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CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(04): 805-810
DOI: 10.4103/ajns.ajns_307_21
Original Article

Rolandic cortex morphology: Magnetic resonance imaging-based three-dimensional cerebral reconstruction study and intraoperative usefulness

Krishnapundha Bunyaratavej
Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok
,
Piyanat Wangsawatwong
Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok
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Background: During brain surgery, the neurosurgeon must be able to identify and avoid injury to the Rolandic cortex. However, when only a small part of the cortex is exposed, it may be difficult to identify the Rolandic cortex with certainty. Despite various advanced methods to identify it, visual recognition remains an important backup for neurosurgeons. The aim of the study was to find any specific morphology pattern that may help to identify the Rolandic cortex intraoperatively. Materials and Methods: Magnetic resonance imaging of the brain from patients with various conditions was used to create the three-dimensional cerebral reconstruction images. A total of 216 patients with 371 intact hemispheres were included. Each image was inspected to note the morphology of the Rolandic cortex and the suprasylvian cortex. In addition, other two evaluators exclusively inspected the morphology of the suprasylvian cortex. Their observation results were compared to find the agreements. Results: A number of distinctive morphology patterns have been identified at the Rolandic cortex and the suprasylvian cortex including a genu, or a knob at the upper precentral gyrus (pre-CG), an angulation of the lower postcentral gyrus (post-CG), a strip for pars opercularis, a rectangle for the lower pre-CG, and a triangle for the lower post-CG. Combined total and partial agreement of the suprasylvian cortex morphology pattern ranged 60.4%–85.2%. Conclusion: The authors have demonstrated the distinctive morphology of the Rolandic cortex and the suprasylvian cortex. This information can provide visual guidance to identify the Rolandic cortex particularly during surgery with limited exposure.

Key-words:

Cerebral cortex - morphology - Rolandic cortex - suprasylvian cortex - three-dimensional reconstruction

Financial support and sponsorship

Nil.




