Brain mapping for lesions in primary motor cortex: integrated surgical approach. (12th October 2019)

• Record Type: Journal Article
• Authors: Lavrador, José; Ghimire, Prajwal; Brogna, Christian; Furlanetti, Luciano; Patel, Sabina; Gullan, Richard; Ashkan, Keyoumars; Bhangoo, Ranjeev; Vergani, Francesco
• Is Part Of: Neuro-oncology. Volume 21(2019)Supplement 4
• Page Start: iv18
• Page End: iv18
• Publication Date: 2019-10-12
• Subjects: Brain Neoplasms -- Periodicals; Brain -- Tumors -- Periodicals; Brain -- Cancer -- Periodicals; Nervous system -- Cancer -- Periodicals; 616.99481
• DOI: 10.1093/neuonc/noz167.078
• Languages: English
• ISSNs: 1522-8517

Abstract

Abstract: Background: Lesions within the corticospinal tract (CST) represent significant surgical challenge with a delicate functional trade-off that should be integrated in the overall patient-centred treatment plan. Methods: Patients with lesions within the CST with preoperative cortical and subcortical mapping (nTMS and tractography), intraoperative mapping and intraoperative provisional histological information (smear +- 5-ALA) were included. This independently acquired information was integrated in a decision-making process model to determine the intraoperative extent of resection. Results: 10 patients (6 patients with metastatic precentral tumour; 1 patient with Grade III and 2 patients with grade IV gliomas; 1 patient with precentral vascular malformation) were included in the study. Majority of the patient had pre-operative motor deficit (60%). 50% patients underwent gross total resection and 40% patients underwent near total resection of the lesions. In only one patient, no surgical resection was possible after both pre-operative and intraoperative mapping. 70% of patients remained stable postoperatively and 20% improved from previous motor weakness. Conclusion: The independently acquired anatomical (anatomical MRI) and functional (nTMS and tractography) in patients with CST lesions provide a more accurate guide for resection. The inclusion of the histological information (smear +- 5-ALA) further allows the surgical team to balance the potential functional risks within the global treatment plan. Therefore, the patient is kept at the centre of the informed decision making process.