Summary
Successful surgery of the sensori-motor region requires precise pre- and intraoperative localization of the sensori-motor region and pyramidal tract. Important aids are the landmarks of cranio-cerebral topography, coronal suture and bregma and the sulcal anatomy of the sensori-motor region, which can be identified in CT or MR images. Due to considerable displacement and distortion of the anatomical structures, elicited by mass lesions, these aids often fail to render reliable support. In this situation, identification of the motor area can be achieved by electrical stimulation of the precentral gyrus in association with the recording of somatosensory evoked potentials of the pre- and postcentral gyrus. The localisation of the “motor mosaics” in relation to the lesion, enable determination of the direction of displacement of the motor strip and the fan of the pyramidal tract. Based on this information the most appropriate route of access to the lesion is selected, either transcortical or transsulcal. Lesion-specific operative techniques as well as locationspecific approaches are discussed. With consequent application of these principles the risk of a new persistent motor deficit was as low as 4% . Thus, the indication for surgery in this area can now be set with greater confidence and far more generously than in the past.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Ahmadi J, Jong SH, Teal SH, Tsai FY, Zee C, Segall HP (1982) Localization of intracranial lesions utilizing the coronal suture as a landmark on axial computed tomography. Surg Neurol 17: 209–212
Allison T (1987) Localization of sensori-motor cortex in neurosurgery by recording of somato-sensory evoked potentials. Yale J Biol Med 60: 143–150
Allison T, Mc Carthy G, Wood CC, Darcey TM, Spencer DD, Williamson PD (1989) Human cortical potentials evoked by stimulation of the median nerve. I. Cytoarchitectonic areas generating short-latency activity. J Neurophysiol 62: 694–710
Allison T, Mc Carthy G, Wood CC, Williamson PD, Spencer DD (1989) Human cortical potentials evoked by stimulation of the median nerve. II. Cytoarchitectonic areas generating long-latency activity. J Neurophysiol 62: 711–722
Apuzzo MLJ (1993) Brain surgery. Complication avoidance and management, vol 1. Churchill Livingstone, New York, pp 379–390
Barr LM (1972) The human nervous system. An anatomical viewpoint. Harper, pp 316–330
Beevor CE (1890) An experimental investigation into the arrangement of the excitable fibers in the internal capsule of the bonnet monkey. Phil Trans Roy Soc (London) 181 B: 49–88
Bennett AH (1885) Case of brachial monoplegia due to lesions of the internal capsule. Brain 8: 78–84
Berger MS, Kincaid J, Ojemann GA, Lettich BA (1989) Brain mapping techniques to maximize resection, safety and seizure control in children with brain tumors. Neurosurgery 25: 786–992
Berger MS, Wendy A, Ojemann GA (1990) Correlation of motor cortex mapping data with magnetic-resonance imaging. J Neurosurg 72: 383–387
Berger MS, Ojemann GA, Lettich E (1990) Neurophysiologieal monitoring during astrocytoma surgery. Neurosurg Clin North Am 1: 65–80
Berger MS, Ghation BS, Haglund MM, Dobbius J, Ojemann GA (1993) Low grade gliomas associated with intractable epilepsy: seizure outcome utilizing electrocorticography during tumor resection. J Neurosurg 79: 62–69
Black P, Ronner SF (1987) Cortical mapping for defining the limits of tumor resection. Neurosurg 20: 914–920
Brodal A (1969) Neurological anatomy — in relation to clinical medicine, 2nd ed. University Press, New York
Bucy PC (ed) (1944) The precentral motor cortex. University of Illinois Press, Urbana
Creutzfeld OD (1983) Cortex cerebri. Leistung, strukturelle und funktionelle Organisation der Hirnrinde. Springer, Berlin Heidelberg New York Tokyo
Crosby EC, Humphrey T, Lauer EW (1962) Correlative anatomy of the nervous system. McMillan, New York
Cunningham DJ (1892) Contribution to the surface anatomy of the cerebral hemispheres. Royal Irish Academy, Dublin
Curran EJ (1909) A new association fiber tract in the cerebrum: with remarks on the fiber tract dissection method of studying the brain. J Comp Neurol 19: 645–657
