Low Threshold Monopolar Motor Mapping for Resection of Primary Motor Cortex Tumors

2012 ◽  
Vol 73 (S 03) ◽  
Author(s):  
K. Seidel ◽  
J. Beck ◽  
L. Stieglitz ◽  
P. Schucht ◽  
A. Raabe
Keyword(s):  
Motor Cortex ◽  
Primary Motor Cortex ◽  
Motor Mapping ◽  
Low Threshold

Low-Threshold Monopolar Motor Mapping for Resection of Primary Motor Cortex Tumors

2012 ◽  
Vol 71 (suppl_1) ◽  
pp. ons104-ons115 ◽  
Author(s):  
Kathleen Seidel ◽  
Jürgen Beck ◽  
Lennart Stieglitz ◽  
Philippe Schucht ◽  
Andreas Raabe
Keyword(s):  
Motor Neurons ◽  
Evoked Potential ◽  
Primary Motor Cortex ◽  
Motor Evoked Potential ◽  
National Institutes Of Health ◽  
Motor Deficit ◽  
Motor Threshold ◽  
Motor Mapping ◽  
Low Threshold ◽  
A Minor

Abstract BACKGROUND: Microsurgery within eloquent cortex is a controversial approach because of the high risk of permanent neurological deficit. Few data exist showing the relationship between the mapping stimulation intensity required for eliciting a muscle motor evoked potential and the distance to the motor neurons; furthermore, the motor threshold at which no deficit occurs remains to be defined. OBJECTIVE: To evaluate the safety of low threshold motor evoked potential mapping for tumor resection close to the primary motor cortex. METHODS: Fourteen patients undergoing tumor surgery were included. Motor threshold was defined as the stimulation intensity that elicited motor evoked potentials from target muscles (amplitude > 30 μV). Monopolar high-frequency motor mapping with train-of-5 stimuli (HF-TOF; pulse duration = 500 microseconds; interstimulus interval = 4.0 milliseconds; frequency = 250 Hz) was used to determine motor response--negative sites where incision and dissection could be performed. At sites negative to 3-mA HF-TOF stimulation, the tumor was resected. RESULTS: HF-TOF mapping localized the motor neurons within the precentral gyrus by using variable, low-stimulation intensities. The lowest motor thresholds after final resection ranged from 3 to 6 mA, indicating close proximity of motor neurons. Postoperatively, 12 patients had no new motor deficit, 1 patient had a minor new temporary deficit (M4+, National Institutes of Health Stroke Scale 1), and another patient had a minor new permanent deficit (M4+, National Institutes of Health Stroke Scale 2). Thirteen patients had complete or gross total resection. CONCLUSION: These preliminary data demonstrate that a monopolar HF-TOF threshold > 3 mA was not associated with a significant new motor deficit.

Gross Total Resection of a Grade IV Astrocytoma Adjacent to the Precentral Gyrus With Nonawake Motor Mapping and Motor-Evoked Potential Monitoring: 3-Dimensional Operative Video

2019 ◽  
Author(s):  
Burak Ozaydin ◽  
Ihsan Dogan ◽  
Bryan J Wheeler ◽  
Mustafa K Baskaya
Keyword(s):  
Motor Cortex ◽  
Evoked Potential ◽  
Primary Motor Cortex ◽  
Motor Evoked Potential ◽  
Gross Total Resection ◽  
Precentral Gyrus ◽  
Total Resection ◽  
Motor Mapping ◽  
3 Dimensional ◽  
Intraoperative Adjuncts

