Localization of function in the excision of lesions from the sensorimotor region.

A method is described which utilizes the recording of somatosensory evoked responses and cortical stimulation to localize the sensorimotor area under general anesthesia. It has been used in 31 patients who had lesions located in or near the somatosensory or motor gyri. Twenty-six of these patients had a tumor, and the remaining five had a tuberculoma, cysticercoid cyst, thrombosed arteriovenous malformation, cystic infarct, and astrocytic proliferation, respectively. Case histories of selected patients are briefly reported to demonstrate how the method can be used to improve the safety of surgical excisions in the sensorimotor area. The neurological results are discussed in relation to recent physiological studies, demonstrating multiple and spatially separate, sensory and motor representations of the body in the somatosensory and motor gyri.

[1]  S. Goldring,et al.  Origin of somatosensory evoked scalp responses in man. , 1969, Journal of neurosurgery.

[2]  H. Suzuki,et al.  Regional difference of the direct cortical response. , 1958, The Japanese journal of physiology.

[3]  P. E. Stohr,et al.  PATTERNS OF UNIT DISCHARGE ASSOCIATED WITH DIRECT CORTICAL RESPONSE IN MONKEY AND CAT. , 1963, Electroencephalography and clinical neurophysiology.

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

[5]  A. Fessard,et al.  Thalamic Integrations and their Consequences at the Telencephalic Level , 1963 .

[6]  J. B. Preston,et al.  Two representations of the hand in area 4 of a primate. I. Motor output organization. , 1982, Journal of neurophysiology.

[7]  M. Fogelman,et al.  Wounds of the liver; review of 100 cases. , 1954, Annals of surgery.

[8]  S. Goldring,et al.  Comparative study of sensory input to motor cortex in animals and man. , 1970, Electroencephalography and clinical neurophysiology.

[9]  J. Kaas,et al.  Organization of the S I Cortex , 1981 .

[10]  J. Semmes,et al.  Behavioral consequences of selective subtotal ablations in the postcentral gyrus of Macaca mulatta. , 1974, Brain research.

[11]  M. Clare,et al.  A note on the characteristic response pattern in primary sensory projection cortex of the cat following a synchronous afferent volley. , 1956, Electroencephalography and clinical neurophysiology.

[12]  S. Goldring,et al.  Surgical management of epilepsy using epidural recordings to localize the seizure focus. Review of 100 cases. , 1984, Journal of neurosurgery.

[13]  S P Wise,et al.  Submodality distribution in sensorimotor cortex of the unanesthetized monkey. , 1981, Journal of neurophysiology.

[14]  C. Woolsey.  Multiple somatic areas , 1981 .

[15]  S. Goldring,et al.  A method for surgical management of focal epilepsy, especially as it relates to children. , 1978, Journal of neurosurgery.

[16]  M P Heilbrun,et al.  Preliminary experience with Brown-Roberts-Wells (BRW) computerized tomography stereotaxic guidance system. , 1983, Journal of neurosurgery.

[17]  T. M. Silver,et al.  Intraoperative use of real-time ultrasonography in neurosurgery. , 1982, Journal of neurosurgery.

[18]  Peter L. Strick,et al.  Multiple representation in the primate motor cortex , 1978, Brain Research.

[19]  Mriganka Sur,et al.  The Postcentral Somatosensory Cortex , 1981 .

[20]  J. B. Preston,et al.  Two representations of the hand in area 4 of a primate. II. Somatosensory input organization. , 1982, Journal of neurophysiology.