Surgical Resection of Non-Glial Tumors in the Motor Cortex

Abstract

BackgroundDirect surgery to resect tumors in the motor cortex could improve neurological symptoms or cause novel motor weakness. The present study describes the neurological outcomes of patients after the surgical resection of non-glial tumors in the primary motor cortex.MethodsThe present study included 25 patients who had pathologically confirmed non-glial tumors in the motor cortex for which they underwent surgery. Tumor location was verified using anatomical landmarks on preoperative magnetic resonance imaging scans. All surgeries involved a craniotomy and tumor resection, especially use of the sulcal dissecting approach for intra-axial tumors.ResultsOf the 25 patients, 10 exhibited metastasis, 13 had a meningioma, and 2 had a cavernous malformation. Motor weakness and seizures were the most common symptoms, while 3 patients experienced only a headache. The tumor size was less than 20 mm in 4 patients, 20–40 mm in 14, and greater than 40 mm in seven. Of the 25 patients, 13 exhibited motor weakness prior to the operation, but most of these symptoms (76.9%) improved following surgery. On the other hand, eight patients experienced seizures prior to the surgery, and in three of these patients (37.5%), the seizures were not controlled after the surgery. In terms of surgical complications, a postoperative hematoma developed in one of the meningioma patients, and the patient's hemiparesis was aggravated.ConclusionThe present findings show that careful and meticulous resection of non-glial tumors in the motor cortex can improve preoperative neurological signs, but it cannot completely control seizure activity.

Predictors of postoperative motor function in rolandic meningiomas

“…Several studies have investigated rolandic meningioma cohorts and reported neurological outcomes, but they have not evaluated predictors of postoperative motor decline. Lee et al 10 described the neurological outcomes of 25 patients who had undergone resection of nonglial tumors (13 meningiomas) over the motor cortex. In their cohort, 52% had presented with preoperative deficits, which improved in 76.9% of patients.…”

“…16 Prior literature has highlighted the increased risk of postoperative morbidity for rolandic meningiomas. 10,16 However, the clinical, histological, and radiological predictors of postoperative weakness following resection of meningiomas over the motor cortex have not been reported in a larger case series. In this study, we sought to examine the rates of postoperative motor decline and to determine if there are preoperative predictors that can be used for advising patients before surgery or for considering radical debulking rather than GTR.…”

Surgical Management of Brain Metastases in the Perirolandic Region

“…Regarding BM at the sensorimotor strips, the central sulcus can be dissected to minimize brain retraction and contusion (11,32,76). Then the corticotomy was preferably established in the depth of the central sulcus overlying the tumor (32).…”

“…neurophysiology, and neurosurgical techniques, patient-tailored surgery has become the pivotal strategy in multimodal treatment paradigms of BM. However, approaching BM in the perirolandic region remains a challenge because there may be a risk of new permanent neurological deficits resulting from impairment of cortical or subcortical structure after resection of the tumors which infiltrate into the surrounding sensorimotor areas (4, [7][8][9][10][11].…”

“…Controversy exists regarding optimal treatment for patients with BM within the perirolandic region (7,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Less-invasive therapies including whole-brain radiation therapy (WBRT) or stereotactic radiotherapy (SRT) has still been preferred although relief of the mass effect was always delayed and patients often suffered from adverse events produced by radiation (5,12,13,17,20,22,23).…”