Functional image-guided surgery of intracranial tumors located in or near the sensorimotor cortex

• Published in: Journal of neurosurgery Vol. 89; no. 3; pp. 412 - 418
• Main Authors: SCHULDER, M, MALDJIAN, J. A, LIU, W.-C, HOLODNY, A. I, KALNIN, A. T, IN KI MUN, CARMEL, P. W
• Format: Journal Article
• Language: English
• Published: Park Ridge, IL American Association of Neurological Surgeons 01-09-1998
• Subjects: Adult; Anesthesia, General; Biological and medical sciences; Brain - metabolism; Brain Mapping - methods; Brain Neoplasms - blood; Brain Neoplasms - surgery; Echo-Planar Imaging; Evoked Potentials, Somatosensory - physiology; Female; Forecasting; Humans; Image Processing, Computer-Assisted; Language; Magnetic Resonance Imaging; Magnetoencephalography; Male; Medical sciences; Middle Aged; Monitoring, Intraoperative; Motor Cortex - physiology; Motor Cortex - surgery; Motor Skills - physiology; Neurosurgery; Oxygen - blood; Radiology, Interventional; Skull, brain, vascular surgery; Somatosensory Cortex - physiology; Somatosensory Cortex - surgery; Stereotaxic Techniques; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Therapy, Computer-Assisted; Tomography, Emission-Computed; Human; Cartography; Intracranial; Nervous system diseases; Navigation; Technical assistance; Surgical resection; Nuclear magnetic resonance imaging; Cerebral disorder; Guidance; Treatment; Stereotaxic surgery; Central nervous system disease; Sensorimotor cortex; Medical imagery; Tumor; Technique; Localization
• ISSN: 0022-3085; 1933-0693
• DOI: 10.3171/jns.1998.89.3.0412

The purpose of this study was to evaluate the efficacy of noninvasive preoperative functional imaging data used in an interactive fashion in the operating room. The authors describe a method of registering preoperative functional magnetic resonance (fMR) imaging localization of sensorimotor cortex with a frameless stereotactic surgical navigation device.
The day before surgery, patients underwent blood oxygen level-dependent fMR imaging while performing a finger-tapping motor paradigm. Immediately afterward an anatomical stereotactic MR image was acquired. Raw fMR imaging data were analyzed offline at a separate workstation, and the resulting functional maps were registered to a high-resolution anatomical scan. The fused functional-anatomical images were then downloaded onto a surgical navigation computer via an ethernet connection. At surgery, the brain was exposed in the standard fashion, and the sensorimotor cortex was identified by direct cortical stimulation, the use of somatosensory evoked potentials, or both. This localization was then compared with that predicted by the registered fMR study. Thirteen procedures were performed in 12 patients. The mean registration error was 2.2 mm. The predicted location of motor and/or sensory cortex matched that found on intraoperative mapping in all 12 patients tested. Maximal tumor resection was accomplished in each case and no new permanent neurological deficits resulted.
Compared with conventional brain mapping techniques, fMR image-guided surgery may allow for smaller brain exposures, localization of the language cortex with the patient under general anesthesia, and the mapping of multiple functional sites. The scanning equipment used in this method may be more readily available than for other functional imaging techniques such as positron emission tomography or magnetoencephalography.