Location of primary motor cotex by direct electronic stimulation in resection of gliomas in precentral gyrus

Objective To explore surgical treatment of gliomas involving the motor eloquent area.Methods Twelve cases of gliomas involving precentral gyrus were underwent awake surgery procedures assisted with neuronavigation and brain functional mapping by cortical electrical stimulation.Results Eleven cases acquired accurate location of both lesions and eloquent areas by neuronavigation and direct cortical stimulation.7 cases of motor cortices and 2 cases of motor speech centers were confirmed during the operation.Resection,verified by postoperative MRI,was total in 8 cases (66.7%) and subtotal in 4 patients.Histological examination revealed an infiltrative glioma in all cases(8 low grade astrocytomas,2 high grade astrocytomas and 2 glioblastoma).Four patients had no postoperative deficit,while the other 8 patients were impaired,with,in all cases except one,complete recovery in 7 days to one month.Conclusions Direct cortical electrical stimulations and awake surgery offer a reliable,precise and safe method,allowing functional mapping especially useful in case of infiltrative cerebral tumors in eloquent areas.This technique allows improvement in the quality of tumoral resection and concurrently a minimization of the risk of definitive postoperative neurological deficit.