Year: 2017
Type: conference-abstract
Abstract: BACKGROUND: Brain 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 awake or asleep impacts extent of resection, and how stimulation mapping influences outcomes. METHODS: A retrospective chart review from 1998-2016 was performed on the senior author’s cohort to identify patients who underwent surgical 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 post-operative motor deficits. Results: Forty-nine patients underwent 53 surgical 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 sub-cortical 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 difference in extent of resection in cases done awake compared to general anesthesia. New or worsened post-operative motor deficits occurred in 32 (60%) patients, and 20 (37%) patients had a permanent deficit. Of the permanent deficits, 14 were mild, 4 were moderate, and 2 were severe (3.7% of cases). Decreased intraoperative motor response and diffusion restriction on post-operative magnetic resonance imaging (MRI) findings were associated with permanent deficit. Awake motor mapping surgery was associated with increased diffusion signal on post-operative MRI. Conclusions: Resection 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 surgical resection and should not be labeled unresectable. Injury to small perforating or en passage blood vessels was the most common cause of infarction that caused moderate or severe deficits. Awake motor mapping was not superior to mapping done under general anesthesia with regards to long-term functional outcome.
Source: Neuro-Oncology
Authors: S. T. Magill, J. Li
Institution: University of California, San Francisco
Language: English
Subfield: Genetics
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2609011395