Onoda Ryo, Fujimoto So, Bokuda Kota, Shimizu Toshio, Matsuo Takeshi
Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Fuchu, Japan.
Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Japan.
Surg Neurol Int. 2025 Jun 6;16:231. doi: 10.25259/SNI_931_2024. eCollection 2025.
Evaluating residual motor function and functional compensation is essential before performing hemispherotomy. We have been evaluating hand motor function using transcranial magnetic stimulation (TMS), which cannot confirm the lower limb functions.
A male teenager with a huge arachnoid cyst in the right frontotemporal region and extensive polymicrogyria and gyral dysplasia in the adjacent lobes experienced focal to bilateral tonic-clonic seizures. We performed functional magnetic resonance imaging (MRI) and electrical cortical stimulation in addition to TMS. Functional MRI and TMS-motor-evoked potential (MEP) results suggested that the left primary motor cortex elicited the bilateral motor response, while intraoperative cortical stimulation MEPs revealed that the primary motor areas of each lower limb were controlled contralaterally. Consequently, we performed a total callosotomy instead of a hemispherotomy.
The results suggest that a preoperative diagnosis of complete hemispheric damage based on noninvasive examinations is not sufficient in some cases to determine the operative strategy. A combination of pre- and intraoperative examinations may be required to prevent unexpected neurological complications.
在进行大脑半球切开术之前，评估残余运动功能和功能代偿至关重要。我们一直在使用经颅磁刺激（TMS）评估手部运动功能，但TMS无法确认下肢功能。
一名男性青少年，右侧额颞叶区域有一个巨大的蛛网膜囊肿，相邻脑叶有广泛的多小脑回和脑回发育异常，经历了局灶性至双侧强直阵挛发作。除了TMS外，我们还进行了功能磁共振成像（MRI）和皮层电刺激。功能MRI和TMS运动诱发电位（MEP）结果表明，左侧初级运动皮层引发双侧运动反应，而术中皮层刺激MEP显示每个下肢的初级运动区域由对侧控制。因此，我们进行了全胼胝体切开术而不是大脑半球切开术。
结果表明，在某些情况下，基于非侵入性检查对完全半球损伤进行术前诊断不足以确定手术策略。可能需要术前和术中检查相结合，以预防意外的神经并发症。
