Abstract
Introduction Surgical treatment of brain tumors in eloquent areas has always been considered a major challenge because removal-related cortical damage can cause serious functional impairment. However, few studies have investigated the association between small craniotomies and the higher risk of incidence of motor deficits and prolonged recovery time. Here, we analyzed neurologic deficits and the prognostic variables after surgery guided by navigation for motor cortex tumors under general anesthesia. Methods This was a prospective study that included 47 patients with tumors in the precentral gyrus. All surgeries were performed with neuronavigation and cortical mapping, with direct electrical stimulation of the motor cortex. We evaluated the prognostic evolution of patients with pre- and postoperative Karnofsky Performance Scale using the Eastern Cooperative Oncology Group scale. Results Complete resection was verified in all 18 cases of metastasis, 13 patients with glioblastoma multiforme, and 5 patients with low-grade gliomas. An analysis of the motor deficits revealed that 11 patients experienced worsening of the deficit on the first day after surgery. Only four patients developed new deficits in the immediate postoperative period, and these improved after 3 weeks. After 3 months, only two patients had deficits that were worse those experienced prior to surgery; both patients had glioblastoma multiforme. Conclusion In our series, motor deficits prior to surgery were the most important factors associated with persistent postoperative deficits. Small craniotomy with navigation associated with intraoperative brain mapping allowed a safe resection and motor preservation in patients with motor cortex brain tumor.
Highlights
Surgical treatment of brain tumors in eloquent areas has always been considered a major challenge because removal-related cortical damage can cause serious functional impairment
Small craniotomy with navigation associated with intraoperative brain mapping allowed a safe resection and motor preservation in patients with motor cortex brain tumor
Complete resection was verified in all Postoperative Deficits following Motor Cortex Tumor Resection Paiva et al e11
Summary
This was a prospective study that included 47 patients with tumors in the precentral gyrus. All surgeries were performed with neuronavigation and cortical mapping, with direct electrical stimulation of the motor cortex. Study Design We performed a prospective study that included 47 consecutive patients with tumors in the precentral gyrus who underwent surgery between July 2009 and January 2013 in the Division of Neurosurgery, University of Sao Paulo Medical School. The sample comprised patients with metastatic and primary lesions, with an average age of 45.66 Æ 14.62 years, ranging from 18 to 70 years, operated using small craniotomy guided by navigation with tumor and partial motor cortex exposure (►Fig. 1). We excluded patients with Karnofsky Performance Scale (KPS) scores < 70, those between 18 and 70 years of age, and individuals with multiple brain lesions. All patients agreed to participate in the study and signed the informed consent form
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