Intraoperative mapping of pre-central motor cortex and subcortex: a proposal for supplemental cortical and novel subcortical maps to Penfield’s motor homunculus

Abstract

Penfield’s motor homunculus describes a caricaturised yet useful representation of the map of various body parts on the pre-central cortex. We propose a supplemental map of the clinically represented areas of human body in pre-central cortex and a novel subcortical corticospinal tract map. We believe this knowledge is essential for safe surgery in patients with eloquent brain lesions. A single-institution retrospective cohort study of patients who underwent craniotomy for motor eloquent lesions with intraoperative motor neuromonitoring (cortical and subcortical) between 2015 and 2020 was performed. All positive cortical and subcortical stimulation points were taken into account and cartographic maps were produced to demonstrate cortical and subcortical areas of motor representation and their configuration. A literature review in PubMed was performed. One hundred and eighty consecutive patients (58.4% male, 41.6% female) were included in the study with 81.6% asleep and 18.4% awake craniotomies for motor eloquent lesions (gliomas 80.7%, metastases 13.8%) with intraoperative cortical and subcortical motor mapping. Based on the data, we propose a supplemental clinical cortical and a novel subcortical motor map to the original Penfield’s motor homunculus, including demonstration of localisation of intercostal muscles both in the cortex and subcortex which has not been previously described. The supplementary clinical cortical and novel subcortical motor maps of the homunculus presented here have been derived from a large cohort of patients undergoing direct cortical and subcortical brain mapping. The information will have direct relevance for improving the safety and outcome of patients undergoing resection of motor eloquent brain lesions.

Design and Implementation of EEG-Mechatronic System Interface for Computational Intelligence

“…The relevant region and corresponding electrode placements for a BCI will depend heavily on the type of BCI paradigm used. Motor imagery is the process of analysing EEG signals to determine how the user is moving their muscles [48]. Motor imagery is popular for BCI tasks and has been used to control and play games [49].…”

Augmented and virtual reality usage in awake craniotomy: a systematic review

“…Given that VR users have the ability to explore the artificial environment, move within it, and interact with other users [ 16 ], a simulation could be devised that enables neurosurgeons to train and plan for conducting an awake craniotomy (AC). Intraoperative brain mapping using direct electrical stimulation of cortical and subcortical regions can be performed in AC to reduce the risk of permanent loss of neurological functions in eloquent areas, such as areas associated with language, motor, or vision by real-time monitoring of neurological functions with the patient participating in different tasks [ 26 , 29 , 42 , 48 , 53 , 54 , 87 , 88 ]. In language mapping, for example, the neurosurgeon uses direct electrical stimulation to stimulate cortical and subcortical areas, while the patient is asked in real time to name images presented to them.…”

White Matter Integrity of the Corticospinal Tract for Estimation of Individual Patient Risk for Postoperative Neurological Deterioration after Glioma Surgery

“…It comprises descending axons from the primary motor area in the precentral gyrus, as well as from the supplementary motor area and some parts of the parietal lobe. Together with a wider network of subcortical and cerebellar pathways it represents the anatomical basis for voluntary physical motion [10,11]. DTI measures the diffusivity along a number of axes in magnetic resonance imaging (MRI).…”