Artikel
Cortical representation of median and ulnar nerve suggests functional reorganisation induced by motor-eloquent gliomas
Die kortikal Repräsentation des N. medianus und N. ulnaris zeigt Hinweise für eine durch motorisch-eloquente Gliome induzierte funktionelle Reorganisation
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Veröffentlicht: | 25. Mai 2022 |
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Objective: Navigated transcranial magnetic stimulation (nTMS) has been applied in routine clinical practice to localize motor-eloquent regions. Yet, the cortical representation of peripheral nerves nor their alterations by gliomas were investigated so far. The current study therefore analyzes the impact and impairment of the median and ulnar nerve in patients with supratentorial tumors by nTMS motor mapping.
Methods: Patients with motor-eloquent gliomas within the left hemisphere were grouped according to the presence of motor deficits. Peripheral nerves-based hand mapping regions were analyzed in grouped patients with (n=20) and without (n=24) motor deficits. Cortical motor representations were analyzed, and corresponding motor evoked potentials (MEP) and their center of gravity (CoG) were calculated for intergroup comparison.
Results: Patient characteristics including gender (p=0.679), tumor type (p=0.158) and age (p=0.97) did not differ between groups. Total motor mapping regions (p = 0.043, 6.47±3.62 cm2 vs. 4.69±1.92 cm2) and ulnar nerve-related mapping regions (p = 0.026, 4.03±3.27 cm2 vs. 2.33±1.46 cm2) were both significantly extended in patients with motor deficits. Still, median nerve-related mapping regions were larger in patients with motor deficits showing borderline significance (p=0.057, 5.79±3.41 cm2 vs. 4.16±2.10 cm2). There were no significant differences in the CoG of the median and ulnar nerve.
Conclusion: The present study shows similar intergroup CoG localizations, indicating the stability of hand motor function's critical regions. The extended cortical representation of median and ulnar nerve in patients with motor deficits suggests a potential mechanism of compensation and functional reorganization induced by motor-eloquent gliomas.