Cushing H (1909) A note upon the faradic stimulation of the precentral gyrus in conscious patients. Brain 32: 44–54
Denny-Brown D (1965) The cerebral control of movement. University Press, Liverpool
Ebeling U, Huber P, Reulen HJ (1986) Localization of the precentral gyrus in the CT and its clinical application. J Neurol 233: 73–76
Ebeling U, Rikli D, Huber P, Reulen HJ (1987) The coronal suture. A useful landmark in neurosurgery? Craniocerebral topography between bony landmarks on the skull and the brain. Acta Neurochir (Wien) 89: 130–134
Ebeling U, Reulen HJ (1989) Neurosurgical topography of the pyramidal tract. In: Klingler M, Brock M, Frowein RA (eds) Advances in neurosurgery, vol 17. Springer, Berlin Heidelberg New York Tokyo
Ebeling U, Steinmetz H, Huang Y, Khan T (1989) Topography and identification of the precentral sulcus in MR-imaging. AJNR 10: 937–942
Ebeling U, Schmid UD, Reulen HJ (1990) Tumor surgery within the central motor strip: surgical results with aid of electrical cortical motor cortex stimulation. Acta Neurochir (Wien) 101: 110–117
Ebeling U, Schmid UD, Ying Z (1991) Mapping bei Tumorpatienten in der Zentralregion. Schweiz Rundschau Med Prax 47: 1318–1323
Ebeling U, Reulen HJ (1992) Subcortical topography and proportions of the pyramidal tract. Acta Neurochir (Wien) 118: 164–171
Ebeling U, Seiler RW, Hasdemir MG (1992) Les astrocytomes différenciés (grade IIOMS) de la region centrale: portée et limites de la chirurgie. Med Hyg 50: 2488–2493
Ebeling U, Schmid UD, Ying Z, Reulen HJ (1992) Safe surgery of lesions near the motor cortex using intraoperative mapping techniques. A report on 50 patients. Acta Neurochir (Wien) 119: 23–28
Ebeling U, Huber P (1992) Localization of central lesions by correlation of CT-findings and neurological deficits. Acta Neurochir (Wien) 119: 17–22
Ebeling U, Hasdemir MG, Barth A (1993) Stereotaktisch geleitete Mikrochirurgie zerebraler Prozesse. Schweiz Med Wschr 123: 1585–1590
Eberstaller O (1890) Das Stirnhirn. Ein Beitrag zur Oberfläche des Gehirnes. Urban und Schwarzenberg, Wien
Englander RN (1975) Location of the pyramidal tract in the internal capsule. Anatomic evidence. Neurology (NY) 25: 823–826
Firsching R, King N, Börner U, Sanker P (1992) Lesions of the sensorimotor region: somatosensory evoked potentials and ultrasound guided surgery. Acta Neurochir (Wien) 118: 87–90
Flechsig P (1881) Zur Anatomie und Entwicklungsgeschichte der Leitungsbahnen im Großhirn. Arch Anat Physiol: 12–75
Flechsig P (1887) Ueber Systemerkrankungen im Rückenmark. Arch Heilk 18: 101, 298 ff
Foerster O, Bumke O (1936) Handbuch der Neurologie, Bd 6. Springer, Berlin, pp 1–357
Freund HJ, Hummelsheim H (1984) Premotor cortex in man: evidence for innervation of proximal limb muscles. Exp Brain Res 53: 479–82
Freund HJ, Hummelsheim H (1985) Lesions of premotor cortex in man. Brain 108: 697–734
Freund HJ (1988) Abnormalities of motor behavior after cortical lesions in humans. In: Handbook of physiology — the nervous system, vol V, pp 763–810
Goldring S (1978) A method of surgical management of focal epilepsy, especially as it relates to children. J Neurosurg 49: 344–356
Goldring S, Gregorie E (1984) Surgical management of epilepsy using recordings to localize the seizure focus. J Neurosurg 60: 457–466
Gregorie S, Goldring S (1984) Localization of function in the excision of lesions from the sensorimotor region. J Neurosurg 61: 1047–1054
Hanaway J, Young RR (1977) Localization of the pyramidal tract in the internal capsule of man. J Neurol Sci 34: 63–70
Harky HL, Al-Mefty O, Haines DE, Smith RR (1989) The surgical anatomy of the sulci. Neurosurgery 24: 651–654
Hasdemir MG, Ebeling U (1993) Stereotactic guided puncture of cerebral abcesses. Acta Neurochir (Wien) 125: 58–63
Holmes G, Horrax G (1981) Disturbance of visual orientation. Br J Ophthalmol 2: 440–468, 506–516
Holmes G, Horrax G (1919) Disturbance of spatial orientation and visual attention with loss of stereoscopic vision. Arch Neurol Psychiatry 1: 385–407
Horsely V (1892) On the topographical relations of the cranium and the surface of the cerebrum. In: Cunningham CJ (ed) Contribution to the surface anatomy of the cerebral hemispheres. Academy House, Dublin, pp 306–355
