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Journal of Neurosurgical Sciences 2007 June;51(2):45-51

Copyright © 2007 EDIZIONI MINERVA MEDICA

language: English

Cortical and subcortical motor mapping in rolandic and perirolandic glioma surgery: impact on postoperative morbidity and extent of resection

Carrabba G. 1, Fava E. 1, Giussani C. 1, Acerbi F. 1, Portaluri F. 1, Songa V. 2, Stocchetti N. 2, Branca V. 3, Gaini S. M. 1, Bello L. 1

1 Department of Neurosurgery, University of Milan Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena IRCCS Foundation, Milan, Italy 2 Unit of Neurosciences Intensive Care, University of Milan Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena IRCCS Foundation, Milan, Italy 3 Unit of Neuroradiology Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena IRCCS Foundation, Milan, Italy


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Aim. 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.
Conclusion. Cortical and subcortical motor areas are identified in a high percentage of patients. Identification of subcortical tracts is associated with a higher incidence of immediate postoperative deficits and a low incidence of definitive morbidity. Total resection was performed in a considerable percentage of patients.

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