Premotor Gliomas

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This video, briefly reviews techniques for resection of gliomas adjacent to the motor cortex. This is a young patient who presented with a seizure and was diagnosed with a right posterior frontal glioma. This is a classic finding for a glioma. As you can see, non enhancing T2 signal changes within their white matter and cortex. Functional MRI was performed to more precisely locate the functional core disease. As you can see that hand area was moved slightly laterally. However, this tumor was noted to be slightly more anterior than the motor cortex. Based on anatomical considerations, this is the central sulcus. This is most likely motor cortex and the tumor is just in front of the central sulcus. And awake craniotomy was chosen to low aggressive resection of the tumor while examining the patient via frequent Intraoperative Neurological Evaluations. Here's patient positioning, a Generous Curvilinear Incision was used. This is the result of the mapping data. You can see the expanded thyroid cause system with the location of the tumor as confirmed on neuronavigation based on MRI. This is the lower extremity, the arm area, the hand area, as well as the thumb, face areas most likely located. Here are two large draining veins. They will attempt to preserve if possible, however, the entire tumor can be aggressively removed and sub-cortical mapping along the posterior aspect of the resection cavity will guide further grow store resection in this area. A segment of suture is used to outline the location of the tumor based on our navigation data. Standards appealed techniques are used. Here is sub-cortical and call mapping along the posterior aspect of the resection cavity. This is the result of the resection. Following mapping of the posterior aspect of the tumor, You can see a generous resection has completed. There was no evidence of any changes in the neurological exam intraoperatively. Posterior veins were protected and the post-operative MRI demonstrates gross total resection of the mass without any complicating features. The patient has remained seizure-free for two years after surgery. Thank you.

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