Mapping the primary motor cortex in healthy subjects and patients with peri-rolandic brain lesions before neurosurgery

Objective: The aim of this study was to establish a robust set of motor tasks that could be used to functionally delineate the motor cortex with blood oxygenation level dependent functional magnetic resonance imaging (BOLD fMRI) at 3 T and produce precise functional maps for preoperative planning and functional neuronavigation. Method: Twelve male and four female control subjects were recruited for this study which examined six different motor tasks. Finger-, tongue-, lip- and toe-movements, as well as isometric upper arm-and thigh-contraction tasks were conducted during separate scans on a 3 T MRI scanner. Furthermore, patients that previously had undergone similar motor tasks were reviewed, to evaluate whether this set of tasks was able to be adopted for use in a population of patients with brain lesions. Results: The results of this study indicated that the finger-, toe-and tongue-motor tasks were the most robust in identifying their respective primary motor area. Moreover, all three tasks activated regions at regular intervals along the convexity of the hemisphere, making it possible to functionally delineate the primary motor cortex in both healthy subjects and patients. Discussion: The motor tasks described in this study (toe, finger and tongue) were effective at localizing the primary motor cortex for the purposes of neurosurgical planning. These three tasks produced the highest success rate and resulted in activations at regular intervals along the convexity of the hemisphere, allowing the delineation of the entire motor strip even in the presence of edema and anatomical distortions. [Neurol Res 2008; 30: 968-973]