Strategies for resection of lesions in the motor area: preliminary results in 42 surgical patients / Estratégias para ressecção de lesões em área motora: resultados preliminares em 42 pacientes operados

In recent years considerable technological advances have been made with the purpose of improving the surgical results in the treatment of eloquent lesions. The overall aim of this study is to evaluate the postoperative surgical outcome in 42 patients who underwent surgery to remove lesions around the motor cortex, in which preoperative planning by using neuroimaging exams, anatomical study, appropriate microsurgery technique and auxiliary methods such as cortical stimulation were performed. Twenty-two patients (52.3 percent) presented a normal motor function in the preoperative period. Of these, six developed transitory deficit. Twenty patients (47.6 percent) had a motor deficit preoperatively, nevertheless 90 percent of these improved postoperatively. Surgery in the motor area becomes safer and more effective with preoperative localization exams, anatomical knowledge and appropriate microsurgery technique. Cortical stimulation is important because it made possible to maximize the resection reducing the risk of a motor deficit. Stereotaxy method was useful in the location of subcortical lesions.

Nos últimos anos, consideráveis avanços tecnológicos, principalmente métodos de localização funcional do córtex cerebral, têm surgido no sentido de melhorar os resultados cirúrgicos no tratamento de lesões em áreas eloqüentes. O objetivo deste estudo é avaliar os resultados pós-operatórios em 42 pacientes submetidos à ressecção de lesões em área motora, utilizando-se de planejamento com exames de neuroimagem, conhecimento anatômico, técnica microcirúrgica adequada e métodos auxiliares a exemplo do estimulador cortical. Vinte e dois pacientes (52,3 por cento) apresentavam força muscular normal no pré-operatório. Destes, seis apresentaram déficit motor transitório. Vinte pacientes (47,6 por cento) tinham déficit motor no pré-operatório, mas 90 por cento destes apresentaram melhora no pós-operatório. A cirurgia em área motora se torna mais segura e eficaz com a utilização de planejamento pré-operatório baseado nos exames de imagem, conhecimento anatômico e técnica microcirúrgica adequada. A utilização de estimulador cortical é importante para maximizar a ressecção minimizando o risco de déficit motor. A estereotaxia foi útil na localização de lesões subcorticais.

Seizure's outcome after cortical resections including the face and tongue rolandic areas in patients with refractory epilepsy and normal MRI submitted to subdural grids' implantation

PURPOSE: To study the seizure's outcome in patients with refractory epilepsy and normal MRI submitted to resections including the rolandic cortex. METHODS: Four adult patients were studied. All patients had motor or somatosensory simple partial seizures and normal MRI and were submitted to subdural grids' implantation with extensive coverage of the cortical convexity (1 in the non-dominant and 3 in the dominant hemisphere). RESULTS: ECoG was able to define focal areas of seizures' onset in every patient. All patients were submitted to resection of the face and tongue motor and sensitive cortex; two patients had resections including the perirolandic cortex and 2 had additional cortical removals. Three patients are seizures' free and one had a greater then 90 percent reduction in seizure frequency. CONCLUSION: Resections including the face and tongue rolandic cortex can be safely performed even within the dominant hemisphere