![]() The lateral surface of the perirolandic region includes the precentral and postcentral gyri divided by the central sulcus and limited anteriorly by the precentral and posteriorly by the postcentral sulcus. The perirolandic region, also known as central lobe ( 1) or paracentral area ( 6), is one of the most eloquent areas of the brain, which consists of pre- and postcentral gyrus, central sulcus, and the paracentral lobule ( 1, 2). Future minimally invasive and multimodal therapies such as laser interstitial thermal therapy (LITT) are discussed, which may lead to new paradigm for management. Close attention has been paid to the indications for surgery, the principles of resection, and the individualized surgical approaches. This review summarizes the impact of surgery on the multimodal management of BM in the perirolandic region. To the best of our knowledge, there are only a few reports with regard to surgical treatment of BM involving the perirolandic region ( 4, 6, 16, 18, 24, 26, 27), while no literature reviews have been performed, leaving the optimal treatment paradigm unresolved. Alternatively, several studies have suggested that optimal resection could promptly reduce mass effect, relieve neurological symptoms, provide pathological diagnosis, and improve local tumor control ( 4, 6, 10, 16, 18, 24– 26). Less-invasive therapies including whole-brain radiation therapy (WBRT) or stereotactic radiotherapy (SRT) has still been preferred although relief of the mass effect was always delayed and patients often suffered from adverse events produced by radiation ( 5, 12, 13, 17, 20, 22, 23). However, approaching BM in the perirolandic region remains a challenge because there may be a risk of new permanent neurological deficits resulting from impairment of cortical or subcortical structure after resection of the tumors which infiltrate into the surrounding sensorimotor areas ( 4, 7– 11).Ĭontroversy exists regarding optimal treatment for patients with BM within the perirolandic region ( 7, 11– 22). With advances in neuroimaging, neurophysiology, and neurosurgical techniques, patient-tailored surgery has become the pivotal strategy in multimodal treatment paradigms of BM. Notably, brain metastases (BM), the most common intracranial tumors ( 3), tend to be located in the eloquent areas such as the perirolandic region where sensorimotor function is often disrupted ( 1, 4– 7). The perirolandic region is essential for neurological functions, supporting motricity, and sensitivity of trunk and extremities ( 1, 2). Future perspectives of advanced neurosurgical techniques are also presented. ![]() This is the first review concerning the characteristics of BM involving the perirolandic region and the current impact of surgical therapy for the lesions. Although management of BM becomes much more tailored and multimodal, surgery remains the cornerstone and principles of resection as well as indications for surgery should be well defined. Since the advance in intraoperative neuroimaging and neurophysiology, resection of BM in the perirolandic region has been proven to be safe and efficacious, sparing this eloquent area while retaining reasonably low morbidity rates. Nevertheless, data are sparse and optimal treatment paradigm is not yet widely described. More recently, several researchers attempt to evaluate the benefit of surgery for BM within this pivotal sensorimotor area. Surgical intervention for BM in the perirolandic region is still under discussion even though prompt relief of mass effect and avoidance of necrosis together with brain edema may not be achieved by radiotherapy. 2Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Chinaīrain metastases (BM) are the most frequent intracranial tumors, which may result in significant morbidity and mortality when the lesions involve the perirolandic region.1Department of Neurosurgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.Fuxing Zuo 1 Ke Hu 1 Jianxin Kong 1 Ye Zhang 2 Jinghai Wan 1*
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