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

Michael Schulder, Joseph A Maldjian, Wen Ching Liu, Andrei I. Holodny, Andrew T. Kalnin, In Ki Mun, Peter W. Carmel

Research output: Contribution to journalArticle

183 Citations (Scopus)

Abstract

Object. 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. Methods. 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. Conclusions. 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.

Original languageEnglish (US)
Pages (from-to)412-418
Number of pages7
JournalJournal of Neurosurgery
Volume89
Issue number3
DOIs
StatePublished - Jan 1 1998

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Computer-Assisted Surgery
Magnetic Resonance Imaging
Neoplasms
Magnetic Resonance Spectroscopy
Brain Mapping
Magnetoencephalography
Equipment and Supplies
Somatosensory Evoked Potentials
Brain
Operating Rooms
Ambulatory Surgical Procedures
Positron-Emission Tomography
General Anesthesia
Fingers
Language
Oxygen
Sensorimotor Cortex

Keywords

  • Brain mapping
  • Brain neoplasm
  • Functional magnetic resonance imaging
  • Image-guided neurosurgery
  • Stereotaxis
  • Surgical navigation

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Functional image-guided surgery of intracranial tumors located in or near the sensorimotor cortex. / Schulder, Michael; Maldjian, Joseph A; Liu, Wen Ching; Holodny, Andrei I.; Kalnin, Andrew T.; Mun, In Ki; Carmel, Peter W.

In: Journal of Neurosurgery, Vol. 89, No. 3, 01.01.1998, p. 412-418.

Research output: Contribution to journalArticle

Schulder, Michael ; Maldjian, Joseph A ; Liu, Wen Ching ; Holodny, Andrei I. ; Kalnin, Andrew T. ; Mun, In Ki ; Carmel, Peter W. / Functional image-guided surgery of intracranial tumors located in or near the sensorimotor cortex. In: Journal of Neurosurgery. 1998 ; Vol. 89, No. 3. pp. 412-418.
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abstract = "Object. 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. Methods. 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. Conclusions. 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.",
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