Postcentral gyrus resection of opercular gliomas is a risk factor for motor deficits caused by damaging the radiologically invisible arteries supplying the descending motor pathway
Postcentral gyrus resection of opercular gliomas is a risk factor for motor deficits caused by damaging the radiologically invisible arteries supplying the descending motor pathway
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DOI：
10.1007/s00701-021-04737-y
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发表时间：
2021-02-03
影响因子：
2.4
通讯作者：
Kumabe, Toshihiro
中科院分区：
文献类型：
--
作者：
Shibahara, Ichiyo;Sato, Sumito;Kumabe, Toshihiro
术后运动障碍是胶质瘤手术最严重的并发症之一。我们的目的是研究与额顶叶眼膜胶质瘤患者术后运动障碍相关的因素。方法对34例额顶叶眼胶质瘤患者的临床资料进行回顾性分析。我们通过MRI检查了术后缺血的变化和位置。结果术后缺血性改变21例（62%）。术后MRI表现为缺血性改变，均位于切除腔的皮质下区。6例患者术后出现运动障碍，而28例患者没有。与无运动缺陷的患者相比，运动缺陷患者与年龄、中央前、后回切除和中央后回切除相关（P分别为0.023、0.024和0.0060）。切除的空腔和蒙特利尔神经学研究所的t1加权脑图谱的合并图像显示，术后运动缺陷的关键区域是岛岛长动脉（LIAs）和中央后回的起源。由Human Connectome Project数据库和t2加权图像创建的详细解剖结构显示，中央后回的皮层下区域是髓质动脉供应的地方，运动通路起源于中央前回。结论在额顶叶眼神经胶质瘤的切除过程中，LIAs的来源可能损害下行运动通路。此外，我们还发现运动通路运行于中枢后回的皮层下区域，这表明中枢后回是一个未被识别的破坏下行运动通路的区域。
Background Postoperative motor deficits are among the worst morbidities of glioma surgery. We aim to investigate factors associated with postoperative motor deficits in patients with frontoparietal opercular gliomas. Methods Thirty-four patients with frontoparietal opercular gliomas were retrospectively investigated. We examined the postoperative ischemic changes and locations obtained from MRI. Results Twenty-one patients (62%) presented postoperative ischemic changes. Postoperative MRI was featured with ischemic changes, all located at the subcortical area of the resection cavity. Six patients had postoperative motor deficits, whereas 28 patients did not. Compared to those without motor deficits, those with motor deficits were associated with old age, pre- and postcentral gyri resection, and postcentral gyrus resection (P = 0.023, 0,024, and 0.0060, respectively). A merged image of the resected cavity and T1-weighted brain atlas of the Montreal Neurological Institute showed that a critical area for postoperative motor deficits is the origin of the long insular arteries (LIAs) and the postcentral gyrus. Detail anatomical architecture created by the Human Connectome Project database and T2-weighted images showed that the subcortical area of the operculum of the postcentral gyrus is where the medullary arteries supply, and the motor pathways originated from the precentral gyrus run. Conclusions We verified that the origin of the LIAs could damage the descending motor pathways during the resection of frontoparietal opercular gliomas. Also, we identified that motor pathways run the subcortical area of the operculum of the postcentral gyrus, indicating that the postcentral gyrus is an unrecognized area of damaging the descending motor pathways.