Strategies for resection of lesions in the motor area (original) (raw)
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Aprendizagem motora em crianças com paralisia cerebral
Journal of Human Growth and Development, 2010
INTRODUÇÃO: a Paralisia Cerebral (PC) tem como característica causar alterações na postura e movimento que dificultam a realização de atividades funcionais. Diante das dificuldades motoras, a reabilitação torna-se essencial e tem como uma opção basear-se na aprendizagem motora. Porém, é importante a investigação do processo de aprendizagem motora em indivíduos com PC para viabilizar a organização de programas de tratamento mais efetivos. OBJETIVO: analisar o processo de aprendizagem motora em crianças com PC. MÉTODO: Para a realização deste trabalho utilizou-se um grupo experimental (GE) e um grupo controle (GC) ambos formados por 4 crianças pareadas em relação ao gênero (um do gênero feminino e três do gênero masculino) e idade (entre sete e doze anos). A tarefa consistia em realizar um caminho em um labirinto, no menor tempo possível. O trabalho consistiu de duas fases, sendo inicialmente a fase de aquisição (AQ) e depois as transferências (Imediata-TI; Curto Prazo-TC e Longo Praz...
2020
The resection of brain tumors located within or near the eloquent tissue has a higher risk of postoperative neurological deficits. The primary concerns include loss of sensory and motor functions in the contralateral face, upper and lower extremities, as well as speech deficits. Intraoperative neurophysiological monitoring (IONM) techniques are performed routinely for the identification and preservation of the functional integrity of the eloquent brain areas during neurosurgical procedures. The IONM modalities involve sensory, motor, and language mapping, which helps in the identification of the boundaries of these areas during surgical resection. Cortical motor Mapping (CmM) technique is considered as a gold-standard technique for mapping of the brain. We present the intraoperative CmM technique, including anesthesia recommendations, types of electrodes, as well as stimulation and recording parameters for successful monitoring.
Journal of Neurology, Neurosurgery & Psychiatry, 2001
Objectives-Brain plasticity is supposed to allow the compensation of motor function in cases of rolandic lesion. The aim was to analyse the mechanisms of functional reorganisation during surgery in the central area. Methods-A motor brain mapping was performed in three right handed patients without any neurological deficit, operated on for a slow growing lesion near the rolandic region (two precentral resected under general anaesthesia and one retrocentral removed under local anaesthesia to allow also sensory mapping) using intraoperative direct electrical stimulations (5 mm space tips bipolar stimulator probe, biphasic square wave pulse current: 1 ms/phase, 60 Hz, 4 to 18 mA). Results-For each patient, the motor areas of the hand and forearm in the primary motor cortex (M1) were identified before and after lesion removal with the same stimulation parameters: the same eloquent sites were found, plus the appearance after resection of additional sites in M1 inducing the same movement during stimulations as the previous areas. Conclusions-Multiple cortical representations for hand and forearm movements in M1 seem to exist. In addition, the results demonstrate the short term capacity of the brain to make changes in local motor maps, by sudden unmasking after tumour resection of a second redundant site participating in the same movement. Finally, it seems not necessary for the whole of the redundant sites to be functional to provide normal movement, a concept with potential implications for surgery within the central region.
Journal of Human Growth and Development, 2012
OBJETIVO: verificar a correlação entre o perfil neurofuncional e as habilidades sensório-motoras de crianças com paralisia cerebral. MÉTODO: a amostra foi composta por 27 crianças com paralisia cerebral. Utilizou-se a ficha de avaliação neurológica para se obter os dados do perfil neurofuncional e o Inventário Portage Operacionalizado para avaliar o desenvolvimento sensório-motor. RESULTADOS: o comprometimento funcional está relacionado com o maior grau de incapacidade, alteração do tônus e déficit das reações corporais das crianças. As reações corporais correlacionam entre si e com as alterações sensoriais. Houve também correlação entre as cinco áreas do desenvolvimento (motora, de linguagem, socialização, autocuidado e cognitiva), indicando a importância de cada uma para o desempenho geral do ser humano. CONCLUSÃO: foi verificado que o déficit nas habilidades dessas crianças está relacionado principalmente ao nível funcional, grau de incapacidade, alterações no sistema sensorial e...
Assimetria Direita-Esquerda e Desenvolvimento Neuropsicomotor Humano
CES Psicología, 2019
O presente artigo tem como objetivo relatar sobre a organização neurológica das crianças em relação ao comportamento motor, buscando evidenciar os processos anteriores ao uso preferencial de um determinado membro e a constituição da lateralidade, salientando as leis céfalo-caudal e próximo-distal. Também são apresentados conceitos referentes ao desenvolvimento motor em neonatos e de que forma irão influenciar a relação de lateralidade discutida. Objetiva-se apresentar a relação entre a lateralidade e a discriminação direita-esquerda e como esta última influencia na aprendizagem. O estudo se deu a partir de revisões teóricas, e os resultados obtidos mostram que o desenvolvimento motor, partindo de neonatos, se dá primeiro com uma constituição bimanual, havendo uma dominância homolateral do corpo, devido à hipotonicidade do eixo axial e à hipertonicidade das extremidades. Uma melhor estruturação do esquema corporal ocorre a partir do desaparecimento dos reflexos presentes e da constit...
