Elsevier

Surgical Neurology

Volume 36, Issue 1, July 1991, Pages 44-48
Surgical Neurology

Resection of intrinsic tumors from nondominant face motor cortex using stimulation mapping: Report of two cases

https://doi.org/10.1016/0090-3019(91)90132-SGet rights and content

Abstract

We report two right-handed patients who underwent resection of intrinsic glial tumors from the nondominant hemisphere, face motor cortex. Both patients underwent preoperative assessment with computed tomography and magnetic resonance imaging localizing the tumor in the inferior region of the Rolandic cortex. With the patients under general anesthesia and without muscular paralysis, the tumor volume was determined by intraoperative ultrasound and resective surgery accomplished with the aid of cortical and subcortical stimulation mapping techniques. Radical resection of the tumor from the face motor cortex was achieved in both patients. A transient contralateral facial weakness and apraxia were noted in each patient, and this resolved within 6 to 8 weeks following surgery. Removal of intrinsic tumors involving the nondominant face motor cortex may be safely achieved using brain mapping techniques to localize inferior Rolandic cortex and avoid resection of the hand motor cortex and descending subcortical motor pathways. Permanent disability will be prevented due to the bilateral representation of face motor function at the neocortical level. However, due to language localization in cortical zones contiguous with the dominant hemisphere, face motor cortex, we do not recommend resection of this region.

References (34)

  • M Ammirati et al.

    Effect of the extent of surgical resection on survival and quality of life in patients with supratentorial glioblastomas and anaplastic astrocytomas

    Neurosurgery

    (1987)
  • R Bartholow

    Experimental observations into functions of the human brain

    Am J Med Sci

    (1874)
  • CE Beevor et al.

    A record of the results obtained by electrical stimulation of the so-called motor cortex and internal capsule in an orangoutan

    Philos Trans R Soc Lond

    (1890)
  • R Benecke et al.

    Transcranial magnetic stimulation of the human brain: responses in muscles supplied by cranial nerves

    Exp Brain Res

    (1988)
  • MS Berger et al.

    Brain mapping techniques to maximize resection, safety, and seizure control in children with brain tumors

    Neurosurgery

    (1989)
  • MS Berger et al.

    Neurophysiological monitoring during astrocytoma surgery

  • P Black et al.

    Cortical mapping in defining the limits of tumor resection

    Neurosurgery

    (1987)
  • I Ciric et al.

    Supratentorial gliomas: surgical considerations and immediate postoperative results

  • H Cushing

    A note upon the faradic stimulation of the postcentral gyrus in conscious patients

    Brain

    (1909)
  • WE Dandy

    Physiological studies following extirpation of the right cerebral hemisphere in man

    Bull Johns Hopkins Hosp

    (1933)
  • O Foerster

    The motor cortex in man in the light of Hughlings Jackson's doctrines

    Brain

    (1936)
  • S Goldring et al.

    Experience with lesions that mimic gliomas in patients presenting with a chronic seizure disorder

    Clin Neurosurg

    (1985)
  • EM Gregorie et al.

    Localization of function in the excision of lesions from the sensorimotor region

    J Neurosurg

    (1984)
  • K Hirakawa et al.

    Multivariate analysis of factors affecting postoperative survival in malignant astrocytomas

    J Neurooncol

    (1984)
  • V Horsely et al.

    A record of experiments upon functions of the cerebral cortex

    Philos Trans

    (1888)
  • AB Jenny et al.

    Organization of the facial nucleus and corticofacial projection in the monkey

  • D Kimura

    Left hemisphere control of oral and brachial movements and their relation to communication

    Philos Trans R Soc Lond Biol

    (1982)
  • Cited by (63)

    • Functional reorganization in the patient with progressing glioma of the pure primary motor cortex: A case report with special reference to the topographic central sulcus defined by somatosensory-evoked potential

      2014, World Neurosurgery
      Citation Excerpt :

      This concept should be quite useful in treating lesions located in classically eloquent areas with surgical exploration. Recent reports indicate that lesions invading topographically eloquent areas, including the Broca and Wernicke speech centers and primary motor cortex, can be resected owing to brain reorganization (7, 12, 13, 14, 19). Several fMRI studies of lesions adjacent to the primary motor cortex in the area of the precentral gyrus known as the Brodmann area 4 (BA4) implicated the lesions in cortical reorganization, and quite a few cases described BA4 reorganization with direct evidence of DES in humans in vivo (7, 8, 12, 14).

    • Electrocorticographic sensorimotor mapping

      2013, Clinical Neurophysiology
    • Tumors in Eloquent Areas of Brain

      2012, Schmidek and Sweet Operative Neurosurgical Techniques: Indications, Methods, and Results: Sixth Edition
    View all citing articles on Scopus

    This work was supported by an American Cancer Society Career Development Award and a Clinical Investigator's Development Award NS 0 1253-01, and by National Institutes of Health Grants NS 17111, 21724, and 20482

    View full text