Jane JA, Yashon D, De Myer D, Bucy PC (1967) The contribution of the precentral gyrus to the pyramidal tract in man. J Neurosurg 26: 244–248
Kido DK, LeMay M, Levanswon AW, Benson WE (1980) Computed tomographic localization of the precentral sulcus. Radiology 135: 373–377
King RB, Schell GR (1987) Cortical localization and monitoring during cerebral operations. J Neurosurg 67: 210–219
Klingler J, Gloor P (1960) The connections of the amygdala and of the anterior temporal cortex in the human brain. J Comp Neurol 115: 333–369
Kròenlein RV (1889) Zur craniocerebralen Topographie. Beiträge zur klinischen Chirurgie XXII: 364–370
Kwan HC, McKay WA, Murphy BT (1978) Spatial organization of the precentral cortex in awake primates, II. Motor outputs. J Neurophysiol 41:1120–1121
Lang J (1981) Klinische Anatomie des Kopfes. Neurokranium, Orbita, kraniozervikaler Übergang. Springer, Berlin Heidelberg New York
Lang J, Belz J (1981) Form und Masse der Gyri und Sulci an der Facies superolateralis und Facies inferior hemispherii. J Hirnforsch 22: 517–533
Lang J (1985) Mikroanatomischer Kurs für junge Neurochirurgen. Anatomisches Institut, Universität Würzburg
Lassek AM (1954) The pyramidal tract. Its status in medicine. Thomas, Springfield
Le Blanc FE, Rasmussen T (1974) Cerebral seizures and brain tumor. In: Vinken PM, Bruyn GW (eds) Handbook of neurology, vol 15. North Holland, Amsterdam, pp 295–301
Le Roux PD, Berger MS, Haglund MM, Pilcher WH, Ojemann GA (1991) Resection of intrinsic tumors from nondominant face motor cortex using stimulation mapping: report of two cases. Surg Neurol 36: 44–48
Ludwig E, Klingler J (1956) Atlas cerebri humani. Karger, Basel
Lüders H, Lesser RP, Hahn J (1983) Cortical somatosensory evoked potentials in response to hand stimulation. J Neurosurg 58: 885–894
Luria AR (1966) Higher cortical functions in man. Basic, New York
Matsui T, Hirano A (1978) An atlas of the human brain for computerized tomography. Fischer, Stuttgart, Igaku-Shoin, Tokyo
Missir O, Dutheil-Desclercs C, Meder JC, Musolino A, Fredy D (1989) Aspect du sillon central en IRM. Central sulcus patterns at MRI. J Neuroradiol 16: 133–144
von Monakow C (1915) Zur Anatomie und Physiologie der Pyramidenbahn und der Armregion, nebst Bemerkungen liber die sekundäre Degeneration des Fasciculus centroparietalis. Neurol Zbl 34: 217–224
Nathan PW, Smith MC (1955) Long descending tract in man. 1st review of present knowledge. Brain 78: 248–303
Nathan PW, Smith MC, Deacon P (1990) The corticospinal tracts in man. Course and location of fibers at different segmental levels. Brain 113: 303–324
Nuwer MR (1991) Localization of motor cortex with median nerve somatosensory evoked potentials. In: Schramm J, Moller AR (eds) Intraoperative neurophysiologic monitoring in neurosurgery. Springer, Berlin Heidelberg New York Tokyo, pp 63–71
Obana WG, Laxer KD, Cogan PH, Walker JA, Davis RL, Barbara NM (1992) Resection of dominant opercular gliosis in refractory partial epilepsy. Report of two cases. J Neurosurg. 77: 632–639
Ojemann GA (1978) Individual variability in cortical localization of language. J Neurosurg 50: 164–169
Ojemann GA (1979) Organization for language from perspective of electrical stimulation mapping. Behav Brain Sci 6: 189–220
Ojemann GA, Ojemann J, Lettich E, Berger M (1989) Cortical language localization in left, dominant hemisphere. J Neurosurg 71: 316–326
Ono M, Kubik S, Abernathy CD (1990) Atlas of the cerebral sulci. Thieme, Stuttgart, pp 36–62
Passet J (1882) Über einige Unterschiede des Großhims nach dem Geschlecht. Archiv für Antropologie (Braunschweig), Bd 14, pp 89–141
Penfield W, Boldrey E (1937) Somatic and sensory representation in the cerebral cortex of man as studied by electrical stimulation. Brain 60: 389–443
Penfield W, Welch K (1949) The supplementary motor area in the cerebral cortex of man. Trans Am Neurol Assoc 74: 179–184
Penfield W, Rasmussen T (1950) The cerebral cortex of man. McMillan, New York
Penfield W (1954) Mechanisms of voluntary movements. Brain 77: 1–17
Pfeiffer RA (1934) Myelogenetisch-anatomische Untersuchungen über den zentralen Abschnitt der Taststrahlung, Pyramidenbahn, der Hirnnerven und zusätzlicher motorischer Bahnen. Nov Acta Leop Carol 1: 341–473
Pia HW (1986) Microsurgery of glioms. Acta Neurochir 80: 1–11
