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Updated: Feb 20, 2026
Anteromesial Temporal Lobectomy for Medically Intractable Temporal Lobe Epilepsy: An Operative Study
Published on: August 15, 2025
Factors Associated With Postoperative Functional Outcome in Rolandic and Perirolandic Metastasis Resection
Eric A Goethe1,2, Rasheed Zakaria1, Subhiksha Srinivasan1
1Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Background And Objectives:
Although there is a clear role for surgery in extending survival and functional independence in patients with brain metastases, the resection of motor strip metastases is often a unique challenge because of concern for postoperative functional decline. We sought to identify factors associated with functional outcome to better inform surgical decision-making.
Methods:
We conducted a retrospective chart review of all patients who underwent a first-time craniotomy for resection of a rolandic/perirolandic metastasis between 2008 and 2020. All patients underwent resection with at least 1 motor mapping technique. Patient demographics, clinical factors, and resection techniques were collected.
Results:
A total of 43 men (50.6%) and 42 women (49.4%) with a median age of 60 years (range, 15-77) were included. The most common malignancies were non-small cell lung cancer (n = 29, 34.1%), breast (n = 14, 16.5%), and melanoma (n = 11, 12.9%). 79 patients (92.9%) were symptomatic at presentation, with 23 (27.1%) presenting with seizures and 49 (59.0%) presenting with extremity weakness. Resection was performed en bloc in 35 patients (41.2%) and piecemeal in 50 patients (58.8%). Gross total resection was achieved in 82 patients (96.5%). 55 patients (64.7%) had prolonged (>3 days) postoperative length of stay, which was associated with hemorrhagic tumor (odds ratio [OR] = 4.83, P = .03), preoperative Karnofsky Performance Scale (KPS) ≤80 (OR = 9.47, P = .001), rolandic location (OR = 4.50, P = .016), and preoperative weakness (OR = 5.68, P = .008) in multivariate analysis. Postoperative KPS was stable to improved in 65 patients (76.5%) and worsened in 20 (23.5%). Nonhome discharge occurred in 27 patients (31.8%) and was associated with age >60 years (OR = 7.88, P = .006), preoperative KPS ≤70 (OR = 4.77, P = .018), rolandic tumor location (OR = 6.58, P = .012), and distance from the surface (OR = 4.06, P = .017).
Conclusion:
We present the largest cohort of patients with motor region metastases undergoing resection. Metastases in this region can be resected with reasonable postoperative functional outcome, high extent of resection rate, and a relatively low risk of permanent worsening of motor function.