Publication History

Received: 28 August 2021

Accepted: 14 September 2021

Article published online:
16 August 2022

© 2021. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Ebeling U, Rikli D, Huber P, Reulen HJ. The coronal suture, a useful bony landmark in neurosurgery? Craniocerebral topography between bony landmarks on the skull and the brain. Acta Neurochir (Wien) 1987;89:130-4.
  • 2 Kendir S, Acar HI, Comert A, Ozdemir M, Kahilogullari G, Elhan A, et al. Window anatomy for neurosurgical approaches. Laboratory investigation. J Neurosurg 2009;111:365-70.
  • 3 Sarmento SA, Jacome DC, de Andrade EM, Melo AV, de Oliveira OR, Tedeschi H. Relationship between the coronal suture and the central lobe: how important is it and how can we use it in surgical planning? Arq Neuropsiquiatr 2008;66:868-71.
  • 4 Lehericy S, Duffau H, Cornu P, Capelle L, Pidoux B, Carpentier A, et al. Correspondence between functional magnetic resonance imaging somatotopy and individual brain anatomy of the central region: comparison with intraoperative stimulation in patients with brain tumors. J Neurosurg 2000;92:589-98.
  • 5 Pujol J, Deus J, Acebes JJ, Villanueva A, Aparicio A, Soriano-Mas C, et al. Identification of the sensorimotor cortex with functional MRI: frequency and actual contribution in a neurosurgical context. J Neuroimaging 2008;18:28-33.
  • 6 Rao SM, Binder JR, Hammeke TA, Bandettini PA, Bobholz JA, Frost JA, et al. Somatotopic mapping of the human primary motor cortex with functional magnetic resonance imaging. Neurology 1995;45:919-24.
  • 7 Sanchez-Panchuelo RM, Francis S, Bowtell R, Schluppeck D. Mapping human somatosensory cortex in individual subjects with 7T functional MRI. J Neurophysiol 2010;103:2544-56.
  • 8 Farrell DF, Burbank N, Lettich E, Ojemann GA. Individual variation in human motor-sensory (rolandic) cortex. J Clin Neurophysiol 2007;24:286-93.
  • 9 Uematsu S, Lesser R, Fisher RS, Gordon B, Hara K, Krauss GL, et al. Motor and sensory cortex in humans: topography studied with chronic subdural stimulation. Neurosurgery 1992;31:59-71.
  • 10 Jannin P, Morandi X, Fleig OJ, Le Rumeur E, Toulouse P, Gibaud B, et al. Integration of sulcal and functional information for multimodal neuronavigation. J Neurosurg 2002;96:713-23.
  • 11 Boling W, Olivier A, Bittar RG, Reutens D. Localization of hand motor activation in Broca's pli de passage moyen. J Neurosurg 1999;91:903-10.
  • 12 Boling W, Reutens DC, Olivier A. Functional topography of the low postcentral area. J Neurosurg 2002;97:388-95.
  • 13 Boling WW, Olivier A. Localization of hand sensory function to the pli de passage moyen of Broca. J Neurosurg 2004;101:278-83.
  • 14 Frigeri T, Paglioli E, de Oliveira E, Rhoton AL, Jr. Microsurgical anatomy of the central lobe. J Neurosurg 2015;122:483-98.
  • 15 Ribas GC, Yasuda A, Ribas EC, Nishikuni K, Rodrigues AJ, Jr. Surgical anatomy of microneurosurgical sulcal key points. Neurosurgery 2006;59:ONS177-210.
  • 16 Yousry TA, Schmid UD, Alkadhi H, Schmidt D, Peraud A, Buettner A, et al. Localization of the motor hand area to a knob on the precentral gyrus. A new landmark. Brain 1997;120:141-57.
  • 17 Wagner M, Jurcoane A, Hattingen E. The U sign: tenth landmark to the central region on brain surface reformatted MR imaging. AJNR Am J Neuroradiol 2013;34:323-6.
  • 18 Berger MS, Cohen WA, Ojemann GA. Correlation of motor cortex brain mapping data with magnetic resonance imaging. J Neurosurg 1990;72:383-7.
  • 19 Bittar RG, Olivier A, Sadikot AF, Andermann F, Pike GB, Reutens DC. Presurgical motor and somatosensory cortex mapping with functional magnetic resonance imaging and positron emission tomography. J Neurosurg 1999;91:915-21.
  • 20 Bittar RG, Olivier A, Sadikot AF, Andermann F, Reutens DC. Cortical motor and somatosensory representation: effect of cerebral lesions. J Neurosurg 2000;92:242-8.
  • 21 Yousry TA, Schmid UD, Jassoy AG, Schmidt D, Eisner WE, Reulen HJ, et al. Topography of the cortical motor hand area: prospective study with functional MR imaging and direct motor mapping at surgery. Radiology 1995;195:23-9.
  • 22 Ribas GC, Ribas EC, Rodrigues CJ. The anterior sylvian point and the suprasylvian operculum. Neurosurg Focus 2005;18:E2.
  • 23 Bunyaratavej K, Siwanuwatn R. Three-Dimensional Cortical Surface Reconstruction Versus Operative Findings: Their Similarity and Applications. World Neurosurg 2017;107:809-19.
  • 24 Chabrerie A, Ozlen F, Nakajima S, Leventon ME, Atsumi H, Grimson E, et al. Three-dimensional image reconstruction for low-grade glioma surgery. Neurosurg Focus 1998;4:e7.
  • 25 Hu XP, Tan KK, Levin DN, Galhotra S, Mullan JF, Hekmatpanah J, et al. Three-dimensional magnetic resonance images of the brain: application to neurosurgical planning. J Neurosurg 1990;72:433-40.
  • 26 Kikinis R, Gleason PL, Moriarty TM, Moore MR, Alexander E, 3rd, Stieg PE, et al. Computer-assisted interactive three-dimensional planning for neurosurgical procedures. Neurosurgery 1996;38:640-9.
  • 27 Zele T, Matos B, Knific J, Bajrovic FF, Prestor B. Use of 3D visualisation of medical images for planning and intraoperative localisation of superficial brain tumours: our experience. Br J Neurosurg 2010;24:555-60.
  • 28 Rhoton AL, Jr. The cerebrum. Neurosurgery 2002;51:S1-51.
  • 29 Ribas GC. The cerebral sulci and gyri. Neurosurg Focus 2010;28:E2.
  • 30 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159-74.
  • 31 Nii Y, Uematsu S, Lesser RP, Gordon B. Does the central sulcus divide motor and sensory functions? Cortical mapping of human hand areas as revealed by electrical stimulation through subdural grid electrodes. Neurology 1996;46:360-7.