Intraoperative identification of the negative motor network during awake surgery to prevent deficit following brain resection in premotor regions

Introduction Surgical resection in premotor areas can lead to supplementary motor area syndrome as well as a permanent deficit. However, recent findings suggest a putative role of the negative motor network in those dysfunctions. Our objective was to compare the functional results in two groups of adult patients who underwent the resection of a frontal glioma with and without resection of the negative motor networks. Material and methods Twelve patients (total of 13 surgeries) were selected for awake surgery for a frontal glioma. Negative motor responses were monitored during surgery at the cortical and subcortical levels. Sites eliciting negative motor responses were first identified then spared (n = 8) or removed (n = 5) upon oncological requirements. Results In the group with removal of the negative motor network (n = 5), all patients presented a complete supplementary motor area syndrome with akinesia and mutism. At 3 months, they all presented bimanual coordination dysfunction and fine movement disorders. In the group with preservation of the negative motor network (n = 8), all patients presented transient and slight disorders of speech or upper limb, they all recovered completely at 3 months. Discussion The negative motor network is a part of a modulatory motor network involved in the occurrence of the supplementary motor area syndrome and the permanent deficit after resection in premotor areas. Then, intraoperative functional cortico-subcortical mapping using direct electrostimulation under awake surgery seems mandatory to avoid deficit in bimanual coordination and fine movements during surgery in premotor areas.