Dada Abraham, Umbach Gray, Majumdar Areti, Kaur Jasleen, Oten Sena, Berger Mitchel S, Brang David, Hervey-Jumper Shawn L
Department of Neurological Surgery, University of California, San Francisco, San Francisco , California , USA.
Department of Psychology, University of Michigan, Ann Arbor , Michigan , USA.
Oper Neurosurg (Hagerstown). 2025 May 1;28(5):667-676. doi: 10.1227/ons.0000000000001349. Epub 2024 Sep 9.
Although diffuse gliomas in the primary somatosensory cortex (S1) are often considered resectable, gliomas in the primary motor cortex require motor mapping to preserve motor function. Recent evidence indicates that some somatosensory cortex neurons may trigger motor responses, necessitating refined somatosensory mapping techniques.
Using piezoelectric tactile stimulators on patients' faces and hands, we delivered 25 Hz vibrations and prompted patients to discriminate between dermatomes. Testing included areas contralateral to tumor-infiltrated and to non-tumor-infiltrated cortical regions. Sensory thresholds were determined by reducing stimulus intensity based on performance. Intraoperatively, electrocorticography electrode arrays were used to map sensory responses, and postoperative assessments evaluated sensory outcomes.
The high-grade glioma case involved a 61-year-old man with right-sided weakness and numbness with a left parietal mass on MRI. Preoperative testing showed that the average vibratory detection threshold of the hand contralateral to the suspected tumor site was significantly higher than that of the hand contralateral to healthy cortex ( P < .001). Intraoperative mapping confirmed the absence of functional involvement in cortical structures overlying the tumor. Postoperative imaging confirmed gross total resection, and sensory vibratory thresholds were normalized ( P = .51). The low-grade glioma case included a 54-year-old man with a left parietal nonenhancing mass on MRI. No baseline sensory impairments were found on preoperative testing. Intraoperative mapping identified motor and sensory cortices, guiding tumor resection while preserving motor function. Postoperative MRI confirmed near-total resection, but new sensory impairments were noted in the hand and face contralateral to the resection site ( P < .001). These deficits resolved by postoperative day 11, with no evidence of tumor progression on follow-up imaging.
The sensory discrimination task provides a quantifiable method for assessing sensory changes and functional outcomes related to glioma. This technique enhances our understanding of how glioma infiltration remodels sensory systems and affects clinical outcomes in patients.
尽管原发性体感皮层（S1）的弥漫性胶质瘤通常被认为可切除，但原发性运动皮层的胶质瘤需要进行运动图谱绘制以保留运动功能。最近的证据表明，一些体感皮层神经元可能触发运动反应，因此需要改进体感图谱绘制技术。
我们使用压电触觉刺激器刺激患者的面部和手部，施加25Hz的振动，并促使患者区分皮节。测试包括肿瘤浸润的皮质区域和未受肿瘤浸润的皮质区域的对侧区域。根据患者表现降低刺激强度来确定感觉阈值。术中，使用皮质脑电图电极阵列绘制感觉反应图谱，术后评估评估感觉结果。
高级别胶质瘤病例为一名61岁男性，有右侧无力和麻木症状，MRI显示左侧顶叶有肿块。术前测试表明，疑似肿瘤部位对侧手部的平均振动检测阈值显著高于健康皮层对侧手部（P<.001）。术中图谱证实肿瘤上方的皮质结构未受功能累及。术后影像学检查证实肿瘤全切，感觉振动阈值恢复正常（P=.51）。低级别胶质瘤病例为一名54岁男性，MRI显示左侧顶叶有一不强化肿块。术前测试未发现基线感觉障碍。术中图谱确定了运动和感觉皮层，在保留运动功能的同时指导肿瘤切除。术后MRI证实近全切，但在切除部位对侧的手部和面部出现了新的感觉障碍（P<.001）。这些缺陷在术后第11天得到缓解，随访影像学检查未发现肿瘤进展迹象。
感觉辨别任务为评估与胶质瘤相关的感觉变化和功能结果提供了一种可量化的方法。该技术增进了我们对胶质瘤浸润如何重塑感觉系统以及影响患者临床结果的理解。
