Cortical stimulation mapping of phantom limb rolandic cortex

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✓ Findings of intraoperative rolandic cortex mapping during awake craniotomy for a tumor in a patient with a contralateral upper-extremity amputation are presented. This patient sustained a traumatic amputation at the mid-humerus 24 years previously. Initially he had experienced rare painless phantom limb sensations but none in the past 10 years. Functional mapping during an awake craniotomy was performed to maximize safe tumor resection. Typical temporal and frontal speech areas were identified; motor representation of face and jaw extended more superiorly than sensory representation. Shoulder movements were evoked more laterally than usual at the superior aspect of the craniotomy. A small region of precentral gyrus, between the jaw and shoulder representations, elicited no detectable effect when stimulated. Somatosensory mapping showed a similar topographical distribution of face and mouth cortex; however, posterior and inferior to the shoulder motor cortex, right arm and hand (phantom) sensations were evoked. Evidence suggests that significant motor reorganization occurs following an amputation, with expansion of neighboring homuncular representations without loss of somatosensory representation, despite a long period of time without any sensation referable to the amputated limb. Contrary to models of sensory cortex plasticity, the plasticity of the adult cortex may be system specific, with reorganization present in motor, but not in sensory, cortical systems.

Article Information

Address reprint requests to: Daniel L. Silbergeld, M.D., Washington University Epilepsy Program, Department of Neurological Surgery, Washington University School of Medicine, Campus Box 8057, 660 South Euclid Avenue, St. Louis, Missouri 63110–1093.

© AANS, except where prohibited by US copyright law.

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    Coronal T1-weighted gadolinium-enhanced magnetic resonance image demonstrating a ring-enhancing lesion in the left temporal lobe with superior displacement of the sylvian fissure.

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    Schematic drawing showing intraoperative cortical stimulation findings. The tumor is in the anterior temporal lobe (cross-hatched area). Two speech areas (frontal and posterior temporal) were found. A region in the motor cortex, between the shoulder and jaw representations, was without response to electrical stimulation (black area). Somatosensory mapping identified an area directly posterior to the motor cortex region in which no responses could be elicited and in which stimulation evoked phantom forearm and finger sensations (italics).

References

1.

Campbell AW: Histological Studies on the Localization of Cerebral Function. Cambridge: Cambridge University Press1905Campbell AW: Histological Studies on the Localization of Cerebral Function. Cambridge: Cambridge University Press 1905

2.

Cohen LGBandinelli SFindley TWet al: Motor reorganization after upper limb amputation in man. Brain 114:6156271991Cohen LG Bandinelli S Findley TW et al: Motor reorganization after upper limb amputation in man. Brain 114:615–627 1991

3.

Cohen LGBrasil-Neto JDaum Met al: Evidence for intracortical plasticity in human motor cortex following amputations. Soc Neurosci Abstr 19:6161993Cohen LG Brasil-Neto J Daum M et al: Evidence for intracortical plasticity in human motor cortex following amputations. Soc Neurosci Abstr 19:616 1993

4.

Cohen LGTopka HCole RAet al: Leg paresthesias induced by magnetic brain stimulation in patients with thoracic spinal cord injury. Neurology 41:128312881991Cohen LG Topka H Cole RA et al: Leg paresthesias induced by magnetic brain stimulation in patients with thoracic spinal cord injury. Neurology 41:1283–1288 1991

5.

Fox PTBurton HRaichle ME: Mapping human somatosensory cortex with positron emission tomography. J Neurosurg 67:34431987Fox PT Burton H Raichle ME: Mapping human somatosensory cortex with positron emission tomography. J Neurosurg 67:34–43 1987

6.

Grafton STWoods RPMazziotta JCet al: Somatotopic mapping of the primary motor cortex in humans: activation studies with cerebral blood flow and positron emission tomography. J Neurophysiol 66:7357431991Grafton ST Woods RP Mazziotta JC et al: Somatotopic mapping of the primary motor cortex in humans: activation studies with cerebral blood flow and positron emission tomography. J Neurophysiol 66:735–743 1991

7.

