Surgery of Lesions in the Motor Strip Combining a Stereotactically-Guided Mini-Craniotomy with Electrophysiological Mapping of the Motor Cortex

Abstract

The removal of space-occupying lesions in the sensori-motor cortex carries a considerable risk of postoperative palsy. Therefore subcortical lesions located in the sensori-motor strip are often considered to be inoperable. Treatment options are stereotactic biopsy and radiosurgery beside radiological control examinations without surgery or surgery with a higher risk of postoperative deficits. The following article focusses on a combined approach involving a stereotactically guided and electrophysiologically controlled surgery. The instruments used (stereotactical system and electric stimulator) are available in almost every neurosurgical department in the Western and Eastern world and had been the first navigation systems in the human brain.

Key words

Sensori-motor Strip - Central Region - Stereotaxy - Electrophysiological Monitoring - Motor Cortex Stimulation

References

• 1 Apuzzo M LJ. Brain surgery. Complication avoidance and management Vol. 1. New York: Churchill Livingstone 1993: 379-390
• 2 Ebeling U, Schmid U D, Reulen H J. Tumor surgery within the central motor strip: surgical results with aid of electrical cortical motor cortex stimulation.  Acta Neurochir (Wien). 1990;  101 110-117
• 3 Eisner W, Reulen H J, Ilmberger J, Swozil U, Bise K. Intraoperative mapping of eloquent brain areas. Frontiers of Radiation Therapy and Oncology, Meyer JL & Hinkelbein W (eds.). Zürich: Karger Verlag 1999 33: 28-36
• 4 Steude U, Hamburger C. Preoperative stereotactic localisation of cerebral tumors: a new tool to improve microsurgical tumor removal.  Appl Neurophysiol. 1987;  50 (1 - 6) 241-242
• 5 Reulen H J, Schmid U D, Ilmberger J, Eisner W, Ebeling U, Gutbrot K. Intraoperative identification of motor and speech functions: The Munich protocol. The Decade of the Brain. In: Siegenthaler W, Haas R (eds). Stuttgart, New York: Georg Thieme Verlag 1995: 58-60
• 6 Ebeling U, Rikli D, Huber P, Reulen H J. The coronal suture. A useful landmark in neurosurgery? Craniocerebral topography between bony landmarks on the skull and the brain.  Acta Neurochir (Wien). 1987;  89 30-134
• 7 Klingler J, Gloor P. The connections of the amygdala and of the anterior cerebral cortex in the human brain.  J Comp Neurol. 1960;  115 333-369
• 8 Brodal A. Neurological anatomy - in relation to clinical medicine. 2^nd ed., New York: University Press 1969
• 9 Jane J A, Yashon D, De Myer D, Bucy P C. The contribution of the precentral gyrus to the pyramidal tract in man.  J Neurosurg. 1967;  26 244-248
• 10 Barr L M. The human nervous system. An anatomical viewpoint. Harper 1972: 316-330
• 11 Ebeling U, Reulen H-J. Space-Occupying Lesions in the Sensori-Motor Region in Advances and Technical Standards in Neurosurgery.  Springer Verlag, Wien - New York.. 1995;  22 137-181