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. 2018 Jun 5;9:400. doi: 10.3389/fneur.2018.00400

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Copyright © 2018 Rosazza, Deleo, D'Incerti, Antelmi, Tringali, Didato, Bruzzone, Villani and Ghielmetti.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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DTI-tractography and fMRI tasks of arm and leg movement of the preoperative and postoperative assessment of Case 3 and Case 4. Case 3 presented with a large right frontal malacic area. In the affected hemisphere, DTI-tractography did not reconstruct the CST (red), but revealed a thin somatosensory tract (yellow) and inter-hemispheric fibers connecting homologous motor regions. After surgery the interhemispheric fibers were no longer visible. FA color-maps at the pons showed absence of CST in the left hemisphere even before surgery. Before surgery, fMRI activations of the paretic arm and leg were generally bilateral, with involvement of intact SMA. After surgery, activations shifted to the intact hemisphere with a strong engagement of the SMA. Case 4 presented with a large left malacic area. In the affected hemisphere, DTI-tractography did not reconstruct the CST (red), nor the somatosensory tract (yellow), while inter-hemispheric fibers connecting homologous motor regions were observed. FA color-maps at the pons showed absence of CST in the left hemisphere even before surgery. fMRI activations of the paretic arm and leg strongly involved the affected motor cortex, and the intact SMA. For technical problems the patient could not be scanned with MRI after surgery.