Abstract Surgical treatment of the gliomas located in or adjacent to the eloquent areas poses significant challenge to neurosurgeons. The main goal of the surgery is to achieve maximal safe resection while preserving the neurological function. This might be possible with utilizing pre- and intraoperative adjuncts such as functional magnetic resonance imaging (MRI), image guidance, mapping of the function of interest, intraoperative MRI, and neurophysiological monitoring. In this video, we demonstrate the utilization of nonawake mapping and motor-evoked potential (MEP) monitoring for the resection of a right-sided posterior superior frontal gyrus grade IV astrocytoma adjacent to the primary motor cortex. The patient is a 69-yr-old woman presented with multiple episodes of simple partial seizures involving her left leg and spreading to the left arm. MRI and functional MRI examinations showed a heterogeneously enhancing mass with peritumoral edema adjacent to the primary motor cortex. Because the patient did not want to undergo an awake craniotomy, a decision was made to perform the resection of the tumor with nonawake motor mapping and continuous MEP monitoring. Nonawake motor mapping and MEP monitoring enabled us to perform gross total resection. Because it has been shown that supratotal resection may provide improved survival outcome,1,2 we extended the white matter resection beyond the contrast enhancing area in noneloquent parts of the tumor. Surgical steps in dealing with vascular anatomy as well as utilizing intraoperative adjuncts such as motor mapping and MEP monitoring to enhance the extent of resection while preserving the function are demonstrated in this 3-dimensional surgical video.  The patient consented to publication of her operative video.

SURG-03. FUNCTIONAL OUTCOMES OF LASER INTERSTITIAL THERMAL THERAPY (LITT) VERSUS RESECTION IN THE TREATMENT OF LESIONS IN OR NEAR THE PRIMARY MOTOR CORTEX

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi195-vi195
Author(s):  
Ethan Srinivasan ◽  
Emily Lerner ◽  
Ryan Edwards ◽  
David Huie ◽  
Peter Fecci
Keyword(s):  
Motor Cortex ◽  
Functional Outcomes ◽  
Primary Motor Cortex ◽  
Thermal Therapy ◽  
Invasive Treatment ◽  
Motor Mapping ◽  
Laser Interstitial Thermal Therapy ◽  
Hospital Stays ◽  
The Difference ◽  
Pre Treatment

Abstract INTRODUCTION Laser interstitial thermal therapy (LITT) is a minimally-invasive treatment option for radiographically-progressive (RP) brain metastases. This study compares the functional outcomes of LITT vs resection (RS) for lesions in or near the primary motor cortex (PMC). METHODS Retrospective review was performed of patients treated for PMC lesions by LITT or RS. Functional outcomes were graded relative to pre-treatment symptoms and categorized as improved, stable, or worsened at 30, 90, and 180 days post-LITT/RS. RESULTS 36 patients were identified with median follow-up of 194 days (IQR 72-503), age 64 years (57-72), and estimated baseline KPS 80 (80-90). 35 (98%) had pre-treatment weakness or motor seizure; 15 (42%) received LITT and 21 (58%) RS; all RS were performed with intra-operative motor mapping while LITT were not. All LITT patients were treated for RP lesions (radiation necrosis (RN) or disease progression) vs. 24% of RS patients (p< 0.01). LITT patients trended towards smaller lesions (1.9 cm vs 2.7 cm, p=0.03) and were more likely to show RN (67% vs 5%, p< 0.01) and be discharged home (87% vs 52%, p=0.04), with shorter ICU (0 vs 1 day, p< 0.01) and hospital stays (1 vs. 2 days, p< 0.01). At 30 days, 89% of surviving patients who received RS had stable or improved symptoms, compared to 46% of the LITT cohort (p=0.02). At 90 days, the difference was 88% to 50% (p=0.07), and at 180 days 100% to 80% (p=0.2941). CONCLUSIONS In the short term (30 days), patients with PMC lesions have better functional outcomes when treated with RS compared to LITT, while those who survive to the 180-day timepoint experience similar outcomes. These differences are likely due to transient, expected post-LITT edema that subsides with time. Taken together, prognosis and patient priorities are important considerations in the decision between LITT and RS.

scholarly journals Resection of primary motor cortex tumors: feasibility and surgical outcomes

