Intraoperative Cortical Sensorimotor Mapping During Glioma Resection Monitored With Drum Playing During Awake...

Area of Science:

• Neurosurgery
• Neuro-oncology
• Brain mapping

Background:

• Resection of tumors in the precentral gyrus presents significant surgical challenges.
• This study investigated a novel awake craniotomy approach for low-grade gliomas in this critical area.
• The technique integrated preoperative navigated transcranial magnetic stimulation (nTMS)-generated diffusion tensor imaging (DTI) and intraoperative high-density electrocorticography (ECoG).

Observation:

• A 36-year-old male with a left hemisphere low-grade glioma underwent awake craniotomy.
• Preoperative nTMS-DTI and intraoperative passive functional mapping using ECoG were employed.
• The patient performed a drumming task during surgery to monitor motor function via somatosensory-evoked potentials (SSEPs).

Findings:

• nTMS-DTI findings were corroborated by intraoperative ECoG, showing an absence of motor-evoked potentials (MEPs) over the tumor.
• Continuous monitoring of the patient's drumming performance guided the resection.
• Gross total resection (GTR) was achieved, with temporary hand weakness that resolved by 6 months.

Implications:

• This multimodal mapping strategy, including awake monitoring of a functional task, enables precise tumor resection.
• The approach facilitates the preservation of motor function during surgery for motor-eloquent gliomas.
• This technique offers a promising method for achieving GTR while minimizing neurological deficits.