Resection of tumors within and near to the primary Sensory-Motor cortex using Phase reversal Cortical mapping and bipolar stimulation

Abstract

Objective Brain mapping techniques allow one to effectively approach tumors involving the primary sensory-motor cortex and nearby area (M1). Tumor resectability and maintenance of patient integrity depend on the ability to successfully identify motor tracts during resection by choosing the most appropriate neurophysiological paradigm for motor mapping. Mapping with a high frequency (HF) stimulation technique has emerged as the most efficient tool to identify motor tracts because of its versatility in different clinical settings. At present, few data are available on the use of HF for removal of tumors predominantly involving M1.  Methods The authors have analysed a series of 6 patients with brain tumors within M1, by reviewing the use of HF as a guide. The neurophysiological protocols adopted during resections were described and correlated with  patients’ clinical and tumor imaging features. Feasibility of mapping, extent of resection, and motor function assessment  were used to evaluate the oncological and functional outcome to be correlated with the selected neurophysiological  parameters used for guiding resection. The study aimed to define the most efficient protocol to guide resection for each  clinical condition. gliomas