2018 ◽  
Vol 129 (4) ◽  
pp. 961-972 ◽  
Author(s):  
Stephen T. Magill ◽  
Seunggu J. Han ◽  
Jing Li ◽  
Mitchel S. Berger
Keyword(s):  
Motor Cortex ◽  
General Anesthesia ◽  
Motor Response ◽  
Primary Motor Cortex ◽  
Extent Of Resection ◽  
Motor Deficit ◽  
Motor Deficits ◽  
Motor Mapping ◽  
Postoperative Mri ◽  
Significant Difference

OBJECTIVEBrain tumors involving the primary motor cortex are often deemed unresectable due to the potential neurological consequences that result from injury to this region. Nevertheless, we have challenged this dogma for many years and used asleep, as well as awake, intraoperative stimulation mapping to maximize extent of resection. It remains unclear whether these tumors can be resected with acceptable morbidity, whether performing the surgery with the patient awake or asleep impacts extent of resection, and how stimulation mapping influences outcomes.METHODSA retrospective chart review was performed on the senior author’s cohort to identify patients treated between 1998 and 2016 who underwent resection of tumors that were located within the primary motor cortex. Clinical notes, operative reports, and radiographic images were reviewed to identify intraoperative stimulation mapping findings and functional outcomes following tumor resection. Extent of resection was quantified volumetrically. Characteristics of patients were analyzed to identify factors associated with postoperative motor deficits.RESULTSForty-nine patients underwent 53 resections of tumors located primarily within the motor cortex. Stimulation mapping was performed in all cases. Positive cortical sites for motor response were identified in 91% of cases, and subcortical sites in 74%. Awake craniotomy was performed in 65% of cases, while 35% were done under general anesthesia. The mean extent of resection was 91%. There was no statistically significant difference in extent of resection in cases done awake compared with those done under general anesthesia. New or worsened postoperative motor deficits occurred in 32 patients (60%), and 20 patients (38%) had a permanent deficit. Of the permanent deficits, 14 were mild, 4 were moderate, and 2 were severe (3.8% of cases). Decreased intraoperative motor response and diffusion restriction on postoperative MRI were associated with permanent deficit. Awake motor mapping surgery was associated with increased diffusion signal on postoperative MRI.CONCLUSIONSResection of tumors from the primary motor cortex is associated with an increased risk of motor deficit, but most of these deficits are transient or mild and have little functional impact. Excellent extent of resection can be achieved with intraoperative stimulation mapping, suggesting that these tumors are indeed amenable to resection and should not be labeled unresectable. Injury to small perforating or en passage blood vessels was the most common cause of infarction that led to moderate or severe deficits. Awake motor mapping was not superior to mapping done under general anesthesia with regard to long-term functional outcome.

Reliability of robotic transcranial magnetic stimulation motor mapping

2021 ◽  
Vol 125 (1) ◽  
pp. 74-85
Author(s):  
Adrianna Giuffre ◽  
Cynthia K. Kahl ◽  
Ephrem Zewdie ◽  
James G. Wrightson ◽  
Anna Bourgeois ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Motor Cortex ◽  
Magnetic Stimulation ◽  
Primary Motor Cortex ◽  
Motor Mapping ◽  
Cortical Motor ◽  
Short And Long Term ◽  
Motor Maps ◽  
Absolute Reliability

Robotic transcranial magnetic stimulation (TMS) is a noninvasive and safe tool that produces cortical motor maps—individualized representations of the primary motor cortex (M1) topography—that may reflect developmental and interventional plasticity. This study is the first to evaluate short- and long-term relative and absolute reliability of TMS mapping outcomes at various M1 excitability levels using novel robotic neuronavigated TMS.

