The authors evaluated the clinical impact of combining functional neuronavigation with subcortical electrical stimulation to preserve motor function following the removal of brain tumors.
Forty patients underwent surgery for treatment of brain tumors located near pyramidal tracts that had been identified by fiber tracking. The distances between the electrically stimulated white matter and the pyramidal tracts were measured intraoperatively with tractography-integrated functional neuronavigation, and correlated with subcortical motor evoked potentials (MEPs) and clinical symptoms during and after resection of the tumors.
Motor function was preserved after appropriate tumor resection in all cases. In 18 of 20 patients, MEPs were elicited from the subcortex within 1 cm of the pyramidal tracts as measured using intraoperative neuronavigation. During resection, improvement of motor weakness was observed in two patients, whereas transient mild motor weakness occurred in two other patients. In 20 patients, the distances between the stimulated subcortex and the estimated pyramidal tracts were more than 1 cm, and MEPs were detected in only three of these patients following stimulation.
Intraoperative functional neuronavigation and subcortical electrical stimulation are complementary techniques that may facilitate the preservation of pyramidal tracts around 1 cm of resected tumors.
Abbreviations used in this paper:CT = computed tomography; DICOM = digital imaging and communications in medicine; DT = diffusion-tensor; MEP = motor evoked potential; MPRAGE = magnetization prepared rapid gradient echo; MR = magnetic resonance; ROI = region of interest.
Address reprint requests to: Nobuhiro Mikuni, M.D., Ph.D., Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 kawahara-cho, Shogoin, Sakyo-ku, Kyoto 6068507, Japan. email:
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