Usefulness of motor functional MRI correlated to cortical mapping in Rolandic low-grade astrocytomas

The indications for surgery of slow growing tumours like low grade astrocytomas in eloquent areas are difficult. The timing and the benefit/risk ratio of the surgery must be evaluated, taking into account the potential post operative deficit. The purpose of this study was: a) to validate the data obtained with functional MRI (FMRI) by direct cortical stimulation in patients who are candidate for surgery; b) to demonstrate the usefulness of FMRI coupled with cortical brain mapping and 3D reconstructions of the surfaces of the brain in low grade astrocytoma. FMRI of the hand-motor cortex was performed in 8 patients with low grade astrocytomas. They subsequently underwent direct cortical mapping to correlate the results of FMRI and resective surgery sparing the functional area. In the 8 cases, the results of direct cortical mapping in the precentral region matched accurately those obtained from FMRI. When surgical resection of low grade astrocytoma in the motor areas is considered, FMRI used with intra-operative cortical mapping can help the surgeon to spare functional areas during tumour removal.