Functional properties of single neurons in the face primary motor cortex of the primate. I. Input and output features of tongue motor cortex

1992 ◽  
Vol 67 (3) ◽  
pp. 747-758 ◽  
Author(s):  
G. M. Murray ◽  
B. J. Sessle
Keyword(s):  
Motor Cortex ◽  
Primary Motor Cortex ◽  
Afferent Input ◽  
Single Neurons ◽  
Tongue Movement ◽  
Tongue Protrusion ◽  
The Face ◽  
Tongue Movements ◽  
Low Threshold ◽  
Organizational Features

1. We have recently demonstrated that reversible, cooling-induced inactivation of the face motor cortex results in a severe impairment in the ability of monkeys (Macaca fascicularis) to perform a tongue-protrusion task but produces only relatively minor effects on the performance of a biting task by the same monkeys. To establish a neuronal correlate for these different behavioral relations, the present study has detailed the afferent input and intracortical microstimulation (ICMS)-defined output features of a population of face motor cortical neurons, and in a subsequent study we have documented the activities of the same population of neurons during the performance of the tongue-protrusion and biting tasks. 2. Of the 231 single neurons recorded within the face motor cortex, 163 were located at sites from which ICMS (less than or equal to 20 microA) could evoke tongue movements (i.e., "tongue-MI" sites) at the lowest threshold for eliciting orofacial movements. The remainder were located at sites from which ICMS evoked jaw movements ("jaw-MI" sites), face movements ("face-MI" sites), or at a few sites, tongue movements and, at the same threshold intensity, either a jaw movement or a facial movement. 3. We confirmed the general organizational features of the face motor cortex that have been defined in previous studies, but we documented in detail the organizational features for tongue-MI. Thus we found that tongue movements were well represented, whereas jaw-closing movements were poorly represented; the representations for face, jaw, and tongue movements were overlapped; the same ICMS-evoked tongue movement could be multiply represented within tongue-MI; tongue-MI was characterized by a prominent input from superficial mechanosensory afferents, whereas there was little evidence for deep input; a close spatial match was found between ICMS-defined motor output and somatosensory afferent input for tongue-MI. 4. A variety of tongue movements could be evoked by ICMS at tongue-MI sites and were categorized into protrusion, retrusion, laterally directed, and other types of tongue movement. Low-threshold (i.e., less than or equal to 5 microA) ICMS-defined tongue-MI sites, which were considered to represent "efferent zones" projecting relatively directly to motoneurons, were reconstructed three dimensionally to provide insights into the spatial organization of tongue-MI. Examples of each of the four low-threshold efferent-zone categories were usually found throughout the ICMS-defined tongue-MI without any apparent preferential distribution. Furthermore, different low-threshold efferent-zone categories had close spatial relationships to each other in cortex.(ABSTRACT TRUNCATED AT 400 WORDS)

Low-threshold monopolar motor mapping for resection of lesions in motor eloquent areas in children and adolescents

2014 ◽  
Vol 13 (5) ◽  
pp. 572-578 ◽  
Author(s):  
Philippe Schucht ◽  
Kathleen Seidel ◽  
Michael Murek ◽  
Lennart Henning Stieglitz ◽  
Natalie Urwyler ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
High Frequency ◽  
Primary Motor Cortex ◽  
Pediatric Patients ◽  
Neurological Deficits ◽  
Precentral Gyrus ◽  
Safe Procedure ◽  
Motor Mapping ◽  
Low Threshold ◽  
Frequency Train

Object Resection of lesions close to the primary motor cortex (M1) and the corticospinal tract (CST) is generally regarded as high-risk surgery due to reported rates of postoperative severe deficits of up to 50%. The authors' objective was to determine the feasibility and safety of low-threshold motor mapping and its efficacy for increasing the extent of lesion resection in the proximity of M1 and the CST in children and adolescents. Methods The authors analyzed 8 consecutive pediatric patients in whom they performed 9 resections for lesions within or close (≤ 10 mm) to M1 and/or the CST. Monopolar high-frequency motor mapping with train-of-five stimuli (pulse duration 500 μsec, interstimulus interval 4.0 msec, frequency 250 Hz) was used. The motor threshold was defined as the minimal stimulation intensity that elicited motor evoked potentials (MEPs) from target muscles (amplitude > 30 μV). Resection was performed toward M1 and the CST at sites negative to 1- to 3-mA high-frequency train-of-five stimulation. Results The M1 was identified through high-frequency train-of-five via application of varying low intensities. The lowest motor thresholds after final resection ranged from 1 to 9 mA in 8 cases and up to 18 mA in 1 case, indicating proximity to motor neurons. Intraoperative electroencephalography documented an absence of seizures during all surgeries. Two transient neurological deficits were observed, but there were no permanent deficits. Postoperative imaging revealed complete resection in 8 patients and a very small remnant (< 0.175 cm3) in 1 patient. Conclusions High-frequency train-of-five with a minimal threshold of 1–3 mA is a feasible and safe procedure for resections in the proximity of the CST. Thus, low-threshold motor mapping might help to expand the area for safe resection in pediatric patients with lesions located within the precentral gyrus and close to the CST, and may be regarded as a functional navigational tool. The additional use of continuous MEP monitoring serves as a safety feedback for the functional integrity of the CST, especially because the true excitability threshold in children is unknown.

