent deficits were observed in 6.5% and 3.5%, respectively. A total resection was achieved in 94.4% of patients with high-grade gliomas and in 46.1% of those with low-grade gliomas.
Carrabba
G
G
Department of Neurosurgery, University of Milan, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, IRCCS Foundation, Milan, Italy. giorgio.carrabba@unimi.it
Fava
E
E
Giussani
C
C
Acerbi
F
F
Portaluri
F
F
Songa
V
V
Stocchetti
N
N
Branca
V
V
Gaini
S M
SM
Bello
L
L
D000328:Adult; D000368:Aged; D001931:Brain Mapping / Q000379:methods*; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D004525:Efferent Pathways / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D004558:Electric Stimulation / Q000379:methods; D004568:Electrodiagnosis / Q000379:methods; D004569:Electroencephalography / Q000379:methods; D005910:Glioma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D009044:Motor Cortex / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D009069:Movement Disorders / Q000517:prevention & control; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome