Multimodal and Repeated Localization of Primary Hand Motor Function to the Lateral Postcentral Gyrus in a Case of Frontal Motor Area Brain Metastasis.

Neurosurgery practice Pub Date : 2024-07-11 eCollection Date: 2024-09-01 DOI:10.1227/neuprac.0000000000000095
Timothy F Boerger, Andrew L DeGroot, Stephanie Schwartz, Nada Botros, Brian D Schmit, Max O Krucoff
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Abstract

Background and importance: The human motor homunculus is a well-known topographical map of the functional-anatomical relationships of the precentral gyrus. Within this homunculus, the primary hand motor area is considered one of the least plastic functional-anatomical relationships. Only a few cases in the literature describe relocation of functional hand representation away from the classical anatomical location. These cases have been reported in the context of children, primary gliomas, or arteriovenous malformations.

Clinical presentation: Here, we describe a unique case where the area of lowest hand motor stimulation threshold (ie, hand motor representation) was found in the postcentral gyrus in an older adult with a metastasis in the premotor area of the brain. This localization was based on intraoperative cortical stimulation-evoked motor potentials and confirmed with electrophysiological phase reversal and MRI-based neuronavigation. This mapping was repeated and consistent 2 months later during a reoperation for recurrence. In addition, the remapped anatomical location was found in an area that was active during finger tapping on preoperative functional MRI.

Conclusion: These findings suggest that neuroplastic remapping of hand motor cortex to the postcentral gyrus can occur in brain metastases even in adults. This has implications for planning tumor resections and interventional neurorehabilitation strategies, and it suggests that the motor homunculus may have more plastic potential in adulthood than previously recognized.

额叶运动区脑转移一例原发性手运动功能多模态和重复定位于外侧中央后回。
背景和重要性:人类运动小丘是一个众所周知的中央前回功能解剖关系的地形图。在这个小矮人中,主要的手部运动区域被认为是最不具可塑性的功能-解剖关系之一。在文献中,只有少数病例描述了功能手的再现偏离经典解剖位置的重新定位。这些病例在儿童,原发性胶质瘤或动静脉畸形的背景下被报道。临床表现:在这里,我们描述了一个独特的病例,在一个老年人的大脑前运动区转移的中枢后回中发现了最低手运动刺激阈值区域(即手运动表征)。这种定位是基于术中皮层刺激诱发的运动电位,并通过电生理相反转和基于mri的神经导航证实。2个月后因复发再次手术时,重复并保持一致。此外,在术前功能MRI上发现,重新定位的解剖位置位于手指敲击时活跃的区域。结论:这些研究结果表明,即使在成人脑转移中,手部运动皮层的神经可塑性重映射也可能发生在中枢后回。这对规划肿瘤切除和介入神经康复策略具有重要意义,并且表明运动小头在成年期可能比以前认识到的具有更多的可塑性潜力。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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