Identification And Function Protection Of Primary Motor Cortex In Aralyzed Brain Tumor Patients With Central Area Involved

Objective: To evaluate the value of the primary motor cortex identification inparalyzed patients by diffusion tensor imaging corticospinal tract reconstruction forthe operative guidence of central area tumor. Methods:21paralyzed brain tumorpatients with the primary motor area involved were included in the study. MRI scansfor DTI and navigation pre-operation. Corticospinal tract was reconstructed tolocalize the primary motor area. Seed points were set in the cerebral peduncle of themidbrain and the ventral of the pons. Corticospinal tract (CST) was reconstructed byfiber assignment continuous tracking. Reconstructed CST was fused with the threedimension anatomical image. Space architecture relationships between tumor andprimary motor area or the pyramid tract were analyzed. Tumor resection was guidedby DTI navigation. Results：They were glioma in10cases, meningioma in3cases,metastasis in3cases, hemangioma in2cases, inflammatory grannuloma in2cases,lymphoma in1case. Tumor was totally resected in17cases, and was subtotallyresected in4cases. Primary motor area was located prior to tumor in9cases, and waslocated behind tumor in11cases. PMA was separated into two parts in one case.Before operation myodynamia was grade0in8cases, grade2in4cases and grade3in9cases. Myodynamia improved to grade3in6cases, and to grade4in2cases twoweeks after surgery among8grade0patients. Myodynamia improved or keeppreoperative state in the other cases except myodynamia deteriorated transiently inone case.3months after surgery, myodynamia achieved to grade3in one case, grade4in7cases and grade5in13cases. KPS score was37.15+/-15.21before surgery,51.90+/-14.01two weeks after surgery, and86.67+/-17.42three months after surgery.There was a significant difference between KPS score2w/3m after surgery and KPSscore before surgery（p<0.01）statistically. Post-operation follow-up ranges from3mto18m, with an average of7.00+/-4.32m, tumor recurred in5cases, two patients diedof multiform glioblastma recurrence. Conclusion: Identification of primary motorarea by DTI scan and CST reconstruction, provided detail information of space architecture relationship between tumor and PMA or CST. Tumor was resected withthe guidance of neuro navigation system. Function state of paralyzed patientimproved effectively. Identification of primary motor area by CST reconstruction isof great importance for the operation plan and protection of anatomy and function inparalyzed functional area tumor patient.