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Functional magnetic resonance imaging-guided brain tumor resection
Walter A Hall1, Peter Kim, Charles L Truwit
1Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, NY 13210, USA. hallw@upstate.edu
Objectives:
We evaluated the safety and efficacy of using functional magnetic resonance imaging (fMRI) brain activation data obtained at both 1.5 and 3 T to guide brain tumor resections using 1.5-T intraoperative MRI (ioMRI) guidance.
Materials And Methods:
From January 1997 to March 2006, fMRI was performed on 29 patients before attempted brain tumor resection. Functional MRI was used to identify and coregister areas of brain activation for motor (n = 18), speech (n = 6), motor and speech (n = 4), and short-term memory and speech (n = 1) with respect to the tumor using a 1.5-T and two 3-T MRI scanners. Surgical resection was accomplished using 2 different 1.5-T ioMRI systems. The appropriate MRI scan sequences were obtained during surgery to determine and maximize the extent of the surgical resection depending on the tumor type.
Results:
Of 29 patients, 20 (69%) had radiographically complete fMRI-guided tumor resections and 2 (7%) had successful MRI-guided brain biopsy because of the proximity of their astrocytomas to the eloquent cortex. The tumors were oligodendrogliomas (n = 16), astrocytomas (n = 4), meningiomas (n = 3), glioblastomas multiforme (n = 2), a pleomorphic astrocytoma (n = 1), and a dysembryoplastic neuroepithelial tumor (n = 1). The preoperative fMRI data were accurate in all cases. After tumor resection, 7 patients (26%) had transient neurologic deficits that resolved completely within 1 month of the surgical procedure in all cases. No adverse events associated with ferromagnetic instrumentation occurred.
Conclusions:
Functional MRI was accurate for localizing areas of eloquent neurologic function before ioMRI-guided brain tumor resection.
Insights
Functional MRI accurately guided brain tumor resections, with 69% of patients achieving complete tumor removal. This technique improved surgical outcomes without adverse events.
Area of Science:
- Neurosurgery
- Neuroimaging
- Oncology
Background:
- Intraoperative MRI (ioMRI) provides real-time imaging during surgery.
- Functional MRI (fMRI) maps brain activity to identify critical functional areas.
- Guiding brain tumor resections with advanced imaging can improve patient outcomes.
Purpose of the Study:
- To evaluate the safety and efficacy of using fMRI data to guide brain tumor resections.
- To assess the accuracy of fMRI at 1.5 T and 3 T for surgical guidance.
- To determine the impact of fMRI guidance on the extent of tumor resection.
Main Methods:
- fMRI was performed on 29 patients prior to tumor resection to map motor, speech, and memory areas.
- fMRI data were coregistered with 1.5-T and 3-T MRI scanners.
- Surgical resections were performed using 1.5-T ioMRI systems.
Main Results:
- Radiographically complete fMRI-guided tumor resections were achieved in 69% of patients.
- fMRI data accurately localized eloquent brain areas in all cases.
- Transient neurologic deficits occurred in 26% of patients but resolved within one month; no adverse events related to instrumentation were reported.
Conclusions:
- fMRI is an accurate tool for localizing eloquent neurologic function before ioMRI-guided brain tumor resection.
- fMRI guidance can enhance the safety and efficacy of brain tumor surgery.
- The use of fMRI data improves the extent of tumor resection while minimizing neurological damage.
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01:24Magnetic Resonance Imaging
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These technologies include computerized axial tomography (CAT or CT scans), positron-emission tomography (PET scans), magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), and Transcranial Magnetic Stimulation (TMS).