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Updated: May 24, 2026
Translational Brain Mapping at the University of Rochester Medical Center: Preserving the Mind Through Personalized Brain Mapping
Published on: August 12, 2019
Rolandic area meningioma resection controlled and guided by intraoperative cortical mapping
Svatopluk Ostrý1, David Netuka, Vladimír Beneš
1Department of Neurosurgery, Charles University in Prague, Central Military Hospital, Czech Republic. svatopluk.ostry@uvn.cz
Background:
The resection of convexity meningiomas should harbour a low rate of morbidity. Functional preservation should be the main goal of surgery and have higher priority over radicality. Involvement of the primary motor cortex (PMC) increases surgical risk. The goal of this study was to evaluate the effect of cortical mapping on surgical morbidity after rolandic area meningioma treatment.
Methods:
From January 2005 to March 2011, 42 patients were operated on for rolandic meningioma involving or compressing the PMC. The cohort consisted of 25 (59.5%) convexity, 10 (23.8%) parasagittal and 7 (16.7%) falcine meningiomas. Four patients were treated for recurrent disease and 25 (59.5%). Intraoperative cortical mapping was used to identify location of PMC. The threshold stimulation current was set at every site of cortical monopolar anodal stimulation around the tumour and at the tumour-cortex junction repeatedly during the meningioma dissection.
Results:
Radical resection (Simpson 1 and 2) was achieved in 30 patients (71.4%) and partial resection (Simpson 4) in 12 (28.6%). New permanent deficit occurred in three patients (7.1%). All patients had moderate preoperative deficit (muscle strength ≤ 3). WHO-I was in 28 cases (66.7%), WHO-II in 14 cases (33.3%). Average follow-up was 33.2 months. Five patients (11.9%) suffered from recurrence after an average of 23.8 months.
Conclusions:
Rolandic area meningiomas should be classified as a higher risk group. Intraoperative cortical mapping is in our experience useful in a situation when the cleavage plane at the PMC is lost. In such a scenario, resection outside the PMC is radical and only at the PMC is a thin remnant left without cortical damage, which helps to be safer with a better long-term prognosis.
Insights
Intraoperative cortical mapping helps surgeons preserve function when operating on rolandic meningiomas near the primary motor cortex (PMC). This technique reduces surgical risk and improves long-term outcomes for patients with these challenging brain tumors.
Area of Science:
- Neurosurgery
- Oncology
- Neurology
Background:
- Convexity meningiomas require low morbidity surgery with functional preservation as the priority.
- Primary motor cortex (PMC) involvement in meningiomas elevates surgical risk.
- Rolandic meningiomas pose a significant challenge due to their proximity to critical brain structures.
Purpose of the Study:
- To evaluate the impact of intraoperative cortical mapping on surgical morbidity.
- To assess functional preservation outcomes in patients with rolandic meningiomas involving the PMC.
Main Methods:
- A cohort of 42 patients with rolandic meningiomas involving or compressing the PMC were analyzed.
- Intraoperative cortical mapping was employed to precisely identify the PMC.
- Cortical stimulation was systematically performed around the tumor and at the tumor-cortex junction.
Main Results:
- Radical resection (Simpson 1-2) was achieved in 71.4% of patients; partial resection (Simpson 4) in 28.6%.
- A low rate of new permanent neurological deficits (7.1%) was observed.
- Tumor recurrence occurred in 11.9% of patients over an average follow-up of 33.2 months.
Conclusions:
- Rolandic area meningiomas represent a high-risk surgical group.
- Intraoperative cortical mapping is a valuable tool for preserving the PMC.
- This technique facilitates safer resection with better long-term prognosis, even when the cleavage plane is unclear.
