Functional rearrangement of the primary and secondary motor cortex in patients with primary tumors of the central nervous system located in the region of the central sulcus depending on the histopathological type and the size of tumor: Examination by means of functional magnetic resonance imaging.
BACKGROUND
The aim of this study was to analyze the reorganization of the centers of the motor cortex in patients with primary neuroepithelial tumors of the central nervous system (CNS) located in the region of the central sulcus in relation to the histopathological type and the size of tumor, as determined by means of functional magnetic resonance imaging (fMRI).


METHODS
The fMRI was performed prior to the surgical treatment of patients with tumors located in the region of the central sulcus (WHO stage I and II, n=15; WHO stage III and IV, n=25). The analysis included a record of the activity in the areas of the primary motor cortex (M1) and the secondary motor cortex: the premotor cortex (PMA) and the accessory motor area (SMA). The results were correlated with the histopathological type of the tumor and its size expressed in cm(3).


RESULTS
The frequency of activation of the motor center was higher in the group of patients who had less aggressive tumors, such as low-grade glioma (LGG), as well as in tumors of lower volume, and this was true both for the hemisphere where the tumor was located and in the contralateral one. Mean values of t-statistics of activation intensity, mean numbers of activated clusters, and their ranges were lower in all analyzed motor areas of LGG tumors. The values of t-statistics and activation areas were higher in the case of small tumors located in ipsilateral centers, and in large tumors located in contralateral centers, aside from the SMA area where the values of t-statistics were equal for both groups. The contralateral SMA area was characterized by the highest stability of all examined centers of secondary motor cortex. No significant association (p>0.05) was observed between the absolute value of the mean registered activity (t-statistics) and the size of examined areas (number of clusters) when the groups were stratified with regards to the analyzed parameters.


CONCLUSIONS
The presence of a neoplastic lesion, its histopathological type and finally its size modulate the functional reorganization of the motor centers as suggested by the differences in the frequency of the neural center activation in the analyzed groups. Processes of functional rearrangement are more pronounced and more precisely defined in patients with less aggressive and/or smaller tumors. The contralateral accessory area is the most frequently activated center in all analyzed groups irrespective of the grade and size of the tumor.
Department of Neurosurgery, Medical University of Łódź, Barlicki University Hospital No.1, Łódź, Poland.
Bartosz
B
Bryszewski
Lucjan
L
Pfajfer
Aneta
A
Antosik-Biernacka
Krzysztof
K
Tybor
Janusz
J
Smigielski
Marek
M
Zawirski
Agata
A
Majos