Quensel R (1910) Über den Stabkranz des menschlichen Stirnhirnes. Folia Neurobiol 4: 319–334
Ross ED (1980) Localization of the pyramidal tract in the internal capsule by whole brain dissection. Neurology 30: 59–64
Rostomily RC, Berger MS, Ojemann GA, Lettich E (1991) Postoperative deficits and functional recovery following removal of tumors involving the dominant hemisphere supplementary motor area. J Neurosurg 75: 62–68
Rowland LP, Mettler FA (1948) Relation between the coronal suture and the cerebrum. J Comp Neurol 89: 21–40
Schmid U, Sturzenegger M, Ludin HP, Seiler RW, Reulen HJ (1988) Orthodromic (intra/extracranial) neurography of monitor facial nerve function intraoperatively. Technical note. Neurosurgery 22: 945–950
Schmid U, Ebeling U, Reulen HJ (1989) Electrophysiological localization of the human sensori-motor cortex. Neurosurgical forum. J Neurosurg 70: 817–818
Seeger W (1978) Atlas of topographical anatomy of the brain and the surrounding structures for neurosurgeons, neuroradiologists and neuropathologists. Springer, Wien New York
Seeger W (1980) Microsurgery of the brain. Anatomical and technical principles, vol 1. Springer, Wien New York
Stöhr M, Dichgans S, Diener HC, Büttner UW (1989) Evozierte Potentiale SEP, VEP, AEP, EKP, MEP, 2nd ed. Springer, Berlin Heidelberg New York Tokyo
Suzuki A, Yasmi N (1992) Intraoperative localization of the central sulcus by cortical somato-sensory evoked potentials in brain tumor. Case report. J Neurosurg 76: 867–870
Talairach J, Bancaud J(1966) The supplementary motor area in man. Int J Neurol 5: 330–347
Talairach J, Szikla G (1967) Atlas of stereotactic anatomy of the telencephalon. Masson and Cie, Paris
Taylor EH, Haughton WS (1900) Some recent researches on the topography and convolutions and fissures of the brain. Transactions of the Royal Academy of Medicine in Ireland 18: 511–522
Taylor E, Haughton VM, Syverston A, Ho K (1980) Taylor Haughton line revisited. Am J Neuroradiol (Baltimore) 1: 55–56
Tredici G, Pizzini G, Bogliun G, Tagliabue M (1982) The site of motor corticospinal fibers in the internal capsule of man. A computerised tomographic study of restricted lesions. J Anat 134: 199–208
Uematsu S, Lesser RP, Gordon B (1992) Localization of sensorimotor cortex: the influence of Sherington and Cushing on the modern concept. Neurosurgery 30: 904–913
Uematsu S, Lesser RP, Fisher RS, Gordon B, Hara K, Krauss GL, Vining EP, Webber RW (1992) Motor and sensor cortex in humans. Topography studied with chronic subdural stimulation. Neurosurgery 31: 59–72
Weiller C, Choller F, Friston KJ, Wise RJS, Frackowiak RSJ (1992) Functional reorganization of the brain in recovery from striatocapsular infarction in man. Ann Neurol 31: 463–472
Weiller C, Ramsay SC, Wise RJS, Friston KJ, Frachowiak RJS (1993) Individual patterns on functional reorganization in the human cerebral after capsular infarction. Ann Neurol 33: 181–189
Wood CC, Spencer DD, Allison T, McCarthy G, Williams PD, Groff WR (1988) Localization of human sensori-motor cortex during surgery by cortical surface recordings of somatosensory evoked potentials. J Neurosurg 68: 99–111
Woolsey CN, Erikson TC, Gibson WE (1979) Localization in somatic sensory and motor areas of human cerebral cortex as determined by direct recording of evoked potentials and electrical stimulation. J Neurosurg 51: 476–506
Yasargil MG, Cravens GC, Roth P (1988) Surgical approaches to “inaccessible” brain tumors. Clin Neurosurg 34: 42–110
Yasargil MG, von Ammon K, Cavazos E, Doczi T, Reeves JD, Roth P (1992) Tumors of the limbic and paralimbic systems. Acta Neurochir (Wien) 118:40–52
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1995 Springer-Verlag/Wien
About this chapter
Cite this chapter
Ebeling, U., Reulen, HJ. (1995). Space-Occupying Lesions of the Sensori-Motor Region. In: Symon, L., et al. Advances and Technical Standards in Neurosurgery. Advances and Technical Standards in Neurosurgery, vol 22. Springer, Vienna. https://doi.org/10.1007/978-3-7091-6898-1_3
Download citation
DOI: https://doi.org/10.1007/978-3-7091-6898-1_3
Publisher Name: Springer, Vienna
Print ISBN: 978-3-7091-7428-9
Online ISBN: 978-3-7091-6898-1
eBook Packages: Springer Book Archive