Rech F, Duffau H, Pinelli C, Masson A, Roublot P, Billy-Jacques A, Brissart H, Civit T
Service de neurochirurgie, hôpital Central, CHU de Nancy, 54000 Nancy, France; Laboratoire, Inserm U1051, institut des neurosciences de Montpellier, 34091 Montpellier, France.
Laboratoire, Inserm U1051, institut des neurosciences de Montpellier, 34091 Montpellier, France; Service de neurochirurgie, hôpital Gui-de-Chauliac, CHU de Montpellier, 34295 Montpellier, France.
Neurochirurgie. 2017 Jun;63(3):235-242. doi: 10.1016/j.neuchi.2016.08.006. Epub 2017 Feb 1.
Surgical resection in premotor areas can lead to supplementary motor area syndrome as well as a permanent deficit. However, recent findings suggest a putative role of the negative motor network in those dysfunctions. Our objective was to compare the functional results in two groups of adult patients who underwent the resection of a frontal glioma with and without resection of the negative motor networks.
Twelve patients (total of 13 surgeries) were selected for awake surgery for a frontal glioma. Negative motor responses were monitored during surgery at the cortical and subcortical levels. Sites eliciting negative motor responses were first identified then spared (n=8) or removed (n=5) upon oncological requirements.
In the group with removal of the negative motor network (n=5), all patients presented a complete supplementary motor area syndrome with akinesia and mutism. At 3months, they all presented bimanual coordination dysfunction and fine movement disorders. In the group with preservation of the negative motor network (n=8), all patients presented transient and slight disorders of speech or upper limb, they all recovered completely at 3months.
The negative motor network is a part of a modulatory motor network involved in the occurrence of the supplementary motor area syndrome and the permanent deficit after resection in premotor areas. Then, intraoperative functional cortico-subcortical mapping using direct electrostimulation under awake surgery seems mandatory to avoid deficit in bimanual coordination and fine movements during surgery in premotor areas.
运动前区的手术切除可导致辅助运动区综合征以及永久性功能缺陷。然而，最近的研究结果表明负性运动网络在这些功能障碍中可能发挥作用。我们的目的是比较两组成年患者的功能结果，这两组患者均接受了额叶胶质瘤切除术，其中一组切除了负性运动网络，另一组未切除。
选择12例患者（共13次手术）进行额叶胶质瘤清醒手术。在手术过程中监测皮质和皮质下水平的负性运动反应。首先确定引发负性运动反应的部位，然后根据肿瘤学要求予以保留（n = 8）或切除（n = 5）。
在切除负性运动网络的组（n = 5）中，所有患者均出现了完全性辅助运动区综合征，伴有运动不能和缄默症。3个月时，他们均出现了双手协调性障碍和精细运动障碍。在保留负性运动网络的组（n = 8）中，所有患者均出现了短暂且轻微的言语或上肢障碍，3个月时均完全恢复。
负性运动网络是调节性运动网络的一部分，参与辅助运动区综合征的发生以及运动前区切除术后的永久性功能缺陷。因此，在清醒手术中使用直接电刺激进行术中功能性皮质-皮质下映射似乎是必要的，以避免运动前区手术期间出现双手协调性和精细运动功能缺陷。