Melzack R: Phantom limbs and the concept of a neuromatrix. Trends Neurosci 13:88921990Melzack R: Phantom limbs and the concept of a neuromatrix. Trends Neurosci 13:88–92 1990

8.

Melzack R: Phantom pain. Sci Am 266:90961992Melzack R: Phantom pain. Sci Am 266:90–96 1992

9.

Merzenich MMNelson RJStryker MPet al: Somatosensory cortical map changes following digit amputation in adult monkeys. J Comp Neurol 224:5916051984 (Abstract)Merzenich MM Nelson RJ Stryker MP et al: Somatosensory cortical map changes following digit amputation in adult monkeys. J Comp Neurol 224:591–605 1984 (Abstract)

10.

Ojemann GOjemann JLettich Eet al: Cortical language localization in left, dominant hemisphere. J Neurosurg 71:3163261989Ojemann G Ojemann J Lettich E et al: Cortical language localization in left dominant hemisphere. J Neurosurg 71:316–326 1989

11.

Penfield WJasper H: Epilepsy and the Functional Anatomy of the Human Brain. Boston: Little Brown1954Penfield W Jasper H: Epilepsy and the Functional Anatomy of the Human Brain. Boston: Little Brown 1954

12.

Pons TPGarraghty PEOmmaya AK: Massive cortical reorganization after sensory deafferentation in adult macaques. Science 252:185718601991Pons TP Garraghty PE Ommaya AK: Massive cortical reorganization after sensory deafferentation in adult macaques. Science 252:1857–1860 1991

13.

Ramachandran VSRogers-Ramachandran DCStewart M: Perceptual correlates of massive cortical reorganization. Neuroreport 3:5835861992Ramachandran VS Rogers-Ramachandran DC Stewart M: Perceptual correlates of massive cortical reorganization. Neuroreport 3:583–586 1992

14.

Sanes JNSuner SDonoghue JP: Dynamic organization of primary motor cortex output to target muscles in adult rats. I. Long-term patterns of reorganization following motor or mixed peripheral nerve lesions. Exp Brain Res 79:4794911990Sanes JN Suner S Donoghue JP: Dynamic organization of primary motor cortex output to target muscles in adult rats. I. Long-term patterns of reorganization following motor or mixed peripheral nerve lesions. Exp Brain Res 79:479–491 1990

15.

Silbergeld DLMueller WMOjemann GAet al: The use of Propofol (Diprivan) for awake craniotomies. Surg Neurol 38:2712751992Silbergeld DL Mueller WM Ojemann GA et al: The use of Propofol (Diprivan) for awake craniotomies. Surg Neurol 38:271–275 1992

16.

Wada JRasmussen T: Intracarotid injection of sodium amytal for the lateralization of cerebral speech dominance. Experimental and clinical observations. J Neurosurg 17:2662821960Wada J Rasmussen T: Intracarotid injection of sodium amytal for the lateralization of cerebral speech dominance. Experimental and clinical observations. J Neurosurg 17:266–282 1960

17.

Waters RSSamulack DDDykes RWet al: Topographic organization of baboon primary motor cortex: face, hand, forelimb, and shoulder representation. Somatosens Mot Res 7:4855141990Waters RS Samulack DD Dykes RW et al: Topographic organization of baboon primary motor cortex: face hand forelimb and shoulder representation. Somatosens Mot Res 7:485–514 1990

18.

Woolsey CNErickson TCGilson WE: Localization in somatic sensory and motor areas of human cerebral cortex as determined by direct recording of evoked potentials and electrical stimulation. J Neurosurg 51:4765061979Woolsey CN Erickson TC Gilson WE: Localization in somatic sensory and motor areas of human cerebral cortex as determined by direct recording of evoked potentials and electrical stimulation. J Neurosurg 51:476–506 1979

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