Cortical Stimulation Mapping-Pitfalls in Patient Selection

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This short video describes the pitfalls in patient selection and evaluation via functional MRI for resection of tumors associated with central lobule. This is a 29 year old male with seizures. MRI evaluation demonstrated a low grade glioma, very close related to their central lobule. Functional MRI demonstrated the location of the motor cortex to be just lateral to the border of the mass. Based on this information, the patient underwent an awake craniotomy for accurate localization of function. You can further see the location of mass in relation to anatomical landmarks. Functional mapping was conducted. You can see the parasagittal veins. Cortical stimulation started at three milliamps. I continue to map the motor cortex while using navigation. Here's the area of the arm. Here was the location of the tumor as marked by the black suture. The area of the leg. And as you can see here is the functional map of the cortex, the arm, the leg, and the thumb area. Based on this mapping information, resection was deemed unsafe. Obviously the functional MRI in this case was not very revealing and informative regarding accurate patient selection. Finally, based on the mapping data, only a biopsy was performed, as a resection was deemed too risky, most likely leading to hemiparesis. Thank you.

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