Gliatumoren im Brodmann-Areal 6: Ausbreitungsmuster und Lagebeziehung zu motorischen Arealen^[1]

Zusammenfassung

Im hinteren Frontallappen des Gehirns befinden sich das Brodmann-Areal 4, der primär-motorische Kortex und das Brodmann-Areal 6, das aus dem supplementär-motorischen Areal auf dem medialen Anteil der Hemisphäre und dem prämotorischen Kortex auf dem lateralen Anteil besteht. In diesem Bereich hängt die sichere Resektion von der genauen Lokalisierung des motorischen Kortex und des Sulcus centralis ab. Üblicherweise erfolgt dies mittels Dünnschichtbildgebung und wird durch andere Verfahren bestätigt. Die verlässlichsten anatomischen Landmarken sind das Repräsentationsareal der Hand (Hand Knob) und der R. marginalis des Sulcus cinguli. Postoperativ können motorische Ausfälle nicht nur aufgrund einer Verletzung des primär-motorischen Kortex auftreten, sondern auch durch eine Verletzung des SMA (supplementär-motorisches Areal) bedingt sein. Im Gegensatz zu Motorkortexverletzungen ist ein SMA-Syndrom transient, sofern es überhaupt dazu kommt. Auf der lateralen Hemisphäre können aufgrund von Verletzungen des prämotorischen Kortex ebenfalls Bewegungs- und Sprachdefizite verursacht werden, allerdings würde ein hochgradiges motorisches Defizit auf eine subkortikale Läsion der kortikospinalen Bahn hindeuten. Der enge Zusammenhang zwischen subkortikalen motorischen Fasern und dem prämotorischen Kortex wird im vorliegenden Beitrag veranschaulicht. Im Gegensatz zu den durchgehenden, nicht unterbrochenen Landmarken des Sulcus centralis und des R. marginalis, die für die präoperative Lokalisierung hilfreich sind, scheinen die variablen Unterbrechungen im Sulcus praecentralis und Sulcus cinguli des hinteren Frontallappens „kortikale Brücken“ für die Ausbreitung infiltrierender Gliome zu bieten.

Abstract

The posterior frontal lobe of the brain houses Brodmann area 4, which is the primary motor cortex, and Brodmann area 6, which consists of the supplementary motor area on the medial portion of the hemisphere and the premotor cortex on the lateral portion. In this area, safe resection is dependent on accurate localization of the motor cortex and the central sulcus, which can usually be achieved by using thin-section imaging and confirmed by using other techniques. The most reliable anatomic landmarks are the “hand knob” area and the marginal ramus of the cingulate sulcus. Postoperatively, motor deficits can occur not only because of injury to primary motor cortex but also because of injury to the supplementary motor area. Unlike motor cortex injury, the supplementary motor area syndrome is transient, if it occurs at all. On the lateral hemisphere, motor and language deficits can also occur because of premotor cortex injury, but a dense motor deficit would indicate subcortical injury to the corticospinal tract. The close relationship of the subcortical motor fibers and premotor cortex is illustrated. In contrast to the more constant landmarks of the central sulcus and marginal ramus, which aid in preoperative localization, the variable interruptions in the precentral and cingulate sulci of the posterior frontal lobe seem to provide “cortical bridges” for spread of infiltrating gliomas.

¹ © 2015 The Radiological Society of North America. All rights reserved. Originally puplished in English in RadioGraphics 2015; 35: 793 – 803. Online published in 10.1148 /rg.2015140207. Translated and reprinted with permission of RSNA. RSNA is not responsible for any inaccuracy or error arising from the translation from English to German.

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