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Real-Time Motor Cortex Mapping for the Safe Resection of Glioma: An Intraoperative Resting-State fMRI Study
1From the Department of Neurological Surgery (T.-m.Q., F.-y.G., X.G., J.-s.W., D.-x.Z., C.-j.Y., X.-l.Z., J.-f.L., F.-p.Z., Y.M., L.-f.Z.), Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
AJNR. American Journal of Neuroradiology
|September 9, 2017
Summary
Intraoperative resting-state fMRI (rs-fMRI) is feasible for real-time motor cortex mapping during glioma surgery. This technique offers a safer alternative to direct cortical stimulation for guiding tumor resection.
Area of Science:
- Neurosurgery
- Neuroradiology
- Neuroimaging
Background:
- Resting-state functional MR imaging (rs-fMRI) is established for presurgical motor mapping.
- Intraoperative application of rs-fMRI for real-time motor cortex mapping has not been previously investigated.
Purpose of the Study:
- To assess the feasibility of intraoperative rs-fMRI for real-time motor cortex mapping.
- To evaluate its safety and efficacy in guiding glioma resection.
Main Methods:
- Interventional MR imaging was used for preoperative and intraoperative rs-fMRI in 30 brain tumor patients.
- Factors influencing image quality (anesthesia type, tumor cavity filling) were analyzed.
- Direct cortical stimulation served as the gold standard for validating rs-fMRI accuracy.
Main Results:
- Intraoperative rs-fMRI successfully mapped the motor cortex in all patients.
- Sensitivity and specificity for motor area localization were 61.7% and 93.7%, respectively.
- Image quality improved when the tumor cavity was filled with normal saline (P = .049).
Conclusions:
- Intraoperative rs-fMRI is a feasible technique for real-time functional localization during neurosurgery.
- It offers a potentially safer alternative to direct cortical stimulation, reducing seizure risk.
- This method can provide crucial information for safe glioma resection.
