Localizing hand motor area using resting-state fMRI: validated with direct cortical stimulation

Introduction: The advantages and the necessity of intraoperative neurophysiological monitoring (IOM) in the surgery of motor area infiltrative tumours is well known. The use of this technique for Rolandic meningioma is still debatable. The absence or the loss of the cleavage plan and an infiltrative border make the dissection exceedingly difficult and increase the risk of new postoperative motor disfunction. Materials and methods: We evaluated the impact of IOM, especially direct cortical stimulation on the degree of resection, new postoperative deficits, symptom remission and clinical-imagistic aspects at one-year follow up of 19 cases of Rolandic meningioma admitted in Third Department of Neurosurgery,” Prof. Dr N. Oblu” Emergency Clinical Hospital, Yassi, Romania, between January 2014 and July 2018. Results: More than half of the cases (57,88%) had epileptic manifestations as the main clinical symptom with the Jacksonian seizures being on the first place (31,57%), followed by progressive paresis (26,31%) and other nonspecific symptoms. Intraparenchymal preoperative oedema was observed in 36,84% of patients. The intensity of direct cortical stimulation was between 6-13 mA (median = 9mA; mode = 12mA). Simpson degree of resection was dominated by S3– 47,36% and S4 was obtained in 15,78% of cases. Postoperative the outcome was favourable for 73,68% patients with 5,26% motor aggravation and 10,52% new deficits. At one-year follow up no imagistic recurrence was observed and the permanent motor deficit was maintained in one of the three cases (5,26%). Conclusion: Even though meningiomas are extranevraxial lesions and those located on the convexity have a low risk of complication, the absence of a clear dissection plan between the tumour and the adjacent motor cortex is associated with a high risk for new postoperative neurological deficits. Therefore, it is important to perform cortical mapping for Rolandic meningioma, to determine the location of the primary motor area and to protect it from mechanical and vascular trauma, during tumour resection.

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Static magnetic field stimulation of the supplementary motor area modulates resting-state activity and motor behavior

Communications Biology ◽

10.1038/s42003-019-0643-8 ◽

2019 ◽

Vol 2 (1) ◽

Cited By ~ 4

Author(s):

José A. Pineda-Pardo ◽

Ignacio Obeso ◽

Pasqualina Guida ◽

Michele Dileone ◽

Bryan A. Strange ◽

...

Keyword(s):

Magnetic Field ◽

Static Magnetic Field ◽

Resting State ◽

Supplementary Motor Area ◽

Motor Behavior ◽

Inferior Frontal Gyrus ◽

Resting State Fmri ◽

Motor Area ◽

Field Stimulation ◽

Speed Accuracy

Abstract Focal application of a strong static magnetic field over the human scalp induces measurable local changes in brain function. Whether it also induces distant effects across the brain and how these local and distant effects collectively affect motor behavior remains unclear. Here we applied transcranial static magnetic field stimulation (tSMS) over the supplementary motor area (SMA) in healthy subjects. At a behavioral level, tSMS increased the time to initiate movement while decreasing errors in choice reaction-time tasks. At a functional level, tSMS increased SMA resting-state fMRI activity and bilateral functional connectivity between the SMA and both the paracentral lobule and the lateral frontotemporal cortex, including the inferior frontal gyrus. These results suggest that tSMS over the SMA can induce behavioral aftereffects associated with modulation of both local and distant functionally-connected cortical circuits involved in the control of speed-accuracy tradeoffs, thus offering a promising protocol for cognitive and clinical research.

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Anomia produced by direct cortical stimulation of the pre-supplementary motor area in a patient undergoing preoperative language mapping

Epileptic Disorders ◽

10.1684/epd.2015.0750 ◽

2015 ◽

Vol 17 (2) ◽

pp. 184-187 ◽

Cited By ~ 1

Author(s):

Verena Eveline Rozanski ◽

Aurelia Peraud ◽

Soheyl Noachtar

Keyword(s):

Supplementary Motor Area ◽

Cortical Stimulation ◽

Motor Area ◽

Language Mapping ◽

Direct Cortical Stimulation ◽

Stimulation Of

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Preoperative Mapping of the Supplementary Motor Area in Patients with Brain Tumor Using Resting-State fMRI with Seed-Based Analysis

American Journal of Neuroradiology ◽

10.3174/ajnr.a5709 ◽

2018 ◽

Cited By ~ 2

Author(s):

J. Wongsripuemtet ◽

A.E. Tyan ◽

A. Carass ◽

S. Agarwal ◽

S.K. Gujar ◽

...

Keyword(s):

Brain Tumor ◽

Resting State ◽

Supplementary Motor Area ◽

Resting State Fmri ◽

Motor Area ◽

Preoperative Mapping

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Intraoperative Seizures in Awake Craniotomy for Perirolandic Glioma Resections That Undergo Cortical Mapping

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0037-1617759 ◽

2018 ◽

Vol 79 (03) ◽

pp. 239-246 ◽

Cited By ~ 13

Author(s):

Chikezie Eseonu ◽

Jordina Rincon-Torroella ◽

Young Lee ◽

Karim ReFaey ◽

Punita Tripathi ◽

...

Keyword(s):

Logistic Regression ◽

Cortical Stimulation ◽

Awake Craniotomy ◽

Motor Area ◽

Perioperative Outcomes ◽

Motor Deficits ◽

Precentral Gyrus ◽

Motor Mapping ◽

Direct Cortical Stimulation ◽

Motor Region

Background Perirolandic motor area gliomas present invasive eloquent region tumors within the precentral gyrus that are difficult to resect without causing neurologic deficits. Study Aims This study evaluates the role of awake craniotomy and motor mapping on neurologic outcome and extent of resection (EOR) of tumor in the perirolandic motor region. It also analyzes preoperative risk factors for intraoperative seizures. Methods We evaluated 57 patients who underwent an awake craniotomy for a perirolandic motor area eloquent region glioma. Patients who had positive mapping (PM) or intraoperative identification of motor regions in the cortex using direct cortical stimulation were compared with patients with no positive motor mapping following direct cortical stimulation and negative mapping (NM). Preoperative risks, intraoperative seizures, perioperative outcomes, tumor characteristics, and EOR were also compared. A logistic regression model was used to evaluate the predictors for intraoperative seizures in this patient cohort. Results Overall, 33 patients were in the PM cohort; 24 were in the NM cohort. Our study showed an 8.8% incidence of intraoperative seizures during cortical and subcortical mapping for awake craniotomies in the perirolandic motor area, none of which aborted the case. PM patients had significantly more intraoperative and postoperative seizures (15.5% and 30.3%, respectively) compared with the NM patients (0% and 8.3%, respectively; p = 0.046 and 0.044). New transient postoperative motor deficits were found more often in the PM group (51.5%) versus the NM group (12.5%; p = 0.002). A univariate logistic regression showed that PM (odds ratio [OR]: 1.16; 95% confidence interval [CI], 1.01–1.34; p = 0.035) and preoperative tumor volume (OR: 0.998; 95% CI, 0.996–0.999; p = 0.049) were significant predictors for intraoperative seizures in patients with perirolandic gliomas. Conclusion Awake craniotomies in the perirolandic motor region can be safely performed with a similar incidence of intraoperative seizures as reported for the language cortex. PM in this region may increase the likelihood of perioperative seizures or motor deficits compared with NM. Craniotomies that minimize cortical exposure for perirolandic gliomas that may not localize motor regions can still allow for extensive tumor resection with a good postoperative outcome.

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