Motor field sensitivity for preoperative localization of motor cortex
Journal of Neurosurgery, 2006
HE preoperative localization of functionally viable brain tissue helps to guide neurosurgical planning in optimizing the region of resection while allowing for improved postsurgical neurological function. Various neuroimaging techniques, including MS and fMR imaging, are now available to preoperatively map functional brain organization. Coregistering structural MR imaging data to functional data acquired via MS or fMR imaging allows for the intraoperative creation of a neuronavigation system. Magnetic source imaging has been shown to be increasingly important in preoperative planning and complements intraoperative mapping by delineating retained areas of function noninvasively and in advance, and thus reducing the time needed for intraoperative procedures. Peaks in evoked neuromagnetic field data are used to localize dipoles with the aid of source modeling algorithms. Utilizing MS imaging, relevant somatosensory, speech, and motor cortices can be mapped preoperatively to aid surgical navigation and avoid resecting the eloquent cortex. Alternatively, fMR imaging can be used in the preoperative planning, but its temporal resolution is inferior to that of MS imaging because its measured responses are not as directly correlat-ed with evoked electrical activity. Both fMR and MS imaging have been validated as adjuncts to intraoperative mapping. With the increasing use of MS imaging at clinical centers worldwide, the accuracy of functional localization has become paramount.
World Neurosurgery, 2017
BACKGROUND: Preservation of function is essential in surgical resection of lesions involving the motor pathways. The aim of this work is to evaluate the effect of anatomic features of lesions located in the motor pathway on neurologic and functional outcome. We propose an evaluation score to assess the risk of postoperative worsening.-METHODS: A total of 92 patients suffering from lesions involving the motor pathways have been studied for what concerns motor functions (muscular strength scale [MRC]) after surgical treatment. Patient-related, surgery-related, and lesion-related data were recorded to identify relations with motor outcomes. Cortical surfacing of the lesion and amount of millimeters of interface between the lesion and corticospinal tract have been investigated with preoperative magnetic resonance imaging sequences and tractographic reconstructions.-RESULTS: Means of the MRC Scale preoperative and 7 days postoperative were 3.6 AE 2.23 and 3.8 AE 2.28 for the upper limbs, and 4.1 AE 2.31 and 4.4 AE 2.33 for the lower limbs, respectively. Patients that were stable or improved at 7 days from surgery were 82.6%. The anatomic features investigated have been summed up in a single score (envelopment/surfacing [ES]). In cases of ES classes V and VI, a total cumulative predicted worsening rate was 24.2% and 14.8%, respectively. The risk of worsening was 1.682 times greater for the higher ES classes (IVeVI).-CONCLUSIONS: The anatomic features of lesions are crucial in the prediction of motor outcome. The new proposed score (ES score) is useful to stratify motor function prognosis.
Neurological Research, 2008
Objective: The aim of this study was to establish a robust set of motor tasks that could be used to functionally delineate the motor cortex with blood oxygenation level dependent functional magnetic resonance imaging (BOLD fMRI) at 3 T and produce precise functional maps for preoperative planning and functional neuronavigation. Method: Twelve male and four female control subjects were recruited for this study which examined six different motor tasks. Finger-, tongue-, lip-and toe-movements, as well as isometric upper arm-and thigh-contraction tasks were conducted during separate scans on a 3 T MRI scanner. Furthermore, patients that previously had undergone similar motor tasks were reviewed, to evaluate whether this set of tasks was able to be adopted for use in a population of patients with brain lesions. Results: The results of this study indicated that the finger-, toe-and tongue-motor tasks were the most robust in identifying their respective primary motor area. Moreover, all three tasks activated regions at regular intervals along the convexity of the hemisphere, making it possible to functionally delineate the primary motor cortex in both healthy subjects and patients. Discussion: The motor tasks described in this study (toe, finger and tongue) were effective at localizing the primary motor cortex for the purposes of neurosurgical planning. These three tasks produced the highest success rate and resulted in activations at regular intervals along the convexity of the hemisphere, allowing the delineation of the entire motor strip even in the presence of edema and anatomical distortions. [Neurol Res 2008; 000: 000-000]
2020
Introduction: Penfield's motor homunculus describes a caricaturised yet useful representation of the map of various body parts on the pre-central cortex. We propose a supplemental map of the clinically represented areas of human body in pre-central cortex and a novel subcortical corticospinal tract map that are accurate and essential for safe surgery in patients with eloquent brain lesions. Materials and methods: A single-institution retrospective cohort study of patients who underwent craniotomy for motor eloquent lesions with intraoperative motor neuromonitoring (cortical and subcortical) between 2015 and 2020 was performed. All positive cortical and subcortical stimulation points were taken into account and cartographic maps were produced to demonstrate cortical and subcortical areas of motor representation and their configuration. A literature review in PubMed was performed. Results: 180 patients (58.4% male, 41.6% female) were included in the study with 81.6% asleep and 18.4% awake craniotomies for motor eloquent lesions (gliomas 80.7%, metastases 13.8%) with intraoperative cortical and subcortical motor mapping. Based on the data, we propose a supplemental clinical cortical and a novel subcortical motor map to the original Penfield's motor homunculus, including demonstration of localisation of intercostal muscles both in the cortex and subcortex which has not been previously described. Conclusion: The supplementary clinical cortical and novel subcortical motor maps of the homunculus presented here have been derived from a large cohort of patients undergoing direct cortical and subcortical brain mapping. The information will have direct relevance for improving the safety and outcome of patients undergoing resection of motor eloquent brain lesions.