Ipsilateral Motor Innervation Discovered Incidentally on Intraoperative Monitoring: A Case Report.

Abstract:

Background and importance:Lesions in the corticospinal tract above the decussation at the medullary pyramids almost universally produce contralateral deficits. Rare cases of supratentorial lesions causing ipsilateral motor deficits have been reported previously, but only ever found secondary to stroke or congenital pyramidal tract malformations. Clinical presentation:Herein, we report a case of ipsilateral corticospinal tract innervation discovered incidentally with intraoperative monitoring during a microsurgical resection of a vestibular schwannoma. Intraoperative monitoring with electrical transcranial stimulation of the frontal scalp triggered motor-evoked potentials in the ipsilateral arms. The uncrossed pathways were later confirmed with MRI tractography using diffusion tensor imaging. Conclusion:To the best of our knowledge, this is the first case of isolated ipsilateral motor innervation of the corticospinal tract discovered incidentally during a neurosurgical procedure. Given the increasing use of intraoperative monitoring, this case underscores the importance of cautious interpretation of seemingly discordant neurophysiological findings. Once technical issues have been ruled out, ipsilateral motor innervation may be considered as a possible explanation and neurosurgeons should be aware of the existence of this rare anatomic variant.

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

Ku J,Mendelsohn D,Chew J,Shewchuk J,Dong C,Akagami R

doi

10.1093/neuros/nyw074

subject

Has Abstract

pub_date

2017-03-01 00:00:00

pages

E194-E200

issue

3

eissn

0148-396X

issn

1524-4040

pii

2884535

journal_volume

80

pub_type

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