Resection of intrinsic tumors from nondominant face motor cortex using stimulation mapping: report of two cases.

We report two right-handed patients who underwent resection of intrinsic glial tumors from the nondominant hemisphere, face motor cortex. Both patients underwent preoperative assessment with computed tomography and magnetic resonance imaging localizing the tumor in the inferior region of the Rolandic cortex. With the patients under general anesthesia and without muscular paralysis, the tumor volume was determined by intraoperative ultrasound and resective surgery accomplished with the aid of cortical and subcortical stimulation mapping techniques. Radical resection of the tumor from the face motor cortex was achieved in both patients. A transient contralateral facial weakness and apraxia were noted in each patient, and this resolved within 6 to 8 weeks following surgery. Removal of intrinsic tumors involving the nondominant face motor cortex may be safely achieved using brain mapping techniques to localize inferior Rolandic cortex and avoid resection of the hand motor cortex and descending subcortical motor pathways. Permanent disability will be prevented due to the bilateral representation of face motor function at the neocortical level. However, due to language localization in cortical zones contiguous with the dominant hemisphere, face motor cortex, we do not recommend resection of this region.

[1]  A. Walker,et al.  ELECTRICAL EXCITABILITY OF THE MOTOR FACE AREA: A COMPARATIVE STUDY IN PRIMATES , 1938 .

[2]  G A Ojemann,et al.  Neurophysiological monitoring during astrocytoma surgery. , 1990, Neurosurgery clinics of North America.

[3]  H. Jasper,et al.  Epilepsy and the functional anatomy of the human brain , 1985 .

[4]  W. Penfield,et al.  SOMATIC MOTOR AND SENSORY REPRESENTATION IN THE CEREBRAL CORTEX OF MAN AS STUDIED BY ELECTRICAL STIMULATION , 1937 .

[5]  D. Kimura,et al.  Left-hemisphere control of oral and brachial movements and their relation to communication. , 1982, Philosophical transactions of the Royal Society of London. Series B, Biological sciences.

[6]  G. Ojemann.  Surgical therapy for medically intractable epilepsy. , 1987, Journal of neurosurgery.

[7]  S. Goldring,et al.  Experience with lesions that mimic gliomas in patients presenting with a chronic seizure disorder. , 1986, Clinical neurosurgery.

[8]  G. Ojemann.  Ojemann's data: Provocative but mysterious , 1983, Behavioral and Brain Sciences.

[9]  H. Kuypers.  Some projections from the peri‐central cortex to the pons and lower brain stem in monkey and chimpanzee , 1958, The Journal of comparative neurology.

[10]  H. Cushing.  A NOTE UPON THE FARADIC STIMULATION OF THE POSTCENTRAL GYRUS IN CONSCIOUS PATIENTS.1 , 1909 .

[11]  H C Kwan,et al.  Spatial organization of precentral cortex in awake primates. II. Motor outputs. , 1978, Journal of neurophysiology.

[12]  O. Foerster,et al.  THE MOTOR CORTEX IN MAN IN THE LIGHT OF HUGHLINGS JACKSON'S DOCTRINES , 1936 .

[13]  G. Ojemann,et al.  Cortical language localization in left, dominant hemisphere. An electrical stimulation mapping investigation in 117 patients. , 1989, Journal of neurosurgery.

[14]  Mitchel S. Berger,et al.  Brain Mapping Techniques to Maximize Resection, Safety, and Seizure Control in Children with Brain Tumors , 1989 .

[15]  R B King,et al.  Cortical localization and monitoring during cerebral operations. , 1987, Journal of neurosurgery.

[16]  H. Kuypers.  CORTICOBULBAR CONNEXIONS TO THE PONS AND LOWER BRAIN-STEM IN MAN , 1958 .

[17]  G A Ojemann,et al.  Individual variability in cortical localization of language. , 1979, Journal of neurosurgery.

[18]  Roberts Bartholow,et al.  Art. I.—Experimental Investigations into the Functions of the Human Brain. , 1874 .

[19]  John F. Fulton,et al.  HEMIDECORTICATION IN CHIMPANZEE, BABOON, MACAQUE, POTTO, CAT AND COATI: A STUDY IN ENCEPHALIZATION , 1938 .

[20]  S. Ronner,et al.  Cortical mapping for defining the limits of tumor resection. , 1987, Neurosurgery.

[21]  V. Horsley,et al.  A Record of the Results Obtained by Electrical Excitation of the So-Called Motor Cortex and Internal Capsule in an Orang-Outang (Simia satyrus) , 1890 .

[22]  C. C. Wood,et al.  Localization of human sensorimotor cortex during surgery by cortical surface recording of somatosensory evoked potentials. , 1988, Journal of neurosurgery.

[23]  E. A. Schafer,et al.  A Record of Experiments upon the Functions of the Cerebral Cortex , 1887 .

[24]  W. Penfield.  The Cerebral Cortex of Man , 1950 .

[25]  S. Goldring,et al.  Localization of function in the excision of lesions from the sensorimotor region. , 1984, Journal of neurosurgery.

[26]  W F Taylor,et al.  Neurosurgical management of low-grade astrocytoma of the cerebral hemispheres. , 1984, Journal of neurosurgery.

[27]  M. Mikhael,et al.  Effect of the extent of surgical resection on survival and quality of life in patients with supratentorial glioblastomas and anaplastic astrocytomas. , 1987, Neurosurgery.