scholarly journals WITHIN-HAND PRIMARY MOTOR CORTEX SOMATOTOPY – MNI NORMALIZATION OF THE RESULTS OF TMS MOTOR MAPPING

2019 ◽  
Author(s):  
Maria Nazarova ◽  
Pavel Novikov ◽  
Ekaterina Ivanina ◽  
Kseniya Kozlova ◽  
Evgenii Blagoveshenskii ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Primary Motor Cortex ◽  
Motor Mapping

scholarly journals SURG-08. Laser Interstitial Thermal Therapy (LITT) versus Resection in the Treatment of Lesions In or Near the Primary Motor Cortex

2021 ◽  
Vol 3 (Supplement_3) ◽  
pp. iii25-iii25
Author(s):  
Ethan Srinivasan ◽  
Emily Lerner ◽  
Ryan Edwards ◽  
David Huie ◽  
Peter Fecci
Keyword(s):  
Motor Cortex ◽  
Functional Outcomes ◽  
Primary Motor Cortex ◽  
Thermal Therapy ◽  
Invasive Treatment ◽  
Motor Mapping ◽  
Laser Interstitial Thermal Therapy ◽  
Hospital Stays ◽  
The Difference ◽  
Pre Treatment

Abstract Introduction Laser interstitial thermal therapy (LITT) is a minimally-invasive treatment option for radiographically-progressive (RP) brain metastases. This study compares the functional outcomes of LITT vs resection (RS) for lesions in or near the primary motor cortex (PMC). Methods Retrospective review was performed of patients treated for PMC lesions by LITT or RS. Functional outcomes were graded relative to pre-treatment symptoms and categorized as improved, stable, or worsened at 30, 90, and 180 days post-LITT/RS. Results 36 patients were identified with median follow-up of 194 days (IQR 72–503), age 64 years (57–72), and estimated baseline KPS 80 (80–90). 35 (98%) had pre-treatment weakness or motor seizure; 15 (42%) received LITT and 21 (58%) RS; all RS were performed with intra-operative motor mapping while LITT were not. All LITT patients were treated for RP lesions (radiation necrosis (RN) or disease progression) vs. 24% of RS patients (p&lt;0.01). LITT patients trended towards smaller lesions (1.9 cm vs 2.7 cm, p=0.03) and were more likely to show RN (67% vs 5%, p&lt;0.01) and be discharged home (87% vs 52%, p=0.04), with shorter ICU (0 vs 1 day, p&lt;0.01) and hospital stays (1 vs. 2 days, p&lt;0.01). At 30 days, 89% of surviving patients who received RS had stable or improved symptoms, compared to 46% of the LITT cohort (p=0.02). At 90 days, the difference was 88% to 50% (p=0.07), and at 180 days 100% to 80% (p=0.2941). Conclusion In the short term (30 days), patients with PMC lesions have better functional outcomes when treated with RS compared to LITT, while those who survive to the 180-day timepoint experience similar outcomes. These differences are likely due to transient, expected post-LITT edema that subsides with time. Taken together, prognosis and patient priorities are important considerations in the decision between LITT and RS.

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