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Published on: August 12, 2019
Topographical risk factor analysis of new neurological deficits following precentral gyrus resection
Young-Hoon Kim1, Chi Heon Kim, June Sic Kim
1*Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea; ‡Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea; §Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea; ¶Department of Neurology, Seoul National University Hospital, Seoul, Korea; ‖Department of Brain and Cognitive Science, Seoul National University College of Natural Science, Seoul, Korea.
Background:
Precentral gyrus resections (PGRs) have been regarded as excessively hazardous interventions because of the risk of postoperative major neurological complications.
Objective:
To evaluate the neurological deterioration that follows PGRs and to assess the topographical risk factors associated with these morbidities.
Methods:
We reviewed 33 consecutive patients who experienced pharmacologically intractable epilepsy and underwent PGR with intraoperative cortical stimulation and mapping while under awake anesthesia. The etiological diagnoses were brain neoplasm in 26 patients (78.8%), cortical lesion in 4 (12.1%), and no lesion in 3 (9.1%). The mean follow-up period was 62.6 months (range, 12-146 months). All topographical analyses of the resected quadrant area were performed based on postoperative magnetic resonance images.
Results:
After PGR, 22 patients (66.7%) experienced neurological worsening, including 5 permanent deficits (15.2%) and 17 transient deficits (51.5%). Permanent deficits included 2 instances of weakness, 1 dysarthria, 1 dysesthesia, and 1 fine-movement disturbance of the hand. While the neurological risk for anterior lower quadrant PGR was 20.0% (1/5), the risk for posterior upper quadrant PGR was 100.0% (10/10). The anterior upper and posterior lower quadrant PGR caused neurological deteriorations in 60.0% (6/10) and 62.5% (5/8) of the patients, respectively. In a multivariate analysis, PGR of the posterior and upper quadrant sections were significant risk factors for post-PGR neurological deteriorations (P = .022 and 0.030, respectively).
Conclusion:
The posterior upper quadrant of the precentral gyrus was vulnerable to post-resective neurological impairment.
