Abstract
Introduction Surgical treatment of brain tumors in eloquent areas has always been considered a
major challenge because removal-related cortical damage can cause serious functional
impairment. However, few studies have investigated the association between small craniotomies
and the higher risk of incidence of motor deficits and prolonged recovery time. Here,
we analyzed neurologic deficits and the prognostic variables after surgery guided
by navigation for motor cortex tumors under general anesthesia.
Methods This was a prospective study that included 47 patients with tumors in the precentral
gyrus. All surgeries were performed with neuronavigation and cortical mapping, with
direct electrical stimulation of the motor cortex. We evaluated the prognostic evolution
of patients with pre- and postoperative Karnofsky Performance Scale using the Eastern
Cooperative Oncology Group scale.
Results Complete resection was verified in all 18 cases of metastasis, 13 patients with glioblastoma
multiforme, and 5 patients with low-grade gliomas. An analysis of the motor deficits
revealed that 11 patients experienced worsening of the deficit on the first day after
surgery. Only four patients developed new deficits in the immediate postoperative
period, and these improved after 3 weeks. After 3 months, only two patients had deficits
that were worse those experienced prior to surgery; both patients had glioblastoma
multiforme.
Conclusion In our series, motor deficits prior to surgery were the most important factors associated
with persistent postoperative deficits. Small craniotomy with navigation associated
with intraoperative brain mapping allowed a safe resection and motor preservation
in patients with motor cortex brain tumor.
Keywords
brain neoplasms - motor cortex - brain mapping - craniotomy
