title: Experiences in surgery of primary malignant brain tumours in the primary sensori-motor cortex practical recommendations and results of a single institution.
abstract: OBJECTIVE
  Tumour resection in the Rolandic region is a challenge. Aim of this study is to review a series of patients malignant glioma surgery in the Rolandic region which was performed by combinations of neuronavigation, sonography, 5-aminolevulinic acid fluorescence guided (5-ALA) surgery and intraoperative electrophysiological monitoring (IOM).
  
  
  METHODS
  29 patients suffering malignant gliomas in the motor cortex (17) and sensory cortex (12) were analyzed with respect to functional outcome and grade of resections.
  
  
  RESULTS
  Improvement of motor function was seen in 41.5% one week after surgery, 41.5% were stable, only 17% deteriorated. After three months patients had an improvement of motor function in 56%, of Karnofsky Score (KPS) 27% and sensory function was improved in 8%. Deterioration of motor function was seen in 16%, in sensory function 4% and in KPS 28% after three months. 25% showed no residual tumour in early post surgical contrast enhanced MRI. 10% had less than 2% residual tumour and 15% had 2-5% residual tumour.
  
  
  CONCLUSIONS
  Preoperative functional neuroimaging, neuronavigation for planning the surgical approach and resection margins, intraoperative sonography and 5-ALA guided surgery in combination with the application of IOM shows that functional outcome and total to subtotal resection of malignant glioma in the Rolandic region is feasible.
authors.affiliation: Department of Neurosurgery, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany.
authors.forename: Susan
authors.initials: S
authors.lastname: Noell
authors.affiliation: Department of Neurosurgery, Bamberg Hospital, Huger Straße 80, 96049 Bamberg, Germany.
authors.forename: Guenther C
authors.initials: GC
authors.lastname: Feigl
authors.affiliation: Department of Neurosurgery, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany.
authors.forename: Georgios
authors.initials: G
authors.lastname: Naros
authors.affiliation: Department of Neurosurgery, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Barking
authors.affiliation: Department of Neurosurgery, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany.
authors.forename: Marcos
authors.initials: M
authors.lastname: Tatagiba
authors.affiliation: Department of Neurosurgery, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany; Department of Neurosurgery, Philipps University Marburg, Baldingerstraße, 35043 Marburg, Germany. Electronic address: rainer_ritz@hotmail.com.
authors.forename: Rainer
authors.initials: R
authors.lastname: Ritz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000601:surgery*; D005260:Female; D005910:Glioma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D009044:Motor Cortex / Q000473:pathology / Q000601:surgery*; D018365:Neoplasm, Residual; D038361:Neuronavigation / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods; D016896:Treatment Outcome
keywords: 5-ALA; Brain tumour surgery; Glioblastoma; Intraoperative monitoring; Rolandic region