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The effect of brain tumors on BOLD functional MR imaging activation in the adjacent motor cortex: implications for
A I Holodny1, M Schulder, W C Liu
1Department of Radiology, UMDNJ-New Jersey Medical School, Newark, University Hospital, 07103-2714, USA.
Background And Purpose:
Functional MR (fMR) imaging data coregistered to a neurosurgical navigation system have been proposed as guides for the resection of brain tumor in or adjacent to eloquent cortices. The purpose of this study was to compare data obtained from the side of the brain affected by tumor with the contralateral side and to determine if there are physiological limitations of fMR imaging in accurately determining the location of the primary motor cortex.
Methods:
Ten patients with tumors in or directly adjacent to the motor cortex were studied with fMR imaging (finger-tapping paradigm). fMR imaging data were analyzed using multiple R values. These data were coregistered to a real-time intraoperative neurosurgical navigation system.
Results:
Significant variability of motor cortex activation patterns was noted among individual patients. The activation volumes on the side of the tumor were significantly smaller compared with the contralateral side for all tumors not previously resected (0.66+/-0.47). This was most pronounced in glioblastomas (0.27+/-0.21). We propose that these differences were caused by a loss of autoregulation in the tumor vasculature of glioblastomas and venous effects.
Conclusion:
Notwithstanding the differences noted, the motor cortex was identified successfully in all patients. This was confirmed by intraoperative physiological identification of the motor cortex and a lack of postoperative neurologic deficit.
Insights
Functional MR (fMR) imaging successfully identified the motor cortex in brain tumor patients, despite reduced activation on the tumor side. This technique aids neurosurgery by mapping eloquent cortices near tumors.
Area of Science:
- Neurosurgery
- Neuroimaging
- Brain Tumor Research
Background:
- Functional MR (fMR) imaging aids neurosurgery for brain tumors near eloquent cortices.
- Coregistration with navigation systems guides tumor resection.
- Study investigates fMR imaging's accuracy for primary motor cortex localization.
Purpose of the Study:
- Compare fMR imaging data from tumor-affected and contralateral brain sides.
- Determine physiological limitations of fMR imaging for motor cortex mapping.
- Assess fMR imaging's utility in guiding brain tumor resection.
Main Methods:
- fMR imaging (finger-tapping paradigm) in 10 patients with motor cortex tumors.
- Analysis of fMR imaging data using multiple R values.
- Coregistration of fMR imaging data with intraoperative neurosurgical navigation.
Main Results:
- Significant inter-patient variability in motor cortex activation patterns.
- Reduced activation volumes on the tumor side compared to the contralateral side (0.66+/-0.47).
- Most pronounced reduction in glioblastomas (0.27+/-0.21), attributed to vascular and venous effects.
Conclusions:
- Successful identification of the motor cortex in all patients.
- Intraoperative physiological confirmation validated motor cortex localization.
- No postoperative neurological deficits observed, confirming